You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Age-related macular degeneration: A randomized clinical trial of a self-management intervention
Abstract 1:
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


Title 2:
Preventing late-life depression in age-related macular degeneration.
Abstract 2:
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


Title 3:
How effective is an integrated approach to low vision rehabilitation? Two year follow up results from south Devon.
Abstract 3:
AIMS --A survey was undertaken to assess the effectiveness of an integrated approach to the provision of  low visual aids ( LVAs ) in south Devon over a 2 year follow up period . This integrated approach includes the assessment of patient needs by low vision therapists , followed by the provision of suitable LVAs , with particular emphasis on training in their use . METHODS --A total of 125 patients were selected at r and om from the 445 patients seen in the low vision clinic at Torbay Hospital in the year 1991 . These patients were sent question naires relating to the service over a 2 year period . Question naires from 111 patients were analysed at 1 year and 75 question naires together with 46 clinical re assessment s , after 2 years . RESULTS --Using a similar question naire to one used in a previous study in the UK from a unit where LVA training was not provided , not only was a higher rate of satisfaction found with the services provided , but also the LVAs dispensed were used more frequently . The majority of the LVAs provided were of the simple , inexpensive variety and wastage was very low . CONCLUSIONS --It was concluded that this integrated approach to low vision rehabilitation with emphasis on training in the use of less complex LVAs exceeds the performance of other types of service that rely on the dispensing of more complex LVAs


Title 4:
Enhanced low vision rehabilitation for people with age related macular degeneration: a randomised controlled trial
Abstract 4:
Aim : To compare the effectiveness of three models of low vision rehabilitation for people with age related macular degeneration ( AMD ) referred for low vision rehabilitation ( LVR ) : ( a ) an enhanced low vision rehabilitation model ( ELVR ) including supplementary home based low vision rehabilitation ; ( b ) conventional low vision rehabilitation ( CLVR ) based in a hospital clinic ; ( c ) CLVR with home visits that did not include rehabilitation ( CELVR ) , intended to act as a control for the additional contact time with ELVR . Method : A single centre parallel group r and omised controlled trial in participants ’ homes and the low vision clinic , Manchester Royal Eye Hospital . People referred for LVR with a primary diagnosis of AMD and visual acuity worse than 6/18 in both eyes and equal to or better than 1/60 in the better eye . The main outcome measures were vision specific quality of life ( QoL ) ( primary outcome , VCM1 ) and generic health related QoL ( SF-36 ) ; psychological adjustment to vision loss ; measured task performance ; restriction in everyday activities ; use of low vision aids ( LVAs ) . Results : 226 participants were recruited ( median age 82 years ) ; 194 completed the trial ( 86 % ) . Except for SF-36 physical and mental component summary scores , arms did not differ significantly for any of the outcomes . Differences for the VCM1 were ELVR v CLVR , 0.06 ( 95 % CI to 0.17 to 0.30 , p = 0.60 ) ; ELVR v CELVR , 0.12 ( 95 % CI to 0.11 to 0.34 , p = 0.31 ) ; CELVR v CLVR , –0.05 ( 95 % CI –0.29 to 0.18 , p = 0.64 ) . Differences for the SF-36 favoured CLVR compared to ELVR ( ELVR v CLVR : physical = –6.05 , 95 % CI –10.2 to –1.91 , p = 0.004 ; mental = –4.04 , 95 % CI –7.44 to –0.65 , p = 0.02 ) . At 12 months , 94 % of participants reported using at least one LVA . Conclusion : ELVR was no more effective than CLVR . Research ers should be wary of proposing new LVR interventions without preliminary evidence of effectiveness , given the manifest lack of effectiveness of the model of enhanced LVR evaluated in the trial


Title 5:
Evaluating the effectiveness of a vision rehabilitation intervention using an objective and subjective measure of functional performance
Abstract 5:
PURPOSE : To test the hypothesis that vision rehabilitation using optometry , occupational therapy and social work services increases patients ' functional ability and to assess whether involving families in the intervention results in more successful outcomes . METHODS : We conducted an outcome study of 97 patients new to the Vision Rehabilitation Service . Subjects were between the ages of 19 and 91 years , with a median age of 76 . Their visual acuities were 20/100 or worse in the better eye , with 50 % of the subjects having acuities worse than 20/200 . Macular degeneration was the most prevalent diagnosis . Subjects were assigned to either an individually focused ( n=48 ) or a family focused ( n=49 ) intervention . The outcome measure was change in function , as assessed by speed and accuracy of performance ( objective measure ) and by the patients ' self-reports of difficulty and dependency in performing daily activities ( subjective measures ) . Data were collected before and after the intervention . RESULTS : Most patients had documented improvement after rehabilita-tion on both objective ( p=.0001 ) and subjective ( decreased dependency , p=.01 ) measures of function . The sample size did not provide adequate statistical power to show differences between family focused and individually focused interventions . CONCLUSIONS : This study documents significant improvement after vision rehabilitation for a predominately elderly population . Patients in both family and individually focused interventions improved comparably


