Hearing Impaired
Conditions
Keywords
audiologic rehabilitation, hearing loss, patient education, patient participation, structured rehabilitation, counseling, Internet
Brief summary
The purpose of this study is to examine the short-term effects of complementing an educational program for hearing aid users with Internet support.
Detailed description
Aural rehabilitation aims to improve communication for people with hearing impairment. Education is widely regarded as an integral part of rehabilitation, but the effect of the delivery method of an educational program on the experience of hearing problems has rarely been investigated in controlled trials. Internet as a complement to aural rehabilitation has been tested in different studies with promising results. Though, until now not applied clinically as a part of an aural rehabilitation, focusing on hearing aid users with persistent self- reported hearing problems. The purpose of this study was to evaluate the effect of an internet-based aural rehabilitation for hearing aid users from a clinical population. Participants were randomly assigned to an intervention or control group. The intervention group followed a five-week program that consisted of reading material, home training assignments, online and telephone interaction with an audiologist, and participation in a discussion forum. The control group only had access to reading material. The Hearing Handicap Inventory for the Elderly (HHIE), the Hospital Anxiety and Depression Scale (HADS) and the Communication Strategies Scale (CSS) were used to measure the outcomes of this study; and were recorded before and directly after the intervention as well as 6 months post-intervention.
Interventions
BEHAVIORALIntervention group
The intervention group followed a five-week program that consisted of reading material, home training assignments, online and telephone interaction with an audiologist, and participation in a discussion forum.
BEHAVIORALControl group
The control group only had access to reading material.
Sponsors
Sodra Alvsborgs Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
20 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* the hearing aid users to be between 20 and 80 yr of age, * the hearing aid users to have conductive or sensorineural hearing loss of mild to moderate degree (20-60 decibel Hearing Level pure-tone average measured across 500, 1000, and 2000 Hertz), * the hearing aid users to have completed a hearing aid fitting at least 3 months before the study began (regardless of hearing aid manufacturer, model, or hearing aid outcomes), * the hearing aid users to have a Hearing Handicap Inventory for the Elderly (HHIE) score of \>20 points (indicative of some residual self-reported hearing problems), * the hearing aid users to provide informed consent to participate
Exclusion criteria
* the hearing aid users who are not fulfilling the conditions to participate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The Hearing Handicap Inventory for the Elderly (HHIE) | 5 weeks, 6 months | The HHIE measures the experience of hearing loss in older people by focusing on the psycosocial and emotional effects of hearing loss. Higher score reflects a higher self-reported hearing problem. Minimum score for the total scale (reported) is 0 and maximum score is 100 points. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| International Outcome Inventory for Hearing Aids (IOI-HA) | pre-measurement | The IOI-HA measures hearing aid outcomes. The IOI-HA includes seven questions, measuring specific dimensions of hearing aid outcomes: daily use, benefits, remaining activity limitations, satisfaction, remaining participation restrictions, impact on the environment, and quality of life. Each question is scored from 1 to 5 (reported), where a higher score indicates a better outcome. |
| Hospital Anxiety and Depression Scale (HADS) | 5 weeks, 6 months | The HADS contains 14 items. Responses are scored from 0 to 3 and a higher score indicates more symptoms of anxiety and depression. Minimum score for the total scale (reported) is 0 and maximum score for the total scale is 42. |
| Communication Strategies Scale (CSS) | 5 weeks, 6 months | CSS is designed to analyze participants' behavior in various communication situations. Scoring for CSS ranges from 1 almost never to 5 almost always for subscales Verbal- and Nonverbal Strategies and conversely for Maladaptive Behaviors; indicating how frequent a specific situation or behavior occurs. Minimum score for the total scale (reported) is 0 and maximum score for the total scale is 125. |
Countries
Sweden
Participant flow
Recruitment details
2013-2014; Borås Hospital, Sweden; Alingsås Hospital, Sweden; Skene Hospital, Sweden.
Pre-assignment details
Participants who registered at the website and completed the screening form (n=108) were called for an interview to assess their eligibility; 104 informed an agreement to participate in the study. 14 of them did not fulfill the criteria for the Hearing Handicap Inventory for the Elderly, and 16 chose not to fill out the requested questionnaires.
