Virtual Health Education vs Meditation in Irreversible Age-Related Vision Loss Patients and Their Caregivers

Virtual Health Education vs Meditation in Irreversible Age-Related Vision Loss Patients and Their Caregivers: A Pilot Randomized Controlled Trial

Vision loss is common among older adults and leads to an increased risk for depression and difficulties in daily tasks, thus requiring dependence on caregivers. This study will assess the feasibility of providing two virtual interventions, Sahaj Samadhi Meditation (SSM) and Health Enhancement Program (HEP), to supplement care of patients with irreversible age-related vision loss (IARVL) and their caregivers, with the goal of enhancing mental health and quality of life.

Study Overview

• Status: Withdrawn
• Conditions: Depression; Quality of Life; Sleep; Anxiety; Caregiver Burnout; Vision; Disorder, Loss
• Intervention / Treatment: Behavioral: Sahaj Samadhi Meditation; Behavioral: Health Enhancement Program

Detailed Description

Through a high-quality, single-blind, three-arm mixed-method pilot feasibility study using randomized treatment assignment, the study team will assess two new innovative interventions, Sahaj Samadhi Meditation (SSM) and Health Enhancement Program (HEP), both delivered virtually, to augment clinical care of patients with irreversible age-related vision loss (IARVL), with the goal of enhancing mental health and quality of life (QOL) for patients and/or their caregivers. Participants will be blinded to the treatment hypothesis, while investigators and treating clinicians will be additionally blinded to the intervention. Both SSM and HEP will be taught over 4 consecutive days in similar sized groups (10 patients and/or their 10 caregivers) followed by weekly reinforcement sessions for subsequent 11 weeks. Self-rated questionnaires will be used to collect data on quality of life and mental health symptoms at 0-week and 12-week follow-up

• Study Type: Interventional
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 83 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Patients diagnosed with irreversible age-related vision loss (IARVL) by an experienced ophthalmologist and/or their caregivers.
2. IARVL patients between the age range of 60 to 85 years, while caregivers between the age range of 18 to 85 years.
3. Be able to provide valid informed consent to participate in the research study.
4. Being able to speak as well as understand English without the requirement for interpretation or other communication assistance.
5. Having no significant self-reported or a physician-diagnosed mental health disorder other than depressive and/or anxiety symptoms.
6. Should reach a minimal threshold of depressive and/or anxiety symptoms as confirmed by either a minimum of Centre for Epidemiologic Studies - Depression (CES-D) 20-item scale score of 16 OR a minimum of 8 on the Hospital Anxiety and Depression Scale - Anxiety subscale (HADS-A).
7. Have sufficient hearing to be able to follow verbal instructions
8. Have the ability to sit independently without physical discomfort for 30 minutes.
9. Willing and able to attend virtual intervention via Cisco WebEx software, the four initial training sessions of SSM or HEP and at least 6 out of 11 weekly follow-up sessions.
10. Willing to dedicate 20 minutes twice per day six days per week to their assigned home practice.

Exclusion Criteria:

