Evaluation of the Amblyopia tracker app.

PURPOSE: The Amblyopia tracker app has been developed to be a tool for parents to monitor changes in vision at home during amblyopia treatment. The aims of this study were to evaluate the feasibility and repeatability of parents testing their children at home and to compare home test results to an assessment in clinic by an orthoptist. METHODS: Children (age < 18 years) with amblyopia (interocular acuity difference of ≥ 0.2logMAR) were recruited. Parents were asked to test their child with the app three times during a two week period followed by an online questionnaire about the usability. Participants also tested within 48 h of their appointment where the measurement was repeated by an orthoptist. RESULTS: Out of 277 potential participants contacted, 37 completed three home measurements, mean age 6.8 years (SD 2.94). Home tests comparisons were made between test two and three to ensure familiarity with the process. Paired t-tests showed no statistically significant difference for either eye or the interocular acuity difference (IAD). However, 29% had a difference in IAD of more than 0.1logMAR on repeated testing, with a maximum of 0.4logMAR difference in the IAD. Questionnaire responses from the parents who participated were predominantly positive with 97% of respondents saying they would use it if were available. Comparison of home and clinical measurements (n = 23, mean age 6.72 SD 2.60) showed no statistically significant differences for either eye or interocular acuity difference (paired t-test, p > 0.3 in all cases). CONCLUSION: Results show no statistically significant differences for the Amblyopia tracker app when used by parents at home on repeated testing, or between the home test by a parent and the test by a clinician. However, variability in the results does indicate that further improvements are required to ensure the results can be used as a reliable clinical tool.

Evaluation of a New Method to Track Changes in Vision at Home for Children Undergoing Amblyopia Treatment.

PURPOSE: A new amblyopia tracker app has been designed to provide parents with a method of monitoring a child's vision by presenting a single optotype size that the tester moves to identify the furthest distance the optotypes can be seen. The aim of this study is to evaluate this methodology in adults, comparing the findings to visual acuity (VA) measured with the iSight app and to determine the test retest variability. METHODS: Adults, aged 18-39 years, with no known eye condition and VA ≤ 0.7 logMAR were recruited. Bangerter filters were used to simulate amblyopia, where VA was reduced below 0.0 with an interocular difference of at least 0.2 logMAR. Testing for both apps was performed monocularly, with the test order being randomised. RESULTS: Data from 32 subjects were analysed. For the test retest variability analysis, paired t-tests showed no statistically significant difference between the tests for either eye, either app or the interocular acuity difference (p > 0.3 in all cases). Bland Altman plots showed similar limits of agreement between the two apps. When comparing measurements between the apps there was no statistically significant difference on the first or second test, either eye or the interocular acuity difference (p > 0.5 in all cases). CONCLUSION: The results support the theory that changing distance is a valid method of assessing VA as the measurements agree well with the standard approach of reducing optotype size. Test retest variability is similar between the two apps and there is good agreement between the measurements.

A community-based exercise and education scheme for stroke survivors: a randomized controlled trial and economic evaluation.

OBJECTIVE: The evaluation of a community-based exercise and education scheme for stroke survivors. DESIGN: A single blind parallel group randomized controlled trial. SETTING: Leisure and community centres in the south-west of England. SUBJECTS: Stroke survivors (median (IQR) time post stroke 10.3 (5.4-17.1) months). 243 participants were randomized to standard care (124) or the intervention (119). INTERVENTION: Exercise and education schemes held twice weekly for eight weeks, facilitated by volunteers and qualified exercise instructors (supported by a physiotherapist), each with nine participants plus carers or family members. METHOD: Participants were assessed by a blinded independent assessor at two weeks before the start of the scheme, nine weeks and six months. One-year follow-up was by postal assessment. PRIMARY OUTCOMES: Subjective Index of Physical and Social Outcome (SIPSO); Frenchay Activities Index; Rivermead Mobility Index. NHS, social care and personal costs. Secondary outcomes included WHOQoL-Bref. ANALYSIS: Intention-to-treat basis, using non-parametric analysis to investigate change from baseline. Economic costs were compared in a cost-consequences analysis. RESULTS: There were significant between-group changes in SIPSO physical at nine weeks (median (95% confidence interval (CI)), 1 (0, 2): P = 0.022) and at one year (0 (-1, 2): P = 0.024). (WHOQol-Bref psychological (6.2 (-0.1, 9.1): P = 0.011) at six months. Mean cost per patient was higher in the intervention group. The difference, excluding inpatient care, was pound296 (95% CI: - pound321 to pound913). CONCLUSION: The community scheme for stroke survivors was a low-cost intervention successful in improving physical integration, maintained at one year, when compared with standard care.

'ALSPAC' infant morbidity and Council Tax Band: doctor consultations are higher in lower bands.

BACKGROUND: The discrepancy between the occurrence of disease and the risk of consulting a doctor is well known, but whether or not it is socially governed is uncertain and could have important implications for primary care manpower and resource allocation. The aim of the study was to investigate whether (i) reported occurrence of common symptoms in infancy and (ii) consulting rates for those symptoms, are associated with socio-economic status as marked by Council Tax Valuation Band (CTVB). METHODS: Compound cross-sectional analysis of data was obtained from sequential parental questionnaires. Data were taken from Avon Longitudinal Study of Parents and Children of over 14,000 responders from Avon county since 1991. Comparative analyses by CTVB and other covariables were carried out. RESULTS: Final study group of nearly 10 000: diarrhoea, wheeze and accidental injuries moderately associated with CTVB but consulting behaviour for all morbidity bar earache strongly associated with CTVB, the lower the band the higher the clinical burden. CONCLUSION: The children from more modest homes are more likely to be taken to a doctor for everyday symptoms: for infant morbidity, the lower the CTVB of home address, the higher the clinical burden for UK general practices.

Mortality in psoriatic arthritis - a single-center study from the UK.

OBJECTIVE: To determine whether the mortality in a cohort of patients with psoriatic arthritis (PsA) from a single center in the UK is significantly different from the general UK population. METHODS: Patients who were entered onto the PsA database at the Royal National Hospital for Rheumatic Diseases, Bath, between 1985 and 2007 were included in this study. Information on patient deaths was collected retrospectively. The National Health Service (NHS) Strategic Tracing Service was used to establish which patients were alive and which had died. Date and cause of death were confirmed by death certificates from the Registry of Births, Marriages and Deaths. A standardized mortality ratio (SMR) was calculated by matching the patient data to single-year, 5-year age-banded England and Wales data from the Office of National Statistics. RESULTS: In this cohort of 453 patients with PsA (232 men, 221 women), there were 37 deaths. Sixteen men and 21 women died. The SMR for the men was 67.87% (95% CI 38.79, 110.22), and for the women, 97.01% (95% CI 60.05, 148.92) and the overall SMR for the PsA cohort was 81.82% (95% CI 57.61, 112.78). The leading causes of death in this cohort were cardiovascular disease (38%), diseases of the respiratory system (27%), and malignancy (14%). CONCLUSION: These results suggest that mortality in our single-center PsA cohort is not significantly different from the general UK population. No increased risk of death was observed in this cohort.