In-home occupational therapy curbs depression in visually impaired patients

March 8, 2017

Johns Hopkins researchers report that in-home occupational therapy appears to reduce the rate and severity of depression in people at higher risk for the disorder because of seriously impaired vision.

The Centers for Disease Control and Prevention says older adults in the United States are already at an increased risk of depression as their health and social lives change. Vision-impairing diseases, such as age-related macular degeneration, contribute to these changes for an estimated 1.6 million Americans.

The new study, described March 8, in Investigative Ophthalmology & Visual Science, used measures obtained from the previous Low Vision Depression Prevention Trial in Age-Related Macular Degeneration (VITAL) study to conclude that low-vision patients who improve in their day-to-day functions, such as cooking, reading mail or using a computer, through at-home training with an occupational therapist have less severe symptoms of depression than similar patients who did not train with an occupational therapist.

"Our goal for this study was to see if was a better investment than supportive therapy in preventing depression in low-vision patients," says Ashley Deemer, O.D., instructor of ophthalmology at the Johns Hopkins University School of Medicine.

The study was based on information originally gathered for the VITAL study at Thomas Jefferson University in Philadelphia and included data on 188 patients with age-related macular degeneration. The patients' average age was 84, and 70.2 percent of the patients were women. The patients had an average visual acuity of 20/96, meaning that the average person in this study could see an object 20 feet away, while someone with normal vision could see the same object at 96 feet. All patients also reported borderline depressive symptoms, scoring greater than five on the Patient Health Questionnaire-9, a clinical survey used to estimate depression risk. In this survey, a score of zero is an indication that the patient has no depression or is at a low risk, and a score of 20 or higher marks a patient as at risk for severe depression.

After enrollment in the study, all patients visited a low vision rehabilitation optometrist and filled out a questionnaire designed to assess the importance and difficulty of daily activities, such as cooking, driving, pleasure reading and using a computer.

Patients were then divided into two treatment groups—an occupational therapy group and a supportive therapy group. The group of patients receiving occupational therapy met with an occupational therapist for six one-hour sessions in their homes. Utilizing tools like magnifying glasses, electronic devices and computer programs, the occupational therapist helped train patients to find new ways to achieve the tasks patients had ranked as both important and difficult.

"For example, if a patient had difficulty reading his or her mail, the therapist would use a magnification device to train and practice with the patient until he or she could successfully read the mail," says Deemer.

The supportive therapy group acted as a control group for comparison. These patients met with a social worker for six one-hour sessions of talk therapy, which emphasized personal expression about loss and disability. In essence, the researchers say, this group got attention and empathetic support but not specific occupational therapy directed to improve their ability to function.

Four months after treatment, the researchers followed up with the patients in the study. Before treatment, the occupational therapy group's average PHQ-9 score was 5.5, and the supportive therapy group's average score was 5.6, placing both groups at the borderline of having a depressive disorder. After re-administering the questionnaire after treatment, the researchers found that the occupational therapy patient group's average score decreased to 4.62 and the supportive therapy's score decreased to 4.54.

At this follow-up, the researchers found that 26 percent of the supportive therapy patients reported that their depression symptoms worsened, while only 12 percent of the occupational therapy patients reported worsening symptoms. In total, these data show that while both forms of therapy decreased depression in patients, the group that received occupational therapy reduced its risk of depression by much more.

Comprehensive low vision rehabilitative services typically incorporate specialized care from an optometrist and other rehabilitation therapists, including occupational therapists. Because the VITAL study was not originally designed to distinguish the differences among these particular low-vision rehabilitation services, Deemer says one limitation of her findings is the researchers were unable to measure visual function improvements from occupational therapy services alone. Rather, the effects on visual function seen here are the result of comprehensive low vision rehabilitative care, including services given by both the optometrist and the occupational therapist.

Deemer says the costs associated with occupational therapy are often covered by Medicare, but such services appear to be underutilized.

"Many caregivers and patients may not realize how prevalent is among people with low vision, and our duty as health care providers is to raise awareness of the problem and the availability of help," says Deemer. "It is good practice not only to refer low vision patients to a mental health expert, but to also suggest low vision rehabilitation and occupational therapy, which could have a huge impact on our patients' lives."

Explore further: Assessing the impact of stress in age-related macular degeneration

Related Stories

Assessing the impact of stress in age-related macular degeneration

March 3, 2017
Age-related macular degeneration (AMD), the leading cause of vision loss among older adults in the United States, is often associated with psychological stress. A simple stress rating scale (the Perceived Stress Scale) is ...

Occupational therapy reduces hospital readmissions

September 15, 2016
An independent study published in Medical Care Research and Review found that "occupational therapy is the only spending category where additional hospital spending has a statistically significant association with lower readmission ...

Rehabilitation helps prevent depression from age-related vision loss

July 9, 2014
Depression is a common risk for people who have lost their vision from age-related macular degeneration (AMD), but a new study shows that a type of rehabilitation therapy can cut this risk in half. The study was funded by ...

Physical therapy proves as effective as surgery for carpal tunnel syndrome

March 2, 2017
Physical therapy is as effective as surgery in treating carpal tunnel syndrome, according to a new study published in the March 2017 issue of the Journal of Orthopaedic & Sports Physical Therapy (JOSPT).

Occupational therapy may have the potential to slow down functional decline and reduce behavioral troubles

December 22, 2016
A French observational study in real life showed that dementia patients benefiting from occupational therapy sessions report relevant clinical benefits over the intervention period, according to a research study published ...

Acute rehabilitation services for trauma patients improve outcomes after hospital discharge

November 1, 2016
As more trauma patients survive their initial hospital stays, new study results show that acute inpatient rehabilitation facilities are the best places for some of these patients to go once they leave the hospital. Yet, the ...

Recommended for you

Researchers identify key compounds to resolve abnormal vascular growth in AMD

August 21, 2017
A compound of specific bioactive products from a major family of enzymes reduced the severity of age-related macular degeneration (AMD) in a preclinical model, according to a new study led by Massachusetts Eye and Ear researchers. ...

World's blind population to soar: study

August 3, 2017
The world's blind will increase threefold from about 36 million today to 115 million in 2050 as populations expand and individuals grow ever older, researchers said Thursday.

Simulations signal early success for fractal-based retinal implants

July 27, 2017
Computer simulations of electrical charges sent to retinal implants based on fractal geometry have University of Oregon researchers moving forward with their eyes focused on biological testing.

Scientists regenerate retinal cells in mice

July 26, 2017
Scientists have successfully regenerated cells in the retina of adult mice at the University of Washington School of Medicine in Seattle.

Genome editing with CRISPR-Cas9 prevents angiogenesis of the retina

July 24, 2017
A research team from the Schepens Eye Research Institute of Massachusetts Eye and Ear has successfully prevented mice from developing angiogenesis of the retina—the sensory tissue at the back of the eye—using gene-editing ...

Too little vitamin D may hinder recovery of injured corneas

July 24, 2017
Injury or disease in combination with too little vitamin D can be bad for the window to your eyes.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.