1. Inability to provide a valid informed consent.
2. Having an underlying major neurocognitive disorder as suggested by a Montreal Cognitive Assessment (MoCA) score < 21.
3. Having significant suicidal ideation as per self-report (CES-D = 3 on item question 14 and/or 15).
4. Having severe depression as confirmed by a CES-D ≥ 24.
5. Participating in other similar studies.
6. Having a lifetime diagnosis of self-reported other serious mental disorders, including bipolar I or II disorder, primary psychotic disorder (schizophrenia, schizoaffective disorder, schizophreniform disorder, delusional disorder).
7. Self-reported substance abuse or dependence within the past 3 months.
8. Having an acutely unstable medical illnesses, including delirium or acute cerebrovascular or cardiovascular events within the last 6 months.
9. Having a terminal medical diagnosis with prognosis of less than 12 months.
10. Having any planned changes to mood-altering medications at the time of enrollment for the next 12 weeks.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Sahaj Samadhi Meditation; Participants randomized to the Sahaj Samadhi Meditation (SSM) arm will undergo SSM training in groups of 10. SSM will be delivered virtually using the Cisco WebEx platform by trained, certified non-clinician teachers. Participants will be trained for 4 consecutive days (2 hours/day) in the first week, followed by 1-hour weekly reinforcement sessions for 11 weeks. Participants will also be encouraged to practice twice daily at home for 20 minutes per session. They will be given a daily practice log on which they check off a box indicating if they have done their home practice.	Behavioral: Sahaj Samadhi Meditation; Sahaj Samadhi Meditation (SSM) is a form of automatic self-transcending meditation that involves relaxed attention to a precise sound (mantra), to allow stress reduction and deep relaxation. This technique is easy to learn and offers the support of a group and facilitator.; Other Names: SSM
Active Comparator: Health Enhancement Program; Participants randomized to the Health Enhancement Program (HEP) arm will undergo HEP training in groups of 10. HEP will be delivered virtually using the Cisco WebEx platform by trained non-clinician teachers. Participants will be trained for 4 consecutive days (2 hours/day) in the first week, followed by 1-hour weekly reinforcement sessions for 11 weeks. Participants will also be encouraged to practice twice daily at home for 20 minutes per session. They will be given a daily practice log on which they check off a box indicating if they have done their home practice.	Behavioral: Health Enhancement Program; The Health Enhancement Program (HEP) is a standardized program used to teach participants about health promotion, including the benefits of a lifestyle of healthy diet, music, recreation, and exercise. In HEP, participants get the support of a group and facilitator, and talk through and try to implement positive health-enhancing life changes.; Other Names: HEP
No Intervention: Treatment as Usual; Participants randomized to the Treatment as Usual (TAU) arm will continue to receive their treatment as usual. The usual standard of care for irreversible age-related vision patients includes no active treatment since eye surgeons have done all that could possibly be done to restore vision.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Potential Participants Approached Per Month	The number of potential participants approached per month will be calculated as a feasibility measure.	1 year
Number of Participants who are Successfully Screened	The number of participants who are successfully screened will be calculated as a feasibility measure.	1 year
Proportion of Successfully Screened in Participants who Enroll	The proportion of successfully screened in participants who enroll in the study will be calculated as a feasibility measure.	1 year
Rate of Retention	The rate of retention of participants in the study will be calculated as a feasibility measure.	1 year
Rate of Adherence to Study Protocol	At the end of the study any deviations from the protocol will be examined to determine the rate of adherence to the study protocol. This information will be calculated as a feasibility measure.	1 year
Proportion of Planned Ratings that are Completed	The proportion of completed planned ratings will be calculated as a feasibility measure.	1 year
Intervention Cost Per Case	The cost per participant of attending the SSM program will be calculated as a feasibility measure.	1 year
Percentage of Time Trade-Off (TTO) Questionnaires Completed	The percentage of TTO questionnaires completed by each participant will be examined at the end of the study to assess the completeness of the data as a feasibility measure.	1 year
Percentage of Visual Function Index (VF-14) Questionnaires Completed	The percentage of VF-14 questionnaires completed by each participant will be examined at the end of the study to assess the completeness of the data as a feasibility measure.	1 year
Percentage of Center for Epidemiologic Studies - Depression (CES-D) Questionnaires Completed	The percentage of CES-D questionnaires completed by each participant will be examined at the end of the study to assess the completeness of the data as a feasibility measure.	1 year
Percentage of Hospital Anxiety and Depression Scale - Anxiety (HADS-A) Questionnaires Completed	The percentage of HADS-A questionnaires completed by each participant will be examined at the end of the study to assess the completeness of the data as a feasibility measure.	1 year
Percentage of Pittsburgh Sleep Quality Index (PSQI) Questionnaires Completed	The percentage of PSQI questionnaires completed by each participant will be examined at the end of the study to assess the completeness of the data as a feasibility measure.	1 year
Percentage of Community Integration Questionnaire (CIQ) Questionnaires Completed	The percentage of CIQ questionnaires completed by each participant will be examined at the end of the study to assess the completeness of the data as a feasibility measure.	1 year
Percentage of Connor-Davidson Resilience Scale (CD-RISC) Questionnaires Completed	The percentage of CD-RISC questionnaires completed by each participant will be examined at the end of the study to assess the completeness of the data as a feasibility measure.	1 year
Percentage of Zarit Burden Interview (ZBI) Questionnaires Completed	The percentage of ZBI questionnaires completed by each participant will be examined at the end of the study to assess the completeness of the data as a feasibility measure.	1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Health-Related Quality of Life Score	Change in Health-Related Quality of Life (HRQOL) score as measured by the Time Trade-Off questionnaire (TTO) over a 12-week follow-up. TTO scores range between 0 and 1, with higher scores indicating a higher quality of life.	Weeks 0 and 12
Change in Vision-Related Quality of Life Score	Change in Vision-Related Quality of Life (VRQOL) score as measured by the Visual Function Index questionnaire (VF-14) over a 12-week follow-up. VF-14 scores range from 0 to 100, with higher scores representing a greater VRQOL.	Weeks 0 and 12
Change in Depressive Symptoms	Change in depressive symptoms as measured by change in Center for Epidemiologic Studies - Depression (CES-D) scores over a 12-week follow-up. The possible range of CES-D scores is 0 to 60, with the higher scores indicating the presence of more depressive symptomatology.	Weeks 0 and 12
Change in Anxiety Symptoms	Change in anxiety symptoms as measured by change in Hospital Anxiety and Depression Scale - Anxiety (HADS-A) scores over a 12-week follow-up. Total scores on the HADS-A range from 0 to 21. Higher scores represent higher levels of psychological distress.	Weeks 0 and 12
Change in Sleep Quality: Pittsburgh Sleep Quality Index (PSQI)	Change in sleep quality as measured by change in Pittsburgh Sleep Quality Index (PSQI) scores over a 12-week follow-up. PSQI scores range from 0 to 21. Higher PSQI scores indicate worse sleep quality.	Weeks 0 and 12
Change in Community Integration	Change in community integration as measured by change in Community Integration Questionnaire (CIQ) scores over a 12-week follow-up. The overall score for the CIQ ranges from 0 to 29. Higher CIQ score represents greater integration.	Weeks 0 and 12
Change in Resilience	Change in resilience as measured by change in Connor-Davidson Resilience Scale (CD-RISC) scores over a 12-week follow-up. Total scores for the CD-RISC range from 0 to 40, with higher scores representing greater resilience.	Weeks 0 and 12
Change in Caregiver Burden	Change in caregiver burden as measured by change in Zarit Burden Interview (ZBI) scores over a 12-week follow-up. Total scores for the ZBI range from 0 to 88. Higher scores represent a more severe self-perceived burden of caregiving.	Weeks 0 and 12

