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Introduction <p>Diabetic retinopathy (DR) often causes vision loss and functional impairment. Standard low vision rehabilitation improves visual function but many patients cannot access it because of cost, travel, and limited specialist availability. We aimed to compare a home-based digital vision rehabilitation program to standard in-clinic rehabilitation in patients with DR.</p> Methods <p>We conducted a retrospective matched cohort study at a tertiary eye center in China. Adults with moderate to severe visual impairment from DR were included. A total of 380 patients were analyzed after 1:1 propensity score matching (190 per group). One group underwent a 12-week home-based digital physiotherapeutic vision training program delivered via a mobile app with daily exercises and weekly telehealth supervision, while the other group received standard in-person low vision rehabilitation over 12&#xa0;weeks. The primary outcome was change in visual functional status measured by the Veterans Affairs Low-Vision Visual Functioning Questionnaire-48 (VA LV VFQ-48). Secondary outcomes included visual acuity, vision-related quality of life, depressive symptoms, mobility, metabolic control, and cost. Outcomes were assessed at baseline, 12, 24, and 48&#xa0;weeks.</p> Results <p>Both the home-based digital training and standard in-clinic rehabilitation groups achieved substantial improvements in vision-specific functional status over 48&#xa0;weeks. VFQ-48 scores increased by 22–26 points in each group, indicating clinically meaningful gains, and the digital program’s improvement was comparable to standard care (demonstrating non-inferiority for the primary outcome). All secondary outcomes improved comparably in both groups, with no significant between-group differences. The digital intervention cost 7791 Chinese yuan (CNY) per patient over 48&#xa0;weeks compared to 10,305&#xa0;CNY with standard care, providing a net savings of 2514&#xa0;CNY per patient. Both approaches were well tolerated, with no major safety concerns.</p> Conclusions <p>Home-based digital rehabilitation was non-inferior to standard in-clinic rehabilitation in improving functional vision, while substantially reducing costs and maintaining safety. These findings support implementing home-based or hybrid telerehabilitation models to broaden access to vision rehabilitation services.</p> Level of Evidence <p>Level III retrospective cohort study.</p>

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Digital Physiotherapeutic Vision-Specific Training System for Patients with Diabetic Retinopathy: A Propensity Score-Matched Retrospective Cohort Study

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  • 出版模式：

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  • 发表日期：

    2025年11月29日

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  • Lisha Ni,
  • Qiuju Zhou,
  • Minghua Fan,
  • Zihui Liu,
  • Shengdi Lu,
  • Yun Shen

摘要

Introduction

Diabetic retinopathy (DR) often causes vision loss and functional impairment. Standard low vision rehabilitation improves visual function but many patients cannot access it because of cost, travel, and limited specialist availability. We aimed to compare a home-based digital vision rehabilitation program to standard in-clinic rehabilitation in patients with DR.

Methods

We conducted a retrospective matched cohort study at a tertiary eye center in China. Adults with moderate to severe visual impairment from DR were included. A total of 380 patients were analyzed after 1:1 propensity score matching (190 per group). One group underwent a 12-week home-based digital physiotherapeutic vision training program delivered via a mobile app with daily exercises and weekly telehealth supervision, while the other group received standard in-person low vision rehabilitation over 12 weeks. The primary outcome was change in visual functional status measured by the Veterans Affairs Low-Vision Visual Functioning Questionnaire-48 (VA LV VFQ-48). Secondary outcomes included visual acuity, vision-related quality of life, depressive symptoms, mobility, metabolic control, and cost. Outcomes were assessed at baseline, 12, 24, and 48 weeks.

Results

Both the home-based digital training and standard in-clinic rehabilitation groups achieved substantial improvements in vision-specific functional status over 48 weeks. VFQ-48 scores increased by 22–26 points in each group, indicating clinically meaningful gains, and the digital program’s improvement was comparable to standard care (demonstrating non-inferiority for the primary outcome). All secondary outcomes improved comparably in both groups, with no significant between-group differences. The digital intervention cost 7791 Chinese yuan (CNY) per patient over 48 weeks compared to 10,305 CNY with standard care, providing a net savings of 2514 CNY per patient. Both approaches were well tolerated, with no major safety concerns.

Conclusions

Home-based digital rehabilitation was non-inferior to standard in-clinic rehabilitation in improving functional vision, while substantially reducing costs and maintaining safety. These findings support implementing home-based or hybrid telerehabilitation models to broaden access to vision rehabilitation services.

Level of Evidence

Level III retrospective cohort study.