背景:严重疲劳是视力障碍患者的常见症状,对情绪功能有不利影响,认知,工作能力和日常生活活动。先前的一项研究发现,抑郁是疲劳的最重要决定因素之一,但对该患者人群中疾病特异性因素的了解较少。本研究旨在探讨低视力成人视力障碍严重程度与疲劳的关系。直接和间接,视特异性因素和抑郁作为潜在的中介。
方法:通过电话访谈收集了220名荷兰低视力服务患者的横断面数据。疲劳被定义为根据严重程度和对日常生活的影响的潜在变量。潜在的介质包括视觉相关症状,适应视力丧失和抑郁。在Mplus中构建了假设的结构方程模型,以测试(in)视觉障碍严重程度的直接影响(轻度/中度,严重,失明)通过上述变量对疲劳的影响。
结果:最终模型解释了60%的疲劳变化,并揭示了视觉障碍严重程度对疲劳的显着总影响。与轻度/中度视力障碍患者(β=-0.50,95%偏差校正置信区间[BCCI][-0.86,-0.16])和失明患者(β=-0.44,95%BCCI[-0.80,-0.07])相比,重度视力障碍患者(参照组)的疲劳症状明显更高。眼睛疲劳和光干扰,抑郁症和与视觉相关的移动性介导了重度和轻度/中度视觉障碍类别之间的疲劳差异。严重视力障碍和失明类别之间的疲劳差异仅由眼睛疲劳和光干扰来解释。此外,抑郁症状(β=0.65,p<0.001)和眼睛疲劳和光障碍(β=0.19,p=0.023)与疲劳直接相关,而与视觉障碍的严重程度无关。
结论:我们的研究结果表明,低视力患者的视觉障碍严重程度与疲劳之间存在倒U形关系。这种关系的复杂性可能是由视觉障碍的后果来解释的,特别是紧张的眼睛和抑郁的情绪,而不是残疾本身的严重程度。
BACKGROUND: Severe fatigue is a common symptom for people with visual impairment, with a detrimental effect on emotional functioning, cognition, work capacity and activities of daily living. A previous study found that depression was one of the most important determinants of fatigue, but less is known about disease-specific factors in this patient population. This study aimed to explore the association between visual impairment severity and fatigue in adults with low vision, both directly and indirectly, with vision-specific factors and depression as potential mediators.
METHODS: Cross-sectional data were collected from 220 Dutch low vision service patients by telephone interviews. Fatigue was defined as a latent variable by severity and impact on daily life. Potential mediators included vision-related symptoms, adaptation to vision loss and depression. Hypothesized structural equation models were constructed in Mplus to test (in)direct effects of visual impairment severity (mild/moderate, severe, blindness) on fatigue through above mentioned variables.
RESULTS: The final model explained 60% of fatigue variance and revealed a significant total effect of visual impairment severity on fatigue. Patients with severe visual impairment (reference group) had significantly higher fatigue symptoms compared to those with mild/moderate visual impairment (β = -0.50, 95% bias-corrected confidence interval [BC CI] [-0.86, -0.16]) and those with blindness (β = -0.44, 95% BC CI [-0.80, -0.07]). Eye strain & light disturbance, depression and vision-related mobility mediated the fatigue difference between the severe and mild/moderate visual impairment categories. The fatigue difference between the severe visual impairment and blindness categories was solely explained by eye strain & light disturbance. Moreover, depressive symptoms (β = 0.65, p < 0.001) and eye strain & light disturbance (β = 0.19, p = 0.023) were directly associated with fatigue independent of visual impairment severity.
CONCLUSIONS: Our findings indicate an inverted-U shaped relationship between visual impairment severity and fatigue in patients with low vision. The complexity of this relationship is likely explained by the consequences of visual impairment, in particular by strained eyes and depressive mood, rather than by severity of the disability itself.