The impact of a video intervention on the use of low vision assistive devices

Abstract

Purpose: An image-enhanced educational and motivational video was developed for patients with low vision and their caretakers. Impact on knowledge, self-efficacy, and attitudes was assessed.

Methods: The video incorporated cognitive restructuring to change emotional response; a "virtual home"; a veridical simulation of vision with age-related macular degeneration and contrast enhancement of the video. Subjects (median age 77.5) were randomized into control (n=79) and intervention (n=75) groups. Telephone interviews were at baseline, 2 weeks and 3 months. Main outcome measures were: knowledge (eight questions), self-efficacy score (seven questions), adaptive behaviors (10 questions), willingness to use devices, and emotional response (4-point scales).

Results: The intervention group showed a statistically significant improvement in knowledge, (difference of 1.1 out of eight questions, p<0.001). Change in use of books-on-tape was more for the intervention group than for controls (p=0.005). The intervention group increased use of books-on-tape from 28 to 51% whereas the control group did not (34% at both times). However, there was no significant change in the use of other assistive devices, including magnifiers. Both groups increased adaptive behaviors. There was no significant difference in change of self-efficacy score or in emotional affect between the two groups.

Conclusions: The video had a small, but statistically significant impact on knowledge and willingness to use assistive devices. There was little impact on adaptive behaviors and emotional affect. The minimal changes in outcome were disappointing, but this does not minimize the importance of patient education; it just emphasizes how hard it is to effect change.

Figure 1

The video includes a simulation of vision with a central scotoma provided for the benefit of the patient’s families. The simulation depicts a more accurate rendition than has been available in the past. The resolution of the image decreases towards the edge and it dynamically illustrates that the patient naturally shifts the scotoma to the side to allow the more relevant portions of the scene to be visible. The beneficial effect of magnification was illustrated by the changing view of an approaching person.

Figure 2

The virtual home animation includes environmental adaptations and use of visual aids such as the large digits wall clock shown to the left of the difficult to see clock that it replaced. Adaptations include installation of additional illumination, for example under the kitchen cabinets and the use of contrasting color surfaces such as the dual color cutting board (as shown here). Adaptations and visual aids are depicted for the kitchen, bathroom, bedroom, and living room.

Figure 2

The virtual home animation includes environmental adaptations and use of visual aids such as the large digits wall clock shown to the left of the difficult to see clock that it replaced. Adaptations include installation of additional illumination, for example under the kitchen cabinets and the use of contrasting color surfaces such as the dual color cutting board (as shown here). Adaptations and visual aids are depicted for the kitchen, bathroom, bedroom, and living room.

Figure 3

The anatomy and basic pathology of AMD are illustrated using a graphic animation. The animation assumes no prior familiarity with any of the anatomy of the eye and orbit and thus it starts with a full face image zooming to the eye as seen by an observer. The facial tissue around the globe then gradually fades as shown here to maintain the relationship between the exposed globe and the normally visible eye. The back of the eye is then gradually opened from the side to reveal a view of the retina while still maintaining the relationship to the face as shown here. These gradual transitions help persons unfamiliar with the anatomy locate various aspects. The animation is provided with as much magnification as possible and with large arrows pointing to items described in the audio. The animation further illustrates the location and nature of changes that occur with macular degeneration. The small portion of the retina affected is emphasized and compared with the large residual functioning retina.

Figure 4

The non-animated parts of the video were enhanced using a technique that has been shown to improve the viewing experience for people with macular degeneration. This figure shows the difference between the enhanced (on the right) and original unenhanced version (on the left). The actual video only presented the enhanced images.

Figure 5

Subjects were recruited at 5 educational/public relation events and after an initial telephone screening-interview they were randomized into treatment and control groups. For both groups, interviews were conducted at 2 weeks and 3 months. After the 3-month interview, the control group was given the video.

Figure 6

Means and standard error of the means of the number of questions answered correctly out of 8 questions compared at baseline and at the 2-week interview. The treatment (video) group improved significantly more than the controls, a difference of about 1 extra question.

Figure 7

The percent of people who use assistive devices at baseline and at Follow Up (3 months following the video) for (a) the control group and (b) the treatment (video) group. The change in use of Books On Tape was significantly more for the video group than the control group. Error bars indicate standard error of the mean. Although there is a similar tendency for the change in use of magnifiers and talking appliances to be greater for the video group, these changes were not significant. The means shown here do not exactly match the results reported from the models because the models adjust for covariates.

Figure 7

The percent of people who use assistive devices at baseline and at Follow Up (3 months following the video) for (a) the control group and (b) the treatment (video) group. The change in use of Books On Tape was significantly more for the video group than the control group. Error bars indicate standard error of the mean. Although there is a similar tendency for the change in use of magnifiers and talking appliances to be greater for the video group, these changes were not significant. The means shown here do not exactly match the results reported from the models because the models adjust for covariates.