Collaborators and Investigators

• Sponsor: Lawson Health Research Institute
• Collaborators: The Art of Living Foundation
• Investigators: Principal Investigator: Akshya Vasudev, MD, London Health Sciences Centre; Principal Investigator: Cindy Hutnik, MD, PhD, St. Joseph's Healthcare London

Study record dates

Study Major Dates

• Study Start (Anticipated): April 1, 2022
• Primary Completion (Actual): April 9, 2022
• Study Completion (Actual): April 9, 2022

Study Registration Dates

• First Submitted: September 21, 2020
• First Submitted That Met QC Criteria: October 6, 2020
• First Posted (Actual): October 12, 2020

Study Record Updates

• Last Update Posted (Actual): April 18, 2022
• Last Update Submitted That Met QC Criteria: April 10, 2022
• Last Verified: April 1, 2022

More Information

Terms related to this study

• Keywords: Depression; Mental Health; Quality of Life; Anxiety; Caregiver Burden; Sleep Quality; Caregivers; Virtual; Resilience; Community Integration; Irreversible Age-Related Vision Loss; Sahaj Samadhi Meditation; Health Enhancement Program
• Additional Relevant MeSH Terms: Behavioral Symptoms; Stress, Psychological; Depression; Caregiver Burden
• Other Study ID Numbers: 4860

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No