Reevaluation of the Amsterdam Inventory for Auditory Disability and Handicap Using Item Response Theory

Listening to speech-in-noise with hearing aids: Do the self-reported outcomes reflect the behavioral speech perception task performance?

BACKGROUND

The aim of this study is to examine the relationship between behavioral speech-in-noise listening tasks and self-reported speech-in-noise outcomes of hearing aid user adult listeners.

METHOD

To measure the self-reported outcomes of hearing, the Hearing Handicap Inventory for Adults [HHI-A], Speech, Spatial and Qualities of Hearing Scale (SSQ) and Amsterdam Inventory for Auditory Disability and Handicap were employed. To screen the cognitive abilities, Montreal Cognitive Assessment (MoCA) tool was used. Turkish matrix sentence test (TMST) was used for speech-in-noise test. Eighteen adult hearing aid users (mean age of 36.6 years) were participated.

CONCLUSIONS

Results showed that some self-reported listening-in-noise outcomes are correlated with lab-based measurements of speech-in-noise test scores but not with the aided speech intelligibility thresholds. Given the present limitations of relying solely on self-report measures, it is important to complement them with objective measures to ensure a comprehensive evaluation.

Exploring Factors That Contribute to the Success of Rehabilitation With Hearing Aids

OBJECTIVES

Hearing aids are an essential and important part of hearing rehabilitation. The combination of technical data on hearing aids and individual rehabilitation needs can give insight into the factors that contribute to the success of rehabilitation. This study sets out to investigate if different subgroups of (comparable) hearing aids lead to differences in the success of rehabilitation, and whether these differences vary between different domains of auditory functioning.

DESIGN

This study explored the advantages of including patient-reported outcome measures (PROMs) in the process of purchasing new hearing aids in a large sample of successful hearing aid users. Subject data were obtained from 64 (commercial) hearing aid dispensers and 10 (noncommercial) audiological centers in the Netherlands. The PROM was a 32-item questionnaire and was used to determine the success of rehabilitation using hearing aids by measuring auditory disability over time. The items were mapped on six domains of auditory functioning: detection, discrimination, localization, speech in quiet, speech in noise, and noise tolerance, encompassing a variety of daily-life listening situations. Hearing aids were grouped by means of cluster analysis, resulting in nine subgroups. In total, 1149 subjects were included in this study. A general linear model was used to model the final PROM results. Model results were analyzed via a multifactor Analysis of Variance. Post hoc analyses provided detailed information on model variables.

RESULTS

Results showed a strong statistically significant effect of hearing aids on self-perceived auditory functioning in general. Clinically relevant differences were found for auditory domains including detection, speech in quiet, speech in noise, and localization. There was only a small, but significant, effect of the different subgroups of hearing aids on the final PROM results, where no differences were found between the auditory domains. Minor differences were found between results obtained in commercial and noncommercial settings, or between novice and experienced users. Severity of Hearing loss, age, gender, and hearing aid style (i.e., behind-the-ear versus receiver-in-canal type) did not have a clinically relevant effect on the final PROM results.

CONCLUSIONS

The use of hearing aids has a large positive effect on self-perceived auditory functioning. There was however no salient effect of the different subgroups of hearing aids on the final PROM results, indicating that technical properties of hearing aids only play a limited role in this respect. This study challenges the belief that premium devices outperform basic ones, highlighting the need for personalized rehabilitation strategies and the importance of evaluating factors contributing to successful rehabilitation for clinical practice.

Development and Validation of a Brief Version of the Vanderbilt Fatigue Scale for Adults: The VFS-A-10

OBJECTIVES

Listening-related fatigue can be a significant problem for adults who struggle to hear and understand, particularly adults with hearing loss. However, valid, sensitive, and clinically useful measures for listening-related fatigue do not currently exist. The purpose of this study was to develop and validate a brief clinical tool for measuring listening-related fatigue in adults.

