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Tiffany L. Chan, Judith E. Goldstein, Robert W. Massof, Low Vision Research Network; Comparison of Physician Estimates of Rehabilitation Potential to Low Vision Rehabilitation Outcomes. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3152.
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To compare physician predictions of the probability of success of low vision rehabilitation to patient self-reported outcomes after provision of usual outpatient low vision rehabilitation services.
The Activity Inventory (AI), an adaptive self-report visual functioning questionnaire, was administered at pre-rehabilitation baseline by telephone interview to 270 low vision patients, across 28 outpatient low vision rehabilitation (LVR) centers participating in a collaborative observational outcome study. The AI was re-administered 6-9 months later, after completion of clinical services. Following the initial patient evaluation, 38 optometrists and ophthalmologists who specialize in low vision rehabilitation estimated the probability of a successful outcome for each of their enrolled patients using a visual analog scale. No criteria or definitions of success were given to the physician.
Kappa statistics were calculated to determine the probability of agreement between physician predicted success and patient outcomes. The definition of success for both the visual analog rating scale and AI outcome measures is arbitrary. Therefore, Kappa was calculated for each combination of criteria ranging from 20% to 90% in increments of 10% for physician ratings and from 0.2 logit to 1.0 logit in increments of 0.2 logit for patient-reported outcomes on the AI (i.e., change scores). Across all comparisons, Kappa ranged from 0.09 to -0.09; none of the Kappa values were significantly different than 0. A Kappa of 0 indicates that the rate of agreement is equivalent to chance.
The physicians’ ability to predict the success of low vision rehabilitation outcomes, relative to patient-reported outcomes, is no better than chance. Overall, low vision physicians exhibit a poor ability to prognosticate, which is similar to observations in other areas of physician prognostication. The most likely explanation is they do not receive consistent reliable feedback from patients or quantitative outcome data to calibrate their expectations. These results suggest a general lack of awareness by low vision physicians of the outcomes of the services they are providing.
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