Recovery of spatial vision following intense light adaptation

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN022166 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Measuring low vision service outcomes: Rasch analysis of the seven-item national eye institute visual function questionnaire

<br>Purpose. Patient anxiety has been shown to be detrimental to healthcare consultations and their outcomes. To date, little is known about the causes of patient anxiety in optometric practice. Therefore, the purpose of this study was to identify the predictors of state anxiety for patients attending optometric consultations.</br> <br>Methods. Three hundred sixty six participants (127 male, 239 female; mean age, 54.5; SD ± 18.0) took part in the study. Each participant completed a preconsultation questionnaire including established measures of “state” anxiety, “trait” anxiety, study specific outcome expectancies, and biographical data. Multiple linear regression analysis was used to identify which variables predict state anxiety.</br> <br>Results. Multiple linear regression analysis showed that the heightened trait anxiety, expecting “bad news” and being a non-spectacle wearer are independent predictors of increased state anxiety. R2 was 0.33, i.e., the regression model explained 33% of the variance.</br> <br>Conclusions. This is the first time that the predictors of state anxiety in optometric practice have been identified. Optometrists should recognize that patients who are “anxious types,” who may be expecting “bad news” and who do not wear spectacles may be more anxious.</br&gt

Content development of the optometric patient anxiety scale

<br>PURPOSE:Patient anxiety has been shown to be detrimental to many aspects of healthcare outcomes. To date, there is no method of evaluating anxiety in optometric practice. Therefore, the purpose of this study was the content development of a questionnaire to measure optometric patient anxiety. Such a tool will have both clinical and research application; allowing the identification of anxious patients in practice and as a method to establish the success of anxiety reducing interventions.</br> <br>METHODS: Selection of initial items was based on patient interviews, literature review, and focus group feedback. The initial 30-item Optometric Patient Anxiety Scale was piloted on 148 patients in optometric practice. Rasch analysis was used to analyze response category operation and to facilitate item removal to ensure a valid and unidimensional scale. Test-retest reliability (test-retest time, 2 weeks) was measured on 59 young adults to test the stability of the measure with time.</br> <br>RESULTS: Rasch analysis identified disordering of category thresholds and underutilization of the end-response category. Therefore, categories were merged to a three response solution. Item reduction was principally driven by infit and outfit statistics. The items in the final 10-item scale all had good infit and outfit values (infit: 0.80-1.20, outfit: 0.7-1.3), good person separation (>2) and high person and item reliability coefficients, 0.84 and 0.88, respectively. Test-retest reliability also demonstrated good stability of the measure with time (intraclass correlation; ICC = 0.85).</br> <br>CONCLUSIONS: The Optometric Patient Anxiety Scale is the first questionnaire to measure patient anxiety specific to optometric practice. The scale was developed using Rasch analysis to ensure that all the items work together to form a valid unidimensional interval scale.</br

Annual report for the year ended 31 December 1992

SIGLEAvailable from British Library Document Supply Centre-DSC:1241.049(1992) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Measuring low vision service outcomes: Rasch analysis of the seven-item national eye institute visual function questionnaire

Purpose. Patient anxiety has been shown to be detrimental to healthcare consultations and their outcomes. To date, little is known about the causes of patient anxiety in optometric practice. Therefore, the purpose of this study was to identify the predictors of state anxiety for patients attending optometric consultations. Methods. Three hundred sixty six participants (127 male, 239 female; mean age, 54.5; SD ± 18.0) took part in the study. Each participant completed a preconsultation questionnaire including established measures of “state” anxiety, “trait” anxiety, study specific outcome expectancies, and biographical data. Multiple linear regression analysis was used to identify which variables predict state anxiety. Results. Multiple linear regression analysis showed that the heightened trait anxiety, expecting “bad news” and being a non-spectacle wearer are independent predictors of increased state anxiety. R2 was 0.33, i.e., the regression model explained 33% of the variance. Conclusions. This is the first time that the predictors of state anxiety in optometric practice have been identified. Optometrists should recognize that patients who are “anxious types,” who may be expecting “bad news” and who do not wear spectacles may be more anxious.</br

Development of the 25-item Cardiff visual ability questionnaire for children (CVAQC)

&lt;br&gt;Aims To develop and validate a short questionnaire to assess self-reported visual ability in children and young people with a visual impairment.&lt;/br&gt; &lt;br&gt;Methods A list of 121 items was generated from 13 focus groups with children and young people with and without a visual impairment. A long 89-item questionnaire was piloted with 45 visually impaired children and young people using face-to-face interviews. Rasch analysis was used to analyse the response category function and to facilitate item removal ensuring a valid unidimensional scale. The validity and reliability of the short questionnaire were assessed on a group of 109 visually impaired children (58.7% boys; median age 13 years) using Rasch analysis and intraclass correlation coefficient (ICC).&lt;/br&gt; &lt;br&gt;Results The final 25-item questionnaire has good validity and reliability as demonstrated by a person separation index of 2.28 and reliability coefficient of 0.84. The items are well targeted to the subjects with a mean difference of −0.40 logit between item and person means, and an ICC of 0.89 demonstrates good temporal stability.&lt;/br&gt; &lt;br&gt;Conclusion The Cardiff Visual Ability Questionnaire for Children (CVAQC) is a short, psychometrically robust and a self-reported instrument that works to form a unidimensional scale for the assessment of the visual ability in children and young people with a visual impairment.&lt;/br&gt

