***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: 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 r and omized 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 PURPOSE To compare the efficacy of behavior activation ( BA ) + low vision rehabilitation ( LVR ) with supportive therapy ( ST ) + LVR to prevent depressive disorders in patients with age-related macular degeneration ( AMD ) . DESIGN Single-masked , attention-controlled , r and omized , clinical trial with outcome assessment at 4 months . PARTICIPANTS Patients with AMD and subsyndromal depressive symptoms attending retina practice s ( n = 188 ) . INTERVENTIONS Before r and omization , all subjects had 2 outpatient LVR visits , and were then r and omized to in-home BA+LVR or ST+LVR . Behavior activation is a structured behavioral treatment that aims to increase adaptive behaviors and achieve valued goals . Supportive therapy is a nondirective , psychological treatment that provides emotional support and controls for attention . MAIN OUTCOME MEASURES The Diagnostic and Statistical Manual IV defined depressive disorder based on the Patient Health Question naire-9 ( primary outcome ) , Activities Inventory , National Eye Institute Vision Function Question naire-25 plus Supplement ( NEI-VFQ ) , and NEI-VFQ quality of life ( secondary outcomes ) . RESULTS At 4 months , 11 BA+LVR subjects ( 12.6 % ) and 18 ST+LVR subjects ( 23.4 % ) developed a depressive disorder ( relative risk [ RR ] , 0.54 ; 95 % CI , 0.27 - 1.06 ; P = 0.067 ) . In planned adjusted analyses the RR was 0.51 ( 95 % CI , 0.27 - 0.98 ; P = 0.04 ) . A mediational analysis suggested that BA+LVR  prevented depression to the extent that it enabled subjects to remain socially engaged . In addition , BA+LVR was associated with greater improvements in functional vision than ST+LVR , although there was no significant between-group difference . There was no significant change or between-group difference in quality of life . CONCLUSIONS An integrated mental health and low vision intervention halved the incidence of depressive disorders relative to st and ard outpatient LVR in patients with AMD . As the population ages , the number of persons with AMD and the adverse effects of comorbid depression will increase . Promoting interactions between ophthalmology , optometry , rehabilitation , psychiatry , and behavioral psychology may prevent depression in this population Abstract The purpose of this study was to conduct a r and omized clinical trial to assess whether a self-management group intervention can improve mood , self-efficacy , and activity in people with central vision loss due to age-related macular degeneration ( AMD ) . Ninety-two elderly patients with AMD ( average age=79 ) from a university ophthalmology clinic were r and omly assigned to the self-management intervention ( n=44 ) or to a wait-list ( n=48 ) . All patients were legally blind in at least one eye . The intervention consisted of 6 weekly 2-hour group sessions providing education about the disease , group discussion , and behavioral and cognitive skills training to address barriers to independence . All participants eventually completed the intervention allowing pre-post comparisons for all patients . The battery of measures included the Profile of Mood States ( POMS ) ; Quality of Well-Being Scale ; and assessment s of self-efficacy , participation in activities , and use of vision aids . Participants ' initial psychological distress was high ( mean total POMS=59.72 ) and similar to distress experienced by other serious chronic illness population s ( e.g. cancer , bone marrow transplant ) . Analysis of covariance testing the primary hypothesis revealed that intervention participants experienced significantly ( p=.04 ) reduced psychological distress ( pre $ $ \bar x = 61.45$$ ; post $ $ \bar x = 51.14$$ ) in comparison with wait-list controls ( pre $ $ \bar x = 57.72$$ ; post $ $ \bar x = 62.32$$ ) . Intervention participants also experienced improved ( p=.02 ) self-efficacy ( pre $ $ \bar x = 70.16$$ ; post $ $ \bar x = 77.27$$ ) in comparison with controls ( pre $ $ \bar x = 67.71$$ ; post $ $ \bar x = 69.07$$ ) . Further , intervention participants increased their use of vision aids ( p<.001 ; pre $ $ \bar x = 3.37$$ , post $ $ \bar x = 6.69$$ ) . This study demonstrates that a relatively brief behavioral intervention can substantially reduce psychological distress and increase self-efficacy in elderly adults experiencing vision loss due to macular degeneration .  Self-management intervention appears to improve mood , self-efficacy , and use of vision aids , further enhancing the lives of poorly sighted individuals with AMD This study implemented and evaluated the effectiveness of an expressive writing intervention among patients with Stargardt ’s disease , a rare disease due to macular degeneration . Participants were r and omly assigned to either an expressive writing intervention or a neutral writing condition . Participants completed measures at three time points : baseline , 3 weeks , and 6 weeks post-intervention . Psychological health outcomes improved at the 3-week follow-up for the intervention condition compared to control . Self-reported physical health improved at the 6-week follow-up in the intervention condition compared to control . These results suggest that expressive writing may be an effective , practical , and low-cost intervention for those with Stargardt ’s disease OBJECTIVE To assess the effectiveness at the 6-month follow-up of an age-related macular degeneration ( AMD )  self-management program consisting of health education and enhancement of problem-solving skills in improving quality of life as shown by measures of mood and function . METHODS Six-month follow-up data were analyzed from 214 of 252 older adult volunteers ( mean age , 80.8 years ) with advanced AMD who had been r and omly assigned to a 12-hour self-management program  ( n = 82 ) , a series of 12 hours of tape-recorded health lectures ( n = 66 ) , or a waiting list ( n = 66 ) . The primary outcome measure was emotional distress ( Profile of Mood States ) . Secondary outcome