DESIGN

The clinical scale was derived from the 40-item version of the Vanderbilt Fatigue Scale for Adults (VFS-A-40), an existing, reliable, and valid research tool for measuring listening-related fatigue. The study consisted of two phases. Phase 1 ( N = 580) and Phase 2 ( N = 607) participants consisted of convenience samples of adults recruited via online advertisements, clinical records review, and a pool of prior research participants. In Phase 1, results from item response theory (IRT) analyses of VFS-A-40 items were used to identify high-quality items for the brief (10-item) clinical scale: the VFS-A-10. In Phase 2, the characteristics and quality of the VFS-A-10 were evaluated in a separate sample of respondents. Dimensionality was evaluated using exploratory factor analyses (EFAs) and item quality and characteristics were evaluated using IRT. VFS-A-10 reliability and validity were assessed in multiple ways. IRT reliability analysis was used to examine VFS-A-10 measurement fidelity. In addition, test-retest reliability was assessed in a subset of Phase 2 participants ( n = 145) who completed the VFS-A-10 a second time approximately one month after their initial measure (range 5 to 90 days). IRT differential item functioning (DIF) was used to assess item bias across different age, gender, and hearing loss subgroups. Convergent construct validity was evaluated by comparing VFS-A-10 responses to two other generic fatigue scales and a measure of hearing disability. Known-groups validity was assessed by comparing VFS-A-10 scores between adults with and without self-reported hearing loss.

RESULTS

EFA suggested a unidimensional structure for the VFS-A-10. IRT analyses confirmed all test items were high quality. IRT reliability analysis revealed good measurement fidelity over a wide range of fatigue severities. Test-retest reliability was excellent ( rs = 0.88, collapsed across participants). IRT DIF analyses confirmed the VFS-A-10 provided a valid measure of listening-related fatigue regardless of respondent age, gender, or hearing status. An examination of associations between VFS-A-10 scores and generic fatigue/vigor measures revealed only weak-to-moderate correlations (Spearman's correlation coefficient, rs = -0.36 to 0.57). Stronger associations were seen between VFS-A-10 scores and a measure of perceived hearing difficulties ( rs = 0.79 to 0.81) providing evidence of convergent construct validity. In addition, the VFS-A-10 was more sensitive to fatigue associated with self-reported hearing difficulties than generic measures. It was also more sensitive than generic measures to variations in fatigue as a function of degree of hearing impairment.

CONCLUSIONS

These findings suggest that the VFS-A-10 is a reliable, valid, and sensitive tool for measuring listening-related fatigue in adults. Its brevity, high sensitivity, and good reliability make it appropriate for clinical use. The scale will be useful for identifying those most affected by listening-related fatigue and for assessing benefits of interventions designed to reduce its negative effects.

The Effects of Tinnitus and Tinnitus Annoyance on Need for Recovery After Work: Results of the Netherlands Longitudinal Study on Hearing

OBJECTIVES

The first aim of this study was to examine the relationship between having tinnitus and the need for recovery after work (NFR). The second aim was to investigate whether the level of tinnitus annoyance is associated with NFR.

DESIGN

Data from the 5- and 10-year follow-up measurement rounds of the Netherlands Longitudinal Study on Hearing (NL-SH) were used in a cross-sectional analyses. The NL-SH is a web-based prospective cohort study and includes participants aged 18 to 70 years at baseline. For this study, we included only participants who worked at least 12 hours/week and were under the age of 65 years. Participants completed questionnaires on demographic, socioeconomic, psychosocial, hearing-related, and work-related characteristics. In addition, participants answered questions about hearing ability and tinnitus and performed an online digit-triplet speech recognition in noise test to measure the speech reception threshold (SRT) in noise. Participants were asked if (1) they suffer from tinnitus and (2) to rate tinnitus annoyance on a 0-100 numeric rating scale. A linear mixed model was used (1) to estimate the overall (i.e., cross-sectional) association between having tinnitus and NFR and (2) to estimate the overall association between the level of tinnitus annoyance and NFR. The models were checked for effect modification and confounding of factors known to be associated with either tinnitus or NFR and available in the NL-SH.

