Ophthalmology, Amsterdam UMC, location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
Amsterdam Public Health, Quality of Care, Mental Health, Aging and Later Life, Amsterdam, The Netherlands.
BMC Health Serv Res. 2023 Nov 16;23(1):1271. doi: 10.1186/s12913-023-10193-4.
Over 50% of adults with visual impairment experience severe fatigue. Therefore, we developed a guided E-health intervention based on cognitive behavioral therapy and self-management to reduce fatigue in this population. This pilot study evaluated the usability, feasibility, fidelity and potential effectiveness of E-nergEYEze.
E-nergEYEze was developed by a design team and customized by conducting a pilot study using an iterative development strategy. The intervention was first tested in a usability study among adults with visual impairment (n = 5). Participants were asked to think-aloud while exploring the intervention features and a semi-structured interview was performed afterwards. Subsequently, the enhanced intervention was tested in a feasibility study. Adults with visual impairment and severe fatigue (n = 10) followed the intervention partially with guidance from a social worker and one-time computer trainer support. Fatigue severity (Checklist Individual Strength), fatigue impact (Modified Fatigue Impact Scale) and cognitive behavioral therapy skills (Competencies of Cognitive Therapy Scale-Self Report) were measured at baseline and at three months follow-up and analyzed with the Wilcoxon signed-rank test. The intervention was evaluated through evaluation forms.
The usability study resulted in adjustments to content and lay-out with regard to optically shortened text sentences, separate pages for information and assignments with one read-aloud audio and an additional descriptive explanation of page content. Digital challenges were overcome with mandatory computer training and e-platform modifications. The feasibility study showed a positive trend in reducing fatigue severity (Z -6.108; P < .001; SD 8.4), impact of fatigue (Z - 4.451; P < .001; SD 11.4) and cognitive behavioral therapy skills (Z -2.278; P = .023; SD 19.3). Participants gave useful feedback regarding accessibility, content and guidance, with an overall positive experience. The intervention was rated with a median score of 8 (range 7-10).
We developed, evaluated and optimized E-nergEYEze by applying a user-centered and iterative approach. E-nergEYEze showed a promising trend to reduce fatigue severity and impact of fatigue and to increase cognitive behavioral therapy skills. The study methods were feasible and the fidelity of the intervention protocol was suitable. Performing a randomized controlled trial is warranted to give insight into whether E-nergEYEze is cost-effective in reducing severe fatigue in adults with visual impairment.
International Clinical Trial Registry Platform: NL7764. Date registered: 28-05-2019.
超过 50%的视力障碍成年人经历严重疲劳。因此，我们开发了一种基于认知行为疗法和自我管理的指导型电子健康干预措施，以减轻该人群的疲劳。这项初步研究评估了 E-nergEYEze 的可用性、可行性、保真度和潜在效果。
E-nergEYEze 由一个设计团队开发，并通过使用迭代开发策略进行试点研究进行定制。该干预措施首先在一项视力障碍成年人（n=5）的可用性研究中进行了测试。参与者在探索干预措施功能时被要求大声思考，之后进行了半结构化访谈。随后，在一项可行性研究中测试了增强型干预措施。视力障碍严重疲劳的成年人（n=10）在社会工作人员的指导下部分遵循干预措施，并接受一次性计算机培训师的支持。疲劳严重程度（个体力量检查表）、疲劳影响（改良疲劳影响量表）和认知行为疗法技能（认知疗法技能量表自我报告）在基线和三个月随访时进行测量，并使用 Wilcoxon 符号秩检验进行分析。干预措施通过评估表进行评估。
可用性研究导致对内容和布局进行了调整，包括缩短文字句子、为信息和任务单独设置页面、使用一个朗读音频以及对页面内容进行额外的描述性解释。通过强制性的计算机培训和电子平台修改克服了数字挑战。可行性研究显示，疲劳严重程度（Z-6.108；P<0.001；SD 8.4）、疲劳影响（Z-4.451；P<0.001；SD 11.4）和认知行为疗法技能（Z-2.278；P=0.023；SD 19.3）呈积极趋势。参与者对可访问性、内容和指导提供了有用的反馈，整体体验积极。干预措施的评分中位数为 8 分（范围为 7-10 分）。
我们通过应用以用户为中心和迭代的方法开发、评估和优化了 E-nergEYEze。E-nergEYEze 显示出减轻疲劳严重程度和疲劳影响、增加认知行为疗法技能的有希望的趋势。研究方法是可行的，干预措施协议的保真度是合适的。进行随机对照试验是值得的，可以深入了解 E-nergEYEze 是否在减轻视力障碍成年人的严重疲劳方面具有成本效益。
国际临床试验注册平台：NL7764。注册日期：2019 年 5 月 28 日。
