Characterizing Functional Complaints in Patients Seeking Outpatient Low-Vision Services in the United States
Characterizing Functional Complaints in Patients Seeking Outpatient Low-Vision Services in the United States
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DOI：
10.1016/j.ophtha.2014.02.030
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发表时间：
2014-08-01
期刊：
影响因子：
13.7
通讯作者：
Ramulu, Pradeep
中科院分区：
文献类型：
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作者：
Brown, Jamie C.;Goldstein, Judith E.;Ramulu, Pradeep
目的：了解新发低视力康复患者的功能主诉。设计：前瞻性观察研究。参与者：低视力康复结果研究在2008年至2011年间从美国28个临床中心招募了819名患者。方法：首次接受低视力康复治疗的患者在就诊前被询问：“您视力方面的主要抱怨是什么？”完整的患者陈述被转录为自由文本。两种方法评估陈述是否在13个功能类别中表明困难：(1)由2名蒙面临床医生阅读陈述进行评估，(2)对文本进行特定单词或单词片段的计算机搜索。使用逻辑回归模型来预测年龄、性别和视力对每个功能类别报告投诉可能性的影响。主要结果测量：患者关注的各种功能类别的患病率和危险因素。结果：阅读是最常见的功能性主诉（66.4%）。至少10%的患者表达的其他功能困难包括驾驶（27.8%）、使用视觉辅助设备（17.5%）、行动（16.3%）、进行家庭活动（15.1%）、照明和眩光（11.7%）、面部识别和社交互动（10.3%）。蒙面临床医生评分者与功能性投诉分类的计算机算法之间存在良好的一致性（13个类别的中位数kappa为0.84）。多变量logistic回归模型显示，阅读困难的可能性随着年龄的增长而轻度增加（比值比为1.4 / 10岁；95%可信区间为1.3-1.6），但与视力没有差异（P = 0.09）。此外，男性更有可能报告驾驶困难和与照明有关的困难，而女性更有可能报告在家庭活动、面部识别或社交互动方面的困难
Purpose: To characterize functional complaints of new low-vision rehabilitation patients.Design: Prospective observational study.Participants: The Low Vision Rehabilitation Outcomes Study recruited 819 patients between 2008 and 2011 from 28 clinical centers in the United States.Methods: New patients referred for low-vision rehabilitation were asked, "What are your chief complaints about your vision?" before their appointment. Full patient statements were transcribed as free text. Two methods assessed whether statements indicated difficulty in each of 13 functional categories: (1) assessment by 2 masked clinicians reading the statement, and (2) a computerized search of the text for specific words or word fragments. Logistic regression models were used to predict the influence of age, gender, and visual acuity on the likelihood of reporting a complaint in each functional category.Main Outcome Measures: Prevalence and risk factors for patient concerns within various functional categories.Results: Reading was the most common functional complaint (66.4% of patients). Other functional difficulties expressed by at least 10% of patients included driving (27.8%), using visual assistive equipment (17.5%), mobility (16.3%), performing in-home activities (15.1%), lighting and glare (11.7%), and facial recognition and social interactions (10.3%). Good agreement was noted between the masked clinician graders and the computerized algorithm for categorization of functional complaints (median kappa of 0.84 across the 13 categories). Multivariate logistic regression models demonstrated that the likelihood of reading difficulties increased mildly with age (odds ratio, 1.4 per 10-year increment in age; 95% confidence interval, 1.3-1.6), but did not differ with visual acuity (P = 0.09). Additionally, men were more likely to report driving difficulties and difficulties related to lighting, whereas women were more likely to report difficulty with either in-home activities or facial recognition or social interaction (P