Title 6:
Participation in daily activities and social roles of older adults with visual impairment
Abstract 6:
Purpose . ( 1 ) to document participation in daily activities and social roles of older adults seeking services for visual impairment ( VI ) and compare it with that of the older population without VI or other disabilities , and ( 2 ) to explore correlates of their participation . Methods . The 64 participants ( 46 women ) had an average age of 79.3 years ( SD = 5.9 years ) and presented various types of VI . Participants were interviewed at home to collect information regarding their visual function ( National Eye Institute Visual Function Question naire-25 ) , sociodemographic and clinical characteristics , including depressive symptoms ( Geriatric Depression Scale ) , and participation ( Assessment of Life Habits/LIFE-H ) . Each participant was matched with another person without disabilities r and omly recruited from the community . Results for the two population s on the Life-H participation domains were compared using t-tests . In the group with VI , general information ( independent variables ) was examined in relation to participation main scores ( dependent variables ) , followed by multiple linear regression analyses . Results . Participation in daily activities and social roles of participants with VI ( mean ± SD ( /9 ) = 6.8 ± 1.0 and 5.6 ± 1.6 , respectively ) was significantly lower than that of participants without VI ( 8.1 ± 0.4 and 8.3 ± 0.4 ) ( p < 0.0001 ) . Depressive symptoms and perceived quality of distance vision were the strongest correlates and together explained more than 65 % of the variance in the participation scores of the subjects with VI . Conclusions . This study demonstrates the participation restrictions associated with VI and underlines the importance of psychological aspects in participation


Title 7:
Quality of light and quality of life--the effect of lighting adaptation among people with low vision.
Abstract 7:
PURPOSE The study has investigated the effect of lighting on the daily activities ( ADL ) of the visually impaired in their homes by comparison before and after light adjustments were made in the kitchen , hall and bathroom . It has also investigated the additional effects on the quality of life after providing task lighting in the living room . METHOD A total of 56 people were consecutively recruited from those receiving lighting adaptation help by the Low Vision Clinic in Göteborg . Ten persons did not complete the study . After medical examinations , lighting st and ards and psychosocial factors were charted . After lighting improvements were carried out in the kitchen , hall and bathroom , the subjects were r and omly divided into two groups , an intervention and a comparison group . The task lighting in the living room was also improved for those included in the intervention group . Follow-up interviews to determine ADL and quality of life were performed 6 months after lighting adaptation . RESULTS A marked effect on quality of life of the lighting in the living room was found for the intervention group . The effect on ADL of the basic lighting adaptation in kitchen , hall and bathroom for both groups was significant for tasks carried out on the working surface in the kitchen . Other activities in the kitchen and in the bathroom tended to improve but changes were not significant . CONCLUSION The results confirm that it is possible to increase quality of life by improving the lighting conditions


Title 8:
A health education program for elderly persons with visual impairments and perceived security in the performance of daily occupations: a randomized study.
Abstract 8:
OBJECTIVE The purpose of this r and omized , longitudinal study was to investigate the impact of a health education program on perceived security in the performance of daily occupations 4 months after the intervention period . METHOD Two groups of persons with age-related macular degeneration were compared : Those who had followed a newly developed health education program that was based on occupation and those who took part in a st and ard individual intervention program .  RESULTS Significant differences in the level of perceived security between the groups were found for 13 of 28 occupations . Participants in the health education group maintained or improved their level of perceived security in 22 daily occupations , whereas those in the individual intervention group declined to a lower level in 17 daily occupations . CONCLUSION This study provides support for the effectiveness of the health education program to enhance security and hinder a progressive decline in perceived security in daily occupations
The strongest evidence supports using a problem-solving approach to improve leisure and social participation for older adults with low vision .
Evidence was moderate supporting the delivery of a combination of services , either by one professional or through an interdisciplinary approach .