Brody Barbara L, Roch-Levecq Anne-Catherine, Thomas Ronald G, Kaplan Robert M, Brown Stuart I
Department of Ophthalmology, University of California, San Diego, La Jolla 92093-0946, USA.
Arch Ophthalmol. 2005 Jan;123(1):46-53. doi: 10.1001/archopht.123.1.46.
To assess the effectiveness at the 6-month follow-up of an age-related macular degeneration (AMD) self-management program consisting of health education and enhancement of problem-solving skills in improving quality of life as shown by measures of mood and function.
Six-month follow-up data were analyzed from 214 of 252 older adult volunteers (mean age, 80.8 years) with advanced AMD who had been randomly assigned to a 12-hour self-management program (n = 82), a series of 12 hours of tape-recorded health lectures (n = 66), or a waiting list (n = 66). The primary outcome measure was emotional distress (Profile of Mood States). Secondary outcome measures included function (National Eye Institute Visual Function Questionnaire), self-confidence to handle AMD-specific challenges in daily life (AMD Self-efficacy Questionnaire), and depression status on the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
At the 6-month follow-up, participants in the self-management program reported significantly less emotional distress (P=.008), better function (P=.05), and increased self-efficacy (P=.006) compared with control subjects. The latter effects were more pronounced in the depressed than in the nondepressed subjects. Finally, the incidence of clinical depression at the 6-month follow-up was significantly lower in the self-management group (P=.05) than in the control group.
The sustained positive effects at the 6-month follow-up provide support for the effectiveness of the AMD self-management program in reducing distress and disability, improving self-efficacy, and preventing depression in poorly sighted elderly patients with AMD.
评估一项年龄相关性黄斑变性（AMD）自我管理项目在6个月随访时的效果，该项目包括健康教育和提高解决问题的能力，通过情绪和功能指标来衡量其对改善生活质量的作用。
对252名患有晚期AMD的老年志愿者（平均年龄80.8岁）中的214名进行了6个月的随访数据分析，这些志愿者被随机分配到一个12小时的自我管理项目组（n = 82）、一系列12小时的录音健康讲座组（n = 66）或等待名单组（n = 66）。主要结局指标是情绪困扰（情绪状态剖面图）。次要结局指标包括功能（美国国立眼科研究所视觉功能问卷）、应对日常生活中AMD特定挑战的自信心（AMD自我效能量表）以及根据《精神障碍诊断与统计手册》第四版结构化临床访谈得出的抑郁状态。
在6个月随访时，与对照组相比，自我管理项目组的参与者报告的情绪困扰明显更少（P = 0.008），功能更好（P = 0.05），自我效能感增强（P = 0.006）。后两种效果在抑郁患者中比在非抑郁患者中更明显。最后，自我管理组在6个月随访时临床抑郁症的发生率显著低于对照组（P = 0.05）。
6个月随访时的持续积极效果为AMD自我管理项目在减轻视力不佳的老年AMD患者的困扰和残疾、提高自我效能感以及预防抑郁症方面的有效性提供了支持。