measures included function ( National Eye Institute Visual Function Question naire ) , self-confidence to h and le AMD-specific challenges in daily life ( AMD Self-efficacy Question naire ) , and depression status on the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition . RESULTS At the 6-month follow-up , participants in the self-management program reported significantly less emotional distress ( P=.008 ) , better function ( P=.05 ) , and increased self-efficacy ( P=.006 ) compared with control subjects . The latter effects were more pronounced in the depressed than in the nondepressed subjects . Finally , the incidence of clinical depression at the 6-month follow-up was significantly lower in the self-management group ( P=.05 ) than in the control group . CONCLUSION The sustained positive effects at the 6-month follow-up provide support for the effectiveness of the AMD self-management program in reducing distress and disability , improving self-efficacy , and preventing depression  in poorly sighted elderly patients with AMD OBJECTIVE To determine whether problem-solving treatment ( PST ) can prevent depressive disorders  in patients with age-related macular degeneration ( AMD ) . DESIGN Two hundred six patients with AMD were r and omly assigned to  PST  ( n = 105 ) or  usual care ( n = 101 ) . PST therapists delivered six PST sessions over 8 weeks in subjects ' homes . MEASUREMENTS Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition Diagnoses of Depressive Disorders , Hamilton Depression Rating Scale scores , and rates of relinquishing valued activities were assessed at 2 months for short-term effects and 6 months for maintenance effects . RESULTS The 2-month incidence rate of depressive disorders in  PST-treated subjects was significantly lower than controls ( 11.6 % versus 23.2 % , respectively ; OR = 0.43 ; 95 % CI [ 0.20 , 0.95 ] ) . PST also reduced the odds of relinquishing a valued activity ( OR = 0.48 ; 95 % CI [ 0.25 , 0.96 ] ) ; this effect mediated the relationship between treatment group and depression . By 6 months most earlier observed benefits had diminished . Secondary analyses showed that a minimal level of depressive symptoms were disabling and predicted incident depressive disorders . CONCLUSION PST prevented depressive disorders and loss of valued activities as a short-term treatment but these benefits were not maintained over time . To sustain PST 's effect , an intervention that uses a problem-solving framework to enhance rehabilitative skills may be necessary Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background / aims Ageing of the population will result in unprecedented numbers of older adults living with age-related vision loss ( ARVL ) .  Self-management models improve health outcomes and reduce healthcare costs ; however , the principles have rarely been applied in low vision services . Methods A two-armed r and omised controlled trial of older adults ( n=77 ) with ARVL compared ‘ usual care ’ provided by a not-for-profit community agency with an extended model of care ( usual care+self-management group intervention ) . The primary outcome variable ( participation in life situations ) was measured using the Activity Card Sort . Secondary outcome measures examined general health and vision-specific domains . Results The intention-to-treat analysis demonstrated that the extended model produced significantly better participation in life situations at post-test when compared with the usual care only group . Gains were made regardless of whether participants were , or were not , depressed at baseline . The addition of the self-management group was also successful in significantly reducing depression , increasing physical and mental health , generalised and domain-specific self-efficacy , and adjustment to ARVL . With the exception of adjustment and mental health , differences were still apparent at 12 weeks ' follow-up . Conclusion Addition of self-management  significantly improved general health and vision-specific rehabilitation outcomes for older adults with ARVL CONTEXT Age-related macular degeneration is a prevalent disease of aging that may cause irreversible vision loss , disability , and depression . The latter is rarely recognized or treated in ophthalmologic setting s. OBJECTIVE To determine whether problem-solving treatment can prevent depressive disorders in patients with recent vision loss . DESIGN R and omized , controlled trial . SETTING Outpatient ophthalmology offices in Philadelphia , Pennsylvania . PATIENTS Two hundred six patients aged 65 years or older with recent diagnoses of neovascular age-related macular degeneration in one eye and pre-existing age-related macular degeneration in the fellow eye . INTERVENTION Patients were r and omly assigned to problem-solving treatment ( n = 105 ) or usual care ( n = 101 ) . Problem-solving treatment therapists delivered 6 sessions during 8 weeks in subjects ' homes . MAIN OUTCOME MEASURES Outcomes were assessed at 2 months for short-term effects and 6 months for maintenance effects . These included DSM-IV-defined diagnoses of depressive disorders , National Eye Institute Vision Function Question naire-17 scores , and rates of relinquishing valued activities . RESULTS The 2-month incidence rate of depressive disorders in problem-solving-treated  subjects was significantly lower than controls ( 11.6 % vs 23.2 % , respectively ; odds ratio , 0.39 ; 95 % confidence interval , 0.17 - 0.92 ; P = .03 ) . Problem-solving treatment also reduced the odds of relinquishing a valued activity ( odds ratio , 0.48 ; 95 % confidence interval , 0.25 - 0.96 ; P = .04 
    Output:
    
Meta-regression analyses showed homogeneity in effect sizes across a range of intervention , population , and study characteristics .
However , after removing a clear outlier the overall effect on depressive symptoms and the influence of age on depressive symptoms and psychological stress were no longer significant , while the influence of age on psychological well-being remained .
There is currently only limited evidence for the effectiveness of psychosocial interventions in the field of low vision .