Evaluation of an Adaptive Skills Training Program for Patients with Advanced Bilateral Age-Related Macular Degeneration: A Prospective Randomized Trial

Abstract

Abstract: : Purpose: To evaluate the efficacy of an adaptive skills training program in improving quality of life in patients with age-related macular degeneration (AMD), as shown by measures of mood and function. Methods: Twenty-two patients with bilateral advanced neovascular or atrophic AMD and visual acuity of ≤20/60 were randomly assigned to a treatment or control group. The treatment program consisted of 5 group sessions once a week for 2 hours covering the following subjects: systematic problem solving, resource and activity management, correlation between emotions and actions, experience exchange, and disease information. For evaluation purposes, a standardized pre- and post assessment interview was completed by both groups. This interview consisted of questions derived from the following standardized instruments: Activities of Daily Living/Instrumental Activities of Daily Living (ADL/IADL), leisure activities, Positive and Negative Affect Scale (PANAS), Geriatric Depression Scale (GDS), Adaptation to Vision Loss Scale (AVL), and modified versions of the Philadelphia Geriatric Center Multilevel Assessment Instrument (MAI), and Subjective Assessment of Independent Living (SIMA). Three groups with a total of 14 patients participated in the counseling group and 8 patients in the control group. Results: As determined by standardized interview, treatment participants demonstrated greater improvement compared to controls on a standardized point scale in the following areas: less difficulty in practical daily living skills (1.0 improvement [imp.] vs. 5.0 decline [dcl.]), improvement in willingness to undertake leisure time activities (3.0 imp. vs. 1.0 imp.), subjective independence (0.8 imp. vs. 1.1 dcl.), and subjective future perspective (0.1 imp. vs. 0.3 dcl.), with reduced signs of depression (1.3 imp. vs. 0.7 dcl.). Conclusions: These results suggest that adaptive skill training can be effective in improving the quality of life for patients suffering bilateral visual loss secondary to AMD. Further research into the development of such interventional programs is warranted.

Keywords: age-related macular degeneration • low vision • aging