Participants by arm
| Arm | Count |
|---|---|
| Intervention Group Professional support via Internet Intervention group: The intervention group is going to have access to a book and to a prepared compendium about communication strategies via the Internet and will receive weekly topic-based reading instructions related to the different chapters of the book or the compendium. The group will also have access to online and telephone support and access to an online discussion forum where new discussion topics will be posted each week. The project leader will evaluate the weekly data via the Internet. | 37 |
| Control Group no professional support
Control group: The control group will only have access to the book's content via the Internet and will be asked to read and evaluate the content. | 37 |
| Total | 74 |
Baseline characteristics
| Characteristic | Intervention Group | Control Group | Total |
|---|---|---|---|
| Age, Continuous | 61.8 years STANDARD_DEVIATION 11.9 | 62.1 years STANDARD_DEVIATION 11.4 | 62.0 years STANDARD_DEVIATION 11.6 |
| Number of Hearing Aids Binaurally | 28 numbers | 31 numbers | 59 numbers |
| Number of Hearing Aids Monaurally | 9 numbers | 6 numbers | 15 numbers |
| Pure-tone average Left ear | 37.8 decibel Hearing Level STANDARD_DEVIATION 10.5 | 36.5 decibel Hearing Level STANDARD_DEVIATION 8.5 | 37.1 decibel Hearing Level STANDARD_DEVIATION 9.5 |
| Pure-tone average Right ear | 37.5 decibel Hearing Level STANDARD_DEVIATION 11.3 | 38.0 decibel Hearing Level STANDARD_DEVIATION 8.6 | 37.8 decibel Hearing Level STANDARD_DEVIATION 10 |
| Sex: Female, Male Female | 13 Participants | 17 Participants | 30 Participants |
| Sex: Female, Male Male | 24 Participants | 20 Participants | 44 Participants |
| Use of hearing aid | 7.5 years STANDARD_DEVIATION 9.6 | 7.4 years STANDARD_DEVIATION 6.3 | 7.5 years STANDARD_DEVIATION 8 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 37 | 0 / 37 |
| serious Total, serious adverse events | 0 / 37 | 0 / 37 |
Outcome results
Primary
The Hearing Handicap Inventory for the Elderly (HHIE)
The HHIE measures the experience of hearing loss in older people by focusing on the psycosocial and emotional effects of hearing loss. Higher score reflects a higher self-reported hearing problem. Minimum score for the total scale (reported) is 0 and maximum score is 100 points.
Time frame: 5 weeks, 6 months
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Intervention Group | The Hearing Handicap Inventory for the Elderly (HHIE) | Pre-measurement | 42.0 units on a scale | Standard Deviation 16.9 |
| Intervention Group | The Hearing Handicap Inventory for the Elderly (HHIE) | Directly after-measurement (5 weeks) | 35.8 units on a scale | Standard Deviation 15.2 |
| Intervention Group | The Hearing Handicap Inventory for the Elderly (HHIE) | 6 months-post measurement | 36.0 units on a scale | Standard Deviation 15.8 |
| Control Group | The Hearing Handicap Inventory for the Elderly (HHIE) | Pre-measurement | 36.1 units on a scale | Standard Deviation 11.8 |
| Control Group | The Hearing Handicap Inventory for the Elderly (HHIE) | Directly after-measurement (5 weeks) | 31.3 units on a scale | Standard Deviation 14.3 |
| Control Group | The Hearing Handicap Inventory for the Elderly (HHIE) | 6 months-post measurement | 34.0 units on a scale | Standard Deviation 13.2 |
p-value: 0.685Mixed Models Analysis
Secondary
Communication Strategies Scale (CSS)
CSS is designed to analyze participants' behavior in various communication situations. Scoring for CSS ranges from 1 almost never to 5 almost always for subscales Verbal- and Nonverbal Strategies and conversely for Maladaptive Behaviors; indicating how frequent a specific situation or behavior occurs. Minimum score for the total scale (reported) is 0 and maximum score for the total scale is 125.
Time frame: 5 weeks, 6 months
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Intervention Group | Communication Strategies Scale (CSS) | Pre-measurement | 68.1 units on a scale | Standard Deviation 13.6 |
| Intervention Group | Communication Strategies Scale (CSS) | Directly after-measurement (5 weeks) | 74.7 units on a scale | Standard Deviation 11.1 |
| Intervention Group | Communication Strategies Scale (CSS) | 6 months post-measurement | 70.9 units on a scale | Standard Deviation 10.5 |
| Control Group | Communication Strategies Scale (CSS) | Pre-measurement | 67.2 units on a scale | Standard Deviation 11.3 |
| Control Group | Communication Strategies Scale (CSS) | Directly after-measurement (5 weeks) | 68.5 units on a scale | Standard Deviation 12.4 |
| Control Group | Communication Strategies Scale (CSS) | 6 months post-measurement | 66.7 units on a scale | Standard Deviation 11.6 |
Secondary
Hospital Anxiety and Depression Scale (HADS)
The HADS contains 14 items. Responses are scored from 0 to 3 and a higher score indicates more symptoms of anxiety and depression. Minimum score for the total scale (reported) is 0 and maximum score for the total scale is 42.