RESULTS

The study sample comprised 770 unique participants in total; 686 and 335 participants at 5- and 10-year follow-up, respectively. Distress, somatization, and self-reported hearing disability appeared to be confounding factors in the analysis of having tinnitus and NFR. After adjusting for these factors, participants with tinnitus had a 2.5% higher NFR (95% confidence interval: -0.9 to 5.9; p = 0.15). In the analysis of tinnitus annoyance and NFR, SRT was an effect modifier. Distress, somatization, depression, and self-reported hearing disability were confounders. After adjustment for effect modification and confounding, tinnitus annoyance was not significantly associated with NFR ( p = 0.79 for tinnitus annoyance).

CONCLUSIONS

This study showed that having tinnitus was not associated with a higher NFR. Also, higher levels of tinnitus annoyance were not associated with a higher NFR. NFR was associated with the psychological factors distress, somatization, and depression, which are known to be intricately related to tinnitus. A longitudinal study design is recommended as it can assess the sequence of events, which might help disentangle the association between tinnitus, NFR, and psychological factors.

Cohort profile: Netherlands Longitudinal Study on Hearing (NL-SH)

PURPOSE

The Netherlands Longitudinal Study on Hearing (NL-SH) was set up to examine associations of hearing ability with psychosocial, work and health outcomes in working age adults.

PARTICIPANTS

Inclusion started in 2006 and is ongoing. Currently the sample comprises 2800 adults with normal and impaired hearing, aged 18-70 years at inclusion. Five-year follow-up started in 2011, 10-year follow-up in 2016 and 15-year follow-up in 2021. All measurements are web-based. Participants perform a speech-in-noise recognition test to measure hearing ability and fill out questionnaires about their hearing status, hearing aid use, self-reported hearing disability and coping, work status and work-related outcomes (work performance, need for recovery), physical and psychosocial health (depression, anxiety, distress, somatisation, loneliness), healthcare usage, lifestyle (smoking, alcohol), and technology use.

FINDINGS TO DATE

The NL-SH has shown the vast implications of reduced hearing ability for the quality of life and health of working-age adults. A selection of results published in 27 papers is presented. Age-related deterioration of hearing ability accelerates after the age of 50 years. Having a history of smoking is associated with a faster decline in hearing ability, but this relationship is not found for other cardiovascular risk factors. Poorer hearing ability is associated with increased distress, somatisation, depression and loneliness. Adults with impaired hearing ability are more likely to be unemployed or unfit for work, and need more time to recuperate from work effort.

FUTURE PLANS

Participant data will be linked to a national database to enable research on the association between hearing ability and mortality. Linking to environmental exposure data will facilitate insight in relations between environmental factors, hearing ability and psychosocial outcomes. The unique breadth of the NL-SH data will also allow for further research on other functional problems, for instance, hearing ability and fall risk.

TRIAL REGISTRATION NUMBER

NL12015.029.06.

Development and Evaluation of Pediatric Versions of the Vanderbilt Fatigue Scale for Children With Hearing Loss

PURPOSE

Growing evidence suggests that fatigue associated with listening difficulties is particularly problematic for children with hearing loss (CHL). However, sensitive, reliable, and valid measures of listening-related fatigue do not exist. To address this gap, this article describes the development, psychometric evaluation, and preliminary validation of a suite of scales designed to assess listening-related fatigue in CHL: the pediatric versions of the Vanderbilt Fatigue Scale (VFS-Peds).

METHOD

Test development employed best practices, including operationalizing the construct of listening-related fatigue from the perspective of target respondents (i.e., children, their parents, and teachers). Test items were developed based on input from these groups. Dimensionality was evaluated using exploratory factor analyses (EFAs). Item response theory (IRT) and differential item functioning (DIF) analyses were used to identify high-quality items, which were further evaluated and refined to create the final versions of the VFS-Peds.

RESULTS

The VFS-Peds is appropriate for use with children aged 6-17 years and consists of child self-report (VFS-C), parent proxy-report (VFS-P), and teacher proxy-report (VFS-T) scales. EFA of child self-report and teacher proxy data suggested that listening-related fatigue was unidimensional in nature. In contrast, parent data suggested a multidimensional construct, composed of mental (cognitive, social, and emotional) and physical domains. IRT analyses suggested that items were of good quality, with high information and good discriminability. DIF analyses revealed the scales provided a comparable measure of fatigue regardless of the child's gender, age, or hearing status. Test information was acceptable over a wide range of fatigue severities and all scales yielded acceptable reliability and validity.

