Melanie Larizza

Methodology and early findings of the Diabetes Management Project: a cohort study investigating the barriers to optimal diabetes care in diabetic patients with and without diabetic retinopathy

Background:  The Diabetes Management Project is investigating the clinical, behavioural and psychosocial barriers to optimal diabetes care in individuals with and without diabetic retinopathy.

In-home monitoring of older adults with vision impairment: exploring patients', caregivers' and professionals' views

OBJECTIVE To develop a conceptual framework for the design of an in-home monitoring system (IMS) based on the requirements of older adults with vision impairment (VI), informal caregivers and eye-care rehabilitation professionals. MATERIALS AND METHODS Concept mapping, a mixed-methods statistical research tool, was used in the construction of the framework. Overall, 40 participants brainstormed or sorted and rated 83 statements concerning an IMS for older adults with VI. Multidimensional scaling and hierarchical cluster analysis were employed to construct the framework. A questionnaire yielded further insights into the views of a wider sample of older adults with VI (n=78) and caregivers (n=25) regarding IMS. RESULTS Concept mapping revealed a nine-cluster model of IMS-related aspects including affordability, awareness of system capabilities, simplicity of installation, operation and maintenance, system integrity and reliability, fall detection and safe movement, user customization, user preferences regarding information delivery, and safety alerts for patients and caregivers. From the questionnaire, independence, safety and fall detection were the most commonly reported reasons for older adults and caregivers to accept an IMS. Concerns included cost, privacy, security of the information obtained through monitoring, system accuracy, and ease of use. DISCUSSION Older adults with VI, caregivers and professionals are receptive to in-home monitoring, mainly for fall detection and safety monitoring, but have concerns that must be addressed when developing an IMS. CONCLUSION Our study provides a novel conceptual framework for the design of an IMS that will be maximally acceptable and beneficial to our ageing and vision-impaired population.

The Reliability of Data Collection Periods of Personal Costs Associated with Vision Impairment

Purpose: To determine the reliability of vision-related personal costs collected over 1, 3 and 6 months (extrapolated to 12 months) compared to one-year data. Methods: Participants of any age, with a presenting visual acuity of < 20/40 in the better eye and an ability to converse in English, were recruited. Monthly cost diaries, in large print and electronic copies with instructions available in audio and Braille, were used prospectively to collect personal costs. The personal expenses were grouped under four categories, namely: (a) medicines, products and equipment, (b) health and community services, (c) informal care and support and (d) other expenses. Sociodemographic and clinical data were also collected. Results: 104 participants (59 females) with a mean age of 64 years completed the 12-months diaries. Almost 40% of the participants had severe visual impairment (< 20/200) in the better eye and the most common cause of vision loss was AMD (n = 40; 38%). The mean total personal costs collected from the 12-months diaries were AUS

A randomised controlled trial of a self-management programme for low vision implemented in low vision rehabilitation services ☆

3,330 ± 2,887. There were no significant differences between the 12-months data and extrapolated 1, 3 and 6-months diaries (t-tests; p = 0.17, 0.89 and 0.73, respectively). However, the 1-month variation was substantially larger (SD ± 5860) compared to the 3-month and 6-month variances (SD ± 3037 and 3030, respectively) for total costs. Also, compared to the 12-months diaries, the 1-month data consistently recorded the weakest correlation coefficients for all cost categories compared to the other time intervals. Conclusions: Given that diary completion can be particularly challenging for individuals with impaired vision, a minimum 3-months data collection period can provide reliable estimates of annual costs associated with vision impairment.

Should family and friends be involved in group-based rehabilitation programs for adults with low vision?

OBJECTIVE To investigate the effectiveness of a low vision self-management programme (LVSMP) in older adults. METHODS Participants (n=153) were existing clients of a national low vision rehabilitation organisation randomly allocated to usual services (n=60) or usual services plus LVSMP (n=93). The LVSMP was an 8-week group programme facilitated by low vision counsellors. The primary outcome was vision-specific quality of life (QoL) measured using the Impact of Vision Impairment (IVI) questionnaire. Secondary outcomes emotional well-being, self-efficacy and adaptation to vision loss were measured using the depression, anxiety, stress scale (DASS), general self-efficacy scale (GSES), and short form adaptation to age-related vision loss scale (AVL12). RESULTS At one and six month follow-up assessments, no significant between-group differences were found for vision-specific QoL, emotional well-being, adaptation to vision loss or self-efficacy (p>0.05). Univariate and multivariate analyses revealed no impact of the intervention on outcome measures. CONCLUSIONS In contrast to previous work, our study found limited benefit of a LVSM programme on QoL for older adults accessing low vision services. PRACTICE IMPLICATIONS When implementing self-management programmes in low vision rehabilitation settings, issues of client interest, divergence of need, programme accessibility and fidelity of intervention delivery need to be addressed.

Studies to determine user requirements regarding in-home monitoring systems

This qualitative study investigates the views of clients with low vision and vision rehabilitation professionals on the involvement of family and friends in group-based rehabilitation programs. Both groups outlined advantages and disadvantages to involving significant others, and it is essential that clients are given the choice. Future work is needed to examine the uptake, process and outcomes of rehabilitation programs in which clients are able to invite family and friends.

Feasibility of screening for diabetic retinopathy at an Australian pathology collection service: a pilot study

The ageing of the world population is leading to an increased number of elderly people remaining in their homes, requiring different levels of care. MIA is a user-centric project aimed at monitoring elderly people in order to help them remain safely in their homes, where the design of the system is informed by the requirements of the stakeholders. In this paper, we present the results of two user studies that ascertain the views of elderly people and their informal carers regarding the acceptability and benefits of in-home monitoring technologies: (1) concept mapping coupled with brainstorming sessions, and (2) questionnaires. We then discuss how these requirements affect the design of our monitoring system.

A self-management program for low vision: Program overview and pilot evaluation

Objective: To evaluate the feasibility of a novel diabetic retinopathy (DR) screening model using a pathology collection centre (PCC) as a screening site.