Time frame: 5 weeks, 6 months
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Intervention Group | Hospital Anxiety and Depression Scale (HADS) | Pre-measurement | 8.5 units on a scale | Standard Deviation 6.6 |
| Intervention Group | Hospital Anxiety and Depression Scale (HADS) | Directly after-measurement (5 weeks) | 7.5 units on a scale | Standard Deviation 6.3 |
| Intervention Group | Hospital Anxiety and Depression Scale (HADS) | 6 months post-measurement | 4.8 units on a scale | Standard Deviation 4.5 |
| Control Group | Hospital Anxiety and Depression Scale (HADS) | Pre-measurement | 7.4 units on a scale | Standard Deviation 4.8 |
| Control Group | Hospital Anxiety and Depression Scale (HADS) | Directly after-measurement (5 weeks) | 6.5 units on a scale | Standard Deviation 5.2 |
| Control Group | Hospital Anxiety and Depression Scale (HADS) | 6 months post-measurement | 6.8 units on a scale | Standard Deviation 5.9 |
Secondary
International Outcome Inventory for Hearing Aids (IOI-HA)
The IOI-HA measures hearing aid outcomes. The IOI-HA includes seven questions, measuring specific dimensions of hearing aid outcomes: daily use, benefits, remaining activity limitations, satisfaction, remaining participation restrictions, impact on the environment, and quality of life. Each question is scored from 1 to 5 (reported), where a higher score indicates a better outcome.
Time frame: pre-measurement
Population: The IOI-HA was used only at the pre-masurement point, to select descriptive data about the participants.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Intervention Group | International Outcome Inventory for Hearing Aids (IOI-HA) | 3. Remaining activity limitation | 3.1 units on a scale | Standard Deviation 0.8 |
| Intervention Group | International Outcome Inventory for Hearing Aids (IOI-HA) | 5. Remaining participation restriction | 3.8 units on a scale | Standard Deviation 1.1 |
| Intervention Group | International Outcome Inventory for Hearing Aids (IOI-HA) | 2. Benefit | 3.8 units on a scale | Standard Deviation 0.9 |
| Intervention Group | International Outcome Inventory for Hearing Aids (IOI-HA) | 6. Impact on environment | 3.6 units on a scale | Standard Deviation 0.9 |
| Intervention Group | International Outcome Inventory for Hearing Aids (IOI-HA) | 4. Satisfaction | 4.1 units on a scale | Standard Deviation 1.1 |
| Intervention Group | International Outcome Inventory for Hearing Aids (IOI-HA) | 7. Quality of life | 3.6 units on a scale | Standard Deviation 0.8 |
| Intervention Group | International Outcome Inventory for Hearing Aids (IOI-HA) | 1. Daily use | 4.1 units on a scale | Standard Deviation 1.1 |
| Control Group | International Outcome Inventory for Hearing Aids (IOI-HA) | 7. Quality of life | 3.6 units on a scale | Standard Deviation 1 |
| Control Group | International Outcome Inventory for Hearing Aids (IOI-HA) | 1. Daily use | 4.4 units on a scale | Standard Deviation 1 |
| Control Group | International Outcome Inventory for Hearing Aids (IOI-HA) | 2. Benefit | 4.1 units on a scale | Standard Deviation 0.9 |
| Control Group | International Outcome Inventory for Hearing Aids (IOI-HA) | 3. Remaining activity limitation | 3.1 units on a scale | Standard Deviation 0.8 |
| Control Group | International Outcome Inventory for Hearing Aids (IOI-HA) | 4. Satisfaction | 4.4 units on a scale | Standard Deviation 0.8 |
| Control Group | International Outcome Inventory for Hearing Aids (IOI-HA) | 5. Remaining participation restriction | 4.1 units on a scale | Standard Deviation 0.8 |
| Control Group | International Outcome Inventory for Hearing Aids (IOI-HA) | 6. Impact on environment | 3.9 units on a scale | Standard Deviation 0.9 |