The newly established primary care based Welsh low vision service is effective and has improved access to low vision services in Wales

Aim:  The aim of this study was to determine whether the new, primary care based, Welsh Low Vision Service (WLVS) improved access to low vision services in Wales and was effective. Method:  The impact of the WLVS was determined by measuring the number of low vision appointments; travel time to the nearest service provider; and waiting times for low vision services for 1 year before, and for 1 year after, its establishment. Change in self-report visual function (using the 7 item NEI-VFQ), near visual acuity, patient satisfaction and use of low vision aids were used to determine the effectiveness of the service. Results:  Following instigation of the WLVS, the number of low vision assessments increased by 51.7%, the waiting time decreased from more than 6 months to less than 2 months for the majority of people, and journey time to the nearest service provider reduced for 80% of people. Visual disability scores improved significantly (p &#60; 0.001) by 0.79 logits and 97.42% patients found the service helpful. Conclusions:  The extension of low vision rehabilitation services into primary care identified a considerable unmet burden of need as evidenced by the substantial increase in the number of low vision assessments provided in Wales. The new service is effective and exhibits improved access.</br

Stepped-care to prevent depression and anxiety in visually impaired older adults - design of a randomised controlled trial

Background: Subthreshold depression and anxiety are common in the growing population of visually impaired older adults and increase the risk of full-blown depressive or anxiety disorders. Adequate treatment may prevent the development of depression or anxiety in this high risk group.Method/design: A stepped-care programme was developed based on other effective interventions and focus groups with professionals and patient representatives of three low vision rehabilitation organisations in the Netherlands and Belgium. The final programme consists of four steps: 1) watchful waiting, 2) guided self-help, 3) problem solving treatment, 4) referral to general practitioner. The (cost-)effectiveness of this programme is evaluated in a randomised controlled trial. Patients (N = 230) are randomly assigned to either a treatment group (stepped-care) or a control group (usual care). The primary outcome is the incidence of depressive and anxiety disorders, measured with the Mini International Neuropsychiatric Interview (MINI).Discussion: Preventive interventions for depression and anxiety have received little attention in the field of low vision. A stepped-care programme that focuses on both depression and anxiety has never been investigated in visually impaired older adults before. If the intervention is shown to be effective, this study will result in an evidence based treatment programme to prevent depression or anxiety in patients from low vision rehabilitation organisations. The pragmatic design of the study greatly enhances the generalisability of the results. However, a possible limitation is the difficulty to investigate the contribution of each individual step. © 2013 van der Aa et al.; licensee BioMed Central Ltd

Stepped care for depression and anxiety in visually impaired older adults: multicentre randomised controlled trial

Study question Is stepped care compared with usual care effective in preventing the onset of major depressive, dysthymic, and anxiety disorders in older people with visual impairment (caused mainly by age related eye disease) and subthreshold depression and/or anxiety? Methods 265 people aged ?50 were randomly assigned to a stepped care programme plus usual care (n=131) or usual care only (n=134). Supervised occupational therapists, social workers, and psychologists from low vision rehabilitation organisations delivered the stepped care programme, which comprised watchful waiting, guided self help based on cognitive behavioural therapy, problem solving treatment, and referral to a general practitioner. The primary outcome was the 24 month cumulative incidence (seven measurements) of major depressive dysthymic and/or anxiety disorders (panic disorder, agoraphobia, social phobia, and generalised anxiety disorder). Secondary outcomes were change in symptoms of depression and anxiety, vision related quality of life, health related quality of life, and adaptation to vision loss over time up to 24 months' follow-up. Study answer and limitations 62 participants (46%) in the usual care group and 38 participants (29%) from the stepped care group developed a disorder. The intervention was associated with a significantly reduced incidence (relative risk 0.63, 95% confidence interval 0.45 to 0.87; P=0.01), even if time to the event was taken into account (adjusted hazard ratio 0.57, 0.35 to 0.93; P=0.02). The number needed to treat was 5.8 (3.5 to 17.3). The dropout rate was fairly high (34.3%), but rates were not significantly different for the two groups, indicating that the intervention was as acceptable as usual care. Participants who volunteered and were selected for this study might not be representative of visually impaired older adults in general (responders were significantly younger than non-responders), thereby reducing the generalisability of the outcomes. What this study adds Stepped care seems to be a promising way to deal with depression and anxiety in visually impaired older adults. This approach could lead to standardised strategies for the screening, monitoring, treatment, and referral of visually impaired older adults with depression and anxiety