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Approaches to Audiological Rehabilitation with Hearing Aids: studies on pre-fitting strategies and assessment of outcomes
Linköping University, Department of Clinical and Experimental Medicine, Technical Audiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Fourteen percent of the Swedish population report subjective hearing loss. The number of persons suffering from hearing loss is expected to increase in accordance with the increased length of the average life span, causing an associated increase in the demand for hearing health care services as new patient groups who expect a higher quality of life begin to request hearing care. The main goal of this thesis was to develop new approaches in audiological rehabilitation to meet these demands and achieve user satisfaction.

Two randomized controlled trials including 39 and 38 subjects, respectively were performed that evaluated two interventions, user-controlled adjustment and sound awareness training, which were performed prior to a hearing aid fitting. The new approaches focused on increasing user participation and activity. To evaluate the goals of audiological rehabilitation, e.g., reducing auditory impairment, optimizing auditory activities and minimizing participation restrictions, several standardized self-reporting instruments were used to assess activity limitations, participation restriction, satisfaction and psychosocial well-being. Several of the instruments were validated for a Swedish population in a postal survey including 162 subjects. Furthermore, an interview instrument that was appropriate for telephone interviews and a categorization rating scale were developed for assessing the global clinical impression of the audiological rehabilitation.

Few significant differences in outcomes were found between the treatment and control groups in the short term, and the interventions did not achieve additional or more successful hearing aid users in the long term. Thus, it was concluded that the hearing aid rehabilitation was effective in and of itself, as both the treatment and control groups showed significant improvements in psychosocial well-being and reduced activity limitation and participation restriction. The self-report instruments were found to be valid, and a factor analysis indicated that the number of questionnaires could be reduced with a recommendation for further clinical use. The telephone interviews evaluating the clinical global impression of the audiological rehabilitation were found to be effective and showed success in a vast majority of the users. Advantages such as simpler administration and less time consumption warrant their continued use in additional audiological settings.

The pre-interventions in these studies need to be further investigated before they could be recommended for clinical use also in a Swedish context. The international standardized self reports, however, can already be recommended for clinical use. A first attempt to evaluate global clinical impression by telephone interviews was found to be effective and further validations are suggested.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2008. , 86 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1074Studies from the Swedish Institute for Disability Research, ISSN 1650-1128 ; 27
National Category
Otorhinolaryngology
Identifiers
URN: urn:nbn:se:liu:diva-12528ISBN: 978-91-7393-828-0 (print)OAI: oai:DiVA.org:liu-12528DiVA: diva2:404
Public defence
2008-09-19, Elsa Brändströmsalen, Universitetssjukhuset, Campus US, Linköpings Universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2008-09-11 Created: 2008-09-11 Last updated: 2014-11-28Bibliographically approved
List of papers
1. Psychometric evaluation of hearing specific self-report measures and their associations with psychosocial and demographic variables
Open this publication in new window or tab >>Psychometric evaluation of hearing specific self-report measures and their associations with psychosocial and demographic variables
2007 (English)In: Audiological Medicine, ISSN 1651-386X, Vol. 5, no 3, 188-199 p.Article in journal (Refereed) Published
Abstract [en]

The main aim of this study was to collect descriptive data and to evaluate the psychometric properties of a range of self-report questionnaires in a Swedish population. Other aims were to investigate the correlations between these measures and the higher order factorial structure of the included questionnaires. One hundred and sixty-two first-time hearing aid users completed four standardized hearing specific questionnaires: the Hearing Handicap Inventory for the Elderly (HHIE); the Satisfaction with Amplification in Daily Life (SADL); the Communication Strategies Scale (CSS); and the International Outcome Inventory for Hearing Aids (IOI-HA). In addition, two psychosocial questionnaires were completed: the Sense of Coherence scale (SOC); and the Hospital Anxiety and Depression Scale (HADS). All measures were administered at one year post hearing aid fitting. Mean scores for the questionnaires were in agreement with previous studies. The questionnaires were found to be reliable and acceptable for further clinical use. Correlations were seen across different hearing specific questionnaires, and between hearing aid use and satisfaction. Psychosocial variables were more strongly associated with participation restriction and satisfaction than with the demographic variables, confirming the importance of subjective measures. The factor analysis extracted four factors: psychosocial well-being, hearing aid satisfaction, adaptive communications strategies, and residual participation restriction, and indicated that the number of questionnaires could be reduced. It is concluded that psychosocial factors are important to consider in hearing aid rehabilitation and their possible role should be further investigated in future studies.

