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B.L. Brody, A.C. Roch-Levecq, R.G. Thomas, K.K. Maclean, R.M. Kaplan, S.I. Brown; Self-Management of Age-Related Macular Degeneration and Quality of Life at 6 Months Follow-Up: A Randomized Controlled Trial . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1834.
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Purpose: Assess long-term effectiveness at 6 months of an age-related macular degeneration (AMD) self-management program consisting of health education & enhancement of problem solving skills in improving quality of life as shown by measures of distress & disability. Method: In a prospective randomized controlled study, 214 community dwelling cognitively intact volunteers (mean age= 80 yrs) with moderate to advanced macular degeneration had been randomly assigned to 12 hour self-management program (N=82), series of 12 hrs of tape-recorded health lectures (N=66), or to waitlist (N=66). The self-management program utilized standard behavioral therapy techniques. The primary outcome measure was emotional distress (Profile of Mood States). Secondary outcome measures included function (National Eye Institute - Visual Function Questionnaire), and self-confidence to handle AMD specific challenges in daily life (AMD Self-Efficacy Questionnaire). Clinical depression was determined by the DSM-IV. Results: The 6 week follow-up results have been published (Arch Ophthalmol.. 2002:1477-1483). We replicated and extended initial positive results. found after 6 week intervention. Randomization produced comparable groups at baseline. There were no differences in attrition between groups [or between depressed and non depressed subjects.] Differences between tape and wait-list groups were non-significant and then collapsed into one control group. Repeated-measure ANOVAs revealed that participants in the self-management program reported less emotional distress, p =.007, better function, p = .07, and increased self-efficacy, p = .006 at 6 month follow-up. The positive effect of the self-management program was more pronounced in depressed subjects (DSM-IV) compared to depressed in the control groups regarding emotional distress, p =.001, function, p=.04, and self-efficacy, p = .04. Conclusions: These findings suggestd that the AMD self-management program is an effective intervention in both the short and thelong-term to reduce distress and disability, and improve self-efficacy in poorly sighted elderly with AMD, especially those who are depressed.
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