CONCLUSIONS

This article describes the development, psychometric evaluation, and validation of the VFS-Peds. Results suggest that the VFS-Peds provide a sensitive, reliable, and valid measure of listening-related fatigue in children that may be appropriate for clinical use. Such scales could be used to identify those children most affected by listening-related fatigue, and given their apparent sensitivity, the scales may also be useful for examining the effectiveness of potential interventions targeting listening-related fatigue in children.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19836154.

Language comprehension in toddlers with significant developmental delays: An IRT approach

PURPOSE

Language comprehension, or the ability to understand spoken language, is critical to a variety of child outcomes. Effective early intervention relies on valid, reliable language comprehension assessment. The purpose of this study was to explore language comprehension in a sample of toddlers with significant developmental delays associated with varied medical conditions.

METHOD

We investigated language comprehension in a sample of 112 toddlers by applying Item Response Theory (IRT) methods to two measures; one standardized and one flexible.

RESULTS

Data from a standardized measure fit the unidimensional model, whereas the flexible measure did not. The overall pattern of results suggested that items related to early social/contextual comprehension are distinct from linguistic comprehension items.

CONCLUSION

Our findings inform clinical practice by underscoring the importance of comprehensive assessment of language comprehension and considering strengths and weaknesses across social/contextual and linguistic comprehension among toddlers with developmental delays.

Uptake of Hearing Aids and Hearing Assistive Technology in a Working Population: Longitudinal Analyses of The Netherlands Longitudinal Study on Hearing

OBJECTIVE

To identify predictors of the 5-year uptake of hearing aids (HAs) and hearing assistive technology (HAT) in a sample of Dutch employees eligible for HAs and/or HAT. The potential predictors included demographic factors (age, sex, marital status, and living situation), education, hearing factors (ability to recognize speech in noise and self-reported hearing disability), distress, self-efficacy, and work-related factors (job demand, job control, and need for recovery).

DESIGN

Five-year follow-up data of the Netherlands Longitudinal Study on Hearing (NL-SH) collected until January 2019 were included. An online digit-triplet in noise test, the National Hearing Test (NHT), was used to assess speech-recognition-in-noise ability. In addition, online questionnaires on demographic, socioeconomic, self-reported hearing disability, health, and work-related characteristics were administered. Adults who worked over 12 hours per week, who had not yet taken up HAs or HAT, but who would be eligible for HAs/HAT based on their NHT score (insufficient or poor hearing ability), were included in the study. The 5-year uptake of HAs/HAT was defined as a dichotomous variable of self-reported HA/HAT use reported 5 years later. Generalized Estimating Equations analyses were performed to analyze the associations between potential predicting factors and the 5-year uptake of HAs/HAT, taking into account the repeated measurements of the predicting factors and the 5-year uptake of HAs/HAT.

RESULTS

Data of 218 participants were included. The cumulative incidence of the 5-year uptake of HAs/HAT was 15 to 33%, of which 52 employees took up HAs and 11 employees took up HAT. Married participants had increased odds for 5-year uptake of HAs/HAT compared with unmarried participants (odds ratio [OR] = 2.13, 95% confidence interval [CI] = 1.05 to 4.35). Higher self-reported hearing disability (per one unit, scale range 0 to 74) was associated with increased odds for 5-year uptake of HAs/HAT (OR = 1.05, 95% CI = 1.03 to 1.07). Job demand showed a significant interaction with sex (p = 0.002), and therefore, stratified analyses were performed. In male participants, participants with higher job demand scores (per one unit, scale range 12 to 48) had increased odds for 5-year uptake of HAs/HAT (OR = 1.18, 95% CI = 1.05 to 1.35). No difference was seen in females.

CONCLUSION

This study confirms that factors predicting the uptake of HAs/HAT in the general or older populations, including marital status and self-reported hearing disability, also extend to the working population. The identification of job demand as a predictor of the uptake of HAs/HAT (in males only) was a novel finding. It demonstrates the importance of considering work-related factors in aural rehabilitation.

Development and validation of the Vanderbilt Fatigue Scale for Adults (VFS-A)

Listening-related fatigue can be a significant burden for adults with hearing loss (AHL), and potentially those with other health or language-related issues (e.g., multiple sclerosis, traumatic brain injury, second language learners) who must allocate substantial cognitive resources to the process of listening. The 40-item Vanderbilt Fatigue Scale for Adults (VFS-A-40) was designed to measure listening-related fatigue in such populations. This article describes the development, and psychometric properties, of the VFS-A-40. Initial qualitative analyses in AHL suggested listening-related fatigue was multidimensional, with physical, mental, emotional, and social domains. However, exploratory factor analyses revealed a unidimensional structure. Item and test characteristics were evaluated using Item Response Theory (IRT). Results confirmed that all test items were of high quality. IRT analyses revealed high marginal reliability and an analysis of test-retest scores revealed adequate reliability. In addition, an analysis of differential item functioning provided evidence of good construct validity across age, gender, and hearing loss groups. In sum, the VFS-A-40 is a reliable and valid tool for quantifying listening-related fatigue in adults. We believe the VFS-A-40 will be useful for identifying those most at risk for severe listening-related fatigue and for assessing interventions to reduce its negative effects. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Operationalization of the Brief ICF Core Set for Hearing Loss: An ICF-Based e-Intake Tool in Clinical Otology and Audiology Practice

OBJECTIVES

According to the International Classification of Functioning, Disability and Health (ICF), functioning reflects the interplay between an individual's body structures and functions, activities, participation, environmental, and personal factors. To be useful in clinical practice, these concepts need to be operationalized into a practical and integral instrument. The Brief ICF Core Set for Hearing Loss (CSHL) provides a minimum standard for the assessment of functioning in adults with hearing loss. The objective of the present study was to operationalize the Brief CSHL into a digital intake tool that could be used in the otology-audiology practice for adults with ear and hearing problems as part of their intake assessment.

DESIGN

A three-step approach was followed: (1) Selecting and formulating questionnaire items and response formats, using the 27 categories of the Brief CSHL as a basis. Additional categories were selected based on relevant literature and clinical expertise. Items were selected from existing, commonly used disease-specific questionnaires, generic questionnaires, or the WHO's official descriptions of ICF categories. The response format was based on the existing item's response categories or on the ICF qualifiers. (2) Carrying out an expert survey and a pilot study (using the three-step test interview. Relevant stakeholders and patients were asked to comment on the relevance, comprehensiveness, and comprehensibility of the items. Results were discussed in the project group, and items were modified based on consensus. (3) Integration of the intake tool into a computer-based system for use in clinical routine.

RESULTS

The Brief CSHL was operationalized into 62 items, clustered into six domains: (1) general information, including reason for visit, sociodemographic, and medical background; (2) general body functions; (3) ear and hearing structures and functions; (4) activities and participation (A&P); (5) environmental factors (EF); and (6) personal factors (mastery and coping). Based on stakeholders' responses, the instructions of the items on A&P and EF were adapted. The three-step test interview showed that the tool had sufficient content validity but that some items on EF were redundant. Overall, the stakeholders and patients indicated that the intake tool was relevant and had a logical and clear structure. The tool was integrated in an online portal.

CONCLUSIONS

In the current study, an ICF-based e-intake tool was developed that aims to screen self-reported functioning problems in adults with an ear/hearing problem. The relevance, comprehensiveness, and comprehensibility of the originally proposed item list was supported, although the stakeholder and patient feedback resulted into some changes of the tool on item-level. Ultimately, the functioning information obtained with the tool could be used to promote patient-centered ear and hearing care taking a biopsychosocial perspective into account.

The Revised Hearing Handicap Inventory and Screening Tool Based on Psychometric Reevaluation of the Hearing Handicap Inventories for the Elderly and Adults

OBJECTIVES

The present study evaluates the items of the Hearing Handicap Inventory for the Elderly and Hearing Handicap Inventory for Adults (HHIE/A) using Mