E-nergEYEze: A vision-specific E-health intervention based on cognitive behavioral therapy and self-management to reduce severe fatigue in adults with visual impairment

The overall aim of this thesis was to address severe fatigue in individuals with visual impairment (VI) with a blended, vision-specific E-health intervention based on cognitive behavioral therapy ((i)CBT) and self-management (iSM). The development of the E-nergEYEze intervention was conducted with stakeholders in the field of low vision, chronic fatigue and E-health (chapter 3). A usability and feasibility study were carried out to optimize accessibility of the E-nergEYEze intervention based on user needs and to test fidelity and potential effectiveness (chapter 3). After the pilot study showed a positive trend in fatigue reduction and adequate fidelity to the study protocol, more extensive research was required to demonstrate ffectiveness and costeffectiveness. Therefore, we conducted a randomized controlled trial (RCT) to investigate the effectiveness of the E-nergEYEze intervention compared to care as usual in combination with an economic evaluation to support policymakers in making an implementation decision (chapter 5). User-experiences of patients, who followed the E-nergEYEze intervention, and of professionals, who provided guidance supporting these patients, were reported. A process evaluation with quantitative and qualitative data was outlined, with a focus on areas for improvement from a user perspective and an identification of patients who would be suitable to follow the E-nergEYEze intervention in future practice (chapter 4). Subsequently, the working mechanisms of the E-nergEYEze intervention on the fatigue-reducing effect were examined, with a focus on cognitive and behavioral factors as potential mediators (chapter 6). Since a ‘high cognitive load’ was reported to be a major cause of fatigue in individuals with VI, we performed an additional study on the association between concentration problems and severity of fatigue in individuals with VI (chapter 7), as a contribution to knowledge on the topic of cognitive overload.1This chapter provides a summary and general discussion of the E-nergEYEze intervention and the main findings of the E-nergEYEze trial. The relevance of our outcomes are outlined for (inter)national researchers, individuals with VI, healthcare professionals, low vision service (LVS) organizations and policy makers.