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Afsane Riazi, Trefor Aspden, Kate Walters, Gary S Rubin, Gareth Ambler, Fatima Jichi, Miriam O'Driscoll; Improving psychological well-being in people recently diagnosed with visual impairment: A pilot randomised controlled trial of Problem-Solving Treatment for Visual Impairment (POSITIVE). Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2096.
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Problem-Solving Treatment (PST), a brief, structured psychological intervention, has been used to treat and prevent depression in a variety of settings. However, the impact of PST on improving psychological well-being in those with recent vision loss remains unknown. We conducted a pilot randomised controlled trial to evaluate whether PST leads to better psychological well-being in people who have been recently registered as blind or partially sighted.
We randomly allocated 61 individuals who were diagnosed with visual impairment during the previous 3 months to either the PST or usual care group. Participants in the intervention arm received 6 sessions of PST delivered over 8 weeks, and a booster session delivered 3-months after completing PST. Outcome measures including psychological well-being, symptoms of distress, mobility, quality of life and self-efficacy were assessed at baseline and 3, 6, and 9-month follow-up. The primary analysis was a comparison of psychological well-being (measured by the Warwick Edinburgh Mental Well-being Scale) across treatment groups using a mixed model that adjusts for baseline scores, stratification factors and measurements at multiple time-points. Where appropriate, analyses were conducted once the measures were transformed to interval-level measurement using Rasch analysis.
PST significantly improved psychological well-being (treatment effect=2.44; 95% CI=0.40-4.47; p=0.019), symptoms of distress (treatment effect=-2.76; 95% CI=-4.92- -0.60; p=0.012), quality of life (treatment effect=3.50; 95% CI=1.49-5.51; p=0.001) and self-efficacy (treatment effect=0.268; 95% CI=0.05-0.48; p=0.014). The treatment effect was observed to be consistent at all three follow-ups. No statistically significant effect was found for mobility. Attrition rate was low (13%).
PST was associated with a significant and sustained improvement in psychological well-being, symptoms of distress, quality of life and self-efficacy in people with recent vision loss. Further large scale trials should be conducted to confirm these findings, and to determine whether PST should be offered routinely to all those newly diagnosed with visual impairment.
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