Selivanova Alexandra, Fenwick Eva, Man Ryan, Seiple William, Jackson Mary Lou
Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.
Optom Vis Sci. 2019 Feb;96(2):87-94. doi: 10.1097/OPX.0000000000001327.
This research is significant because, although vision-related quality of life (VRQoL) is improved after vision rehabilitation (VR), patients with certain characteristics respond less positively on VRQoL measures, and this should inform future care.
The purposes of this study were to evaluate how two VRQoL questionnaires compare in measuring change in patient-reported outcomes after VR and to determine if patient characteristics or occupational therapy (OT) predict higher scores after rehabilitation.
In a prospective clinical cohort study, 109 patients with low vision completed the Impact of Vision Impairment (IVI) and the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) before and after VR. Comprehensive VR included consultation with an ophthalmologist and OT if required. The relationships of six baseline characteristics (age, sex, visual acuity, contrast sensitivity, field loss, diagnosis) and OT were assessed with VRQoL scores using multivariable logistic regression.
The mean (SD) age was 68.5 (19.2) years, and 61 (56%) were female. After rehabilitation, increases in scores were observed in all IVI subscales (reading [P < .001], mobility [P = .002], well-being [P = .0003]) and all NEI VFQ-25 subscales (functional [P = .01], socioemotional [P = .003]). Those who were referred to OT but did not attend and those who had hemianopia/field loss were less likely to have higher VRQoL in IVI mobility and well-being. Those attending OT for more than 3 hours were less likely to have better scores in emotional NEI VFQ. Men were less likely to have increased scores in functional and emotional NEI VFQ, whereas those with diagnoses of nonmacular diseases had higher odds of having increased scores on the emotional NEI VFQ (all, P < .05).
Both the IVI and the NEI VFQ-25 detected change in patients' VRQoL after rehabilitation. Most of the patient characteristics we considered predicted a lower likelihood of increased scores in VRQoL.
本研究具有重要意义，因为尽管视力康复（VR）后与视力相关的生活质量（VRQoL）有所改善，但具有某些特征的患者在VRQoL测量中的反应不太积极，这应为未来的护理提供参考。
本研究的目的是评估两种VRQoL问卷在测量VR后患者报告结局的变化方面的比较情况，并确定患者特征或职业治疗（OT）是否能预测康复后更高的分数。
在一项前瞻性临床队列研究中，109名低视力患者在VR前后完成了视力损害影响（IVI）和国家眼科研究所视觉功能问卷（NEI VFQ - 25）。全面的VR包括必要时与眼科医生和OT进行会诊。使用多变量逻辑回归评估六个基线特征（年龄、性别、视力、对比敏感度、视野缺损、诊断）和OT与VRQoL分数的关系。
平均（标准差）年龄为68.5（19.2）岁，61名（56%）为女性。康复后，所有IVI子量表（阅读[P <.001]、活动能力[P =.002]、幸福感[P =.0003]）和所有NEI VFQ - 25子量表（功能[P =.01]、社会情感[P =.003]）的分数均有所增加。那些被转诊至OT但未就诊的患者以及患有偏盲/视野缺损的患者在IVI活动能力和幸福感方面获得更高VRQoL的可能性较小。接受OT超过3小时的患者在NEI VFQ情感方面获得更好分数的可能性较小。男性在NEI VFQ功能和情感方面分数增加的可能性较小，而诊断为非黄斑疾病的患者在NEI VFQ情感方面分数增加的几率更高（所有P <.05）。
IVI和NEI VFQ - 25均检测到康复后患者VRQoL的变化。我们考虑的大多数患者特征预测VRQoL分数增加的可能性较低。