Keyword
Hearing aids, satisfaction, participation restriction, sense of coherence
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:liu:diva-12456 (URN)10.1080/16513860701560214 (DOI)
Available from: 2008-09-05 Created: 2008-09-05 Last updated: 2014-11-28
2. The effects of a pre-fitting intervention on hearing aid benefit:a randomized controlled trial
Open this publication in new window or tab >>The effects of a pre-fitting intervention on hearing aid benefit:a randomized controlled trial
2009 (English)In: Audiological Medicine, ISSN 1651-386X, Vol. 7, no 4, 211-215 p.Article in journal (Other (popular science, discussion, etc.)) Published
Abstract [en]

Thirty-nine first time hearing aid users with mild to moderate hearing losses were randomly assigned to a pre-fitting intervention group (N=19) or a control group (N=20). The pre-fitting intervention consisted of three weekly visits, where the user adjusted the amplification of an experimental hearing aid to preferred settings, and wore the aid between the visits. After the pre-fitting intervention phase, both groups received conventional hearing aid fitting. Standardized questionnaires (IOI-HA, HHIE, ECHO, SADL, HADS) were administered before and after pre-fitting intervention, after conventional hearing aid fitting, and at one-year follow-up. Hearing aid success was evaluated by an independent audiologist at the one- year follow-up appointment. The pre-fitting intervention phase showed positive effects for the intervention group but not for the control group on activity limitation and participation restriction, and expectations. However, the intervention in its current version had no lasting effects beyond the control group after conventional hearing aid fitting or after a year. Furthermore, both groups showed mostly successful hearing aid fittings, improved psychosocial well-being, quality of life, and reduced participation restriction.

Keyword
Pre-fitting intervention, user-controlled adjustment, randomized clinical trial, independent evaluation, hearing aid benefit, hearing aid use, satisfaction, activity limitation, participation restriction, psychosocial well-being, counselling
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:liu:diva-12457 (URN)10.3109/16513860903309790 (DOI)
Available from: 2008-09-05 Created: 2008-09-05 Last updated: 2014-11-28Bibliographically approved
3. The effects of a sound awareness pre-fitting intervention: A randomized controlled trial
Open this publication in new window or tab >>The effects of a sound awareness pre-fitting intervention: A randomized controlled trial
2008 (English)In: Audiological Medicine, ISSN 1651-386X, E-ISSN 1651-3835, Vol. 6, no 6, 129-140 p.Article in journal (Refereed) Published
Abstract [en]

The objective of the study was to evaluate the effects of an individual pre-fitting intervention for first-time hearing aid users. Thirty-eight hearing impaired adults were randomly assigned to a sound awareness pre-fitting intervention (n=19) or to a control group (n=19). The purpose of the sound awareness training was to facilitate the users' acclimatization to amplified sound. The pre-fitting intervention consisted of three visits and was followed by conventional hearing aid fitting that was identical for both groups. Standardized questionnaires were administered before and after the pre-fitting intervention, after the conventional hearing aid fitting, and at a one-year follow-up. The follow-up also included a clinical assessment by means of a telephone interview performed by an independent audiologist. The pre-intervention did not result in any major improvement over and above the control group. However, improvements were found for both groups following hearing aid fitting. In addition, most participants were considered as successful users in the interview. Future research should target individuals in need of extended hearing aid rehabilitation.

Place, publisher, year, edition, pages
Taylor & Francis, 2008
Keyword
Hearing aids, participation restrictions, one-year follow-up
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:liu:diva-12455 (URN)10.1080/16513860802042062 (DOI)
Available from: 2008-09-11 Created: 2008-09-05 Last updated: 2015-10-23Bibliographically approved
4. Development and initial validation of the “Clinical Global Impression” to measure outcomes for audiological rehabilitation
Open this publication in new window or tab >>Development and initial validation of the “Clinical Global Impression” to measure outcomes for audiological rehabilitation
Show others...
2009 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, no 17, 1409-1417 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to develop and validate an interview instrument for assessing outcome following hearing aid fitting based on clinical global impressions.

Method: The Audiological Rehabilitation Clinical Global Impression (AR-CGI) was developed and used in a telephone interview in two separate samples. The first sample (N=69) consisted of hearing aid owners who had participated in two intervention studies and the second sample consisted of hearing aid owners receiving regular services from a hearing clinic (N=21). Following the structured telephone interview, participants were categorized into three categories: Successful, Successful with some limitations, or Unsuccessful.

Results: A vast majority were categorized as Successful (80% of the intervention sample and 71% of the clinical sample). Those categorized as successful were found to differ from those categorized as less successful in terms of age and self-reported hearing aid use, depressed mood, and residual participation restriction, but they did not differ in terms of degree of hearing loss.

Conclusion: It is suggested that the brevity and usefulness of the AR-CGI makes it a potential tool for further use in audiological settings.

Keyword
Validation, clinical global impression, telephone interview, audiological rehabilitation
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:liu:diva-12527 (URN)10.1080/09638280802621408 (DOI)
Available from: 2008-09-11 Created: 2008-09-11 Last updated: 2014-11-28

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