Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, 1720 University Blvd, Suite 302, Birmingham, AL, 35233, USA.
Mailman School of Public Health, Columbia University in the City of New York, New York, NY, 10032, USA.
BMC Ophthalmol. 2024 Sep 27;24(1):417. doi: 10.1186/s12886-024-03683-4.
Instrumental activities of daily living (IADL) are typically self-reported ability to perform complex tasks vital for independent living. There is a need for a complementary objective, performance-based approach especially in tracking outcomes in visual rehabilitation for patients with irreversible vision impairment ("low vision"). Our goals are: (1) To describe the validity of timed performance of instrumental activities of daily living (timed IADL or TIADL) tasks in individuals with irreversible vision impairment, by examining its association with visual function (visual acuity, contrast sensitivity, visual field), (2) To explore the correlation between TIADL and self-reported IADL.
Twenty TIADL tasks were administered to 88 patients (median age 63.3 years, IQR 37.4-78.0) recruited from the UAB Department of Ophthalmology, Callahan Eye Hospital Clinics. An average Z-score incorporating time and accuracy of task completion was constructed. Minor accuracy errors were penalized 1 standard deviation from their calculated Z-score and major accuracy errors were assigned maximum allotted time. Linear regression was used to analyze the association between TIADL score and measured visual acuity (Early Treatment Diabetic Retinopathy Study, ETDRS chart), contrast sensitivity (Pelli-Robson), and binocular visual field (Esterman) with an unadjusted model and an adjusted model accounting for age, comorbidities, and depression scale (Center for Epidemiological Studies Depression, CES-D). Pearson correlation was used to estimate the correlation between TIADL and IADL.
Increased time to task completion was associated with decreased visual function. Each decreased line of ETDRS read was associated with an increase of 0.002 (95% CI 0.001, 0.002) Z-score (P < 0.01). A decreased ability to discern each Pelli-Robson letter was associated with an increase of 0.26 (95% CI 0.19, 0.33) Z-score (P < 0.01). For each less Esterman target identified, there was an increase of 0.01 (95% CI 0.003, 0.02) Z-score. Self-reported IADL and TIADL were correlated for reading tasks such as newspapers, nutrients on food can, and microwave timer (P < 0.05).
Longer time to perform TIADL is associated with decreased visual acuity, contrast sensitivity, and binocular visual field. TIADL and self-reported IADL are significantly correlated for reading tasks providing an accurate, complementary outcome measure in clinical practice and research.
工具性日常生活活动（IADL）通常是指自我报告的执行复杂任务的能力，这些任务对独立生活至关重要。需要一种补充的客观、基于表现的方法，特别是在跟踪不可逆视力损害（“低视力”）患者的视觉康复结果时。我们的目标是：（1）通过检查与视觉功能（视力、对比敏感度、视野）的相关性，描述不可逆视力损害个体中工具性日常生活活动（计时 IADL 或 TIADL）任务的计时表现的有效性；（2）探讨 TIADL 与自我报告的 IADL 之间的相关性。
对来自 UAB 眼科、Callahan 眼科医院诊所的 88 名患者（中位年龄 63.3 岁，IQR 37.4-78.0）进行了 20 项 TIADL 任务的测试。构建了一个包含任务完成时间和准确性的平均 Z 分数。对小的准确性误差进行了 1 个标准差的惩罚，并对大的准确性误差分配了最大允许时间。使用线性回归分析 TIADL 评分与测量的视力（早期糖尿病视网膜病变研究，ETDRS 图表）、对比敏感度（Pelli-Robson）和双眼视野（Ester-man）之间的关联，使用未调整模型和调整模型，该模型考虑了年龄、合并症和抑郁量表（流行病学研究中心抑郁量表，CES-D）。使用 Pearson 相关系数估计 TIADL 和 IADL 之间的相关性。
完成任务的时间延长与视觉功能下降有关。每减少一行 ETDRS 阅读，Z 分数增加 0.002（95%CI 0.001，0.002）（P<0.01）。辨别每个 Pelli-Robson 字母的能力下降 0.26（95%CI 0.19，0.33）个 Z 分数（P<0.01）。每个识别出的 Esterman 目标减少 0.01（95%CI 0.003，0.02）个 Z 分数。自我报告的 IADL 和 TIADL 与报纸阅读、食物罐头营养成分和微波炉定时器等阅读任务相关（P<0.05）。
执行 TIADL 的时间延长与视力、对比敏感度和双眼视野下降有关。TIADL 和自我报告的 IADL 在阅读任务方面具有显著相关性，为临床实践和研究提供了一种准确、互补的结果测量方法。
