Age-related macular degeneration: a randomized clinical trial of a self-management intervention.

The purpose of this study was to conduct a randomized clinical trial to assess whether a self-management group intervention can improve mood, self-efficacy, and activity in people with central vision loss due to age-related macular degeneration (AMD). Ninety-two elderly patients with AMD (average age=79) from a university ophthalmology clinic were randomly assigned to the self-management intervention (n=44) or to a wait-list (n=48). All patients were legally blind in at least one eye. The intervention consisted of 6 weekly 2-hour group sessions providing education about the disease, group discussion, and behavioral and cognitive skills training to address barriers to independence. All participants eventually completed the intervention allowing pre-post comparisons for all patients. The battery of measures included the Profile of Mood States (POMS); Quality of Well-Being Scale; and assessments of self-efficacy, participation in activities, and use of vision aids. Participants' initial psychological distress was high (mean total POMS=59.72) and similar to distress experienced by other serious chronic illness populations (e.g. cancer, bone marrow transplant). Analysis of covariance testing the primary hypothesis revealed that intervention participants experienced significantly (p=.04) reduced psychological distress (pre\(\bar x = 61.45\); post\(\bar x = 51.14\)) in comparison with wait-list controls (pre\(\bar x = 57.72\); post\(\bar x = 62.32\)). Intervention participants also experienced improved (p=.02) self-efficacy (pre\(\bar x = 70.16\); post\(\bar x = 77.27\)) in comparison with controls (pre\(\bar x = 67.71\); post\(\bar x = 69.07\)). Further, intervention participants increased their use of vision aids (p<.001; pre\(\bar x = 3.37\), post\(\bar x = 6.69\)). This study demonstrates that a relatively brief behavioral intervention can substantially reduce psychological distress and increase self-efficacy in elderly adults experiencing vision loss due to macular degeneration. Self-management intervention appears to improve mood, self-efficacy, and use of vision aids, further enhancing the lives of poorly sighted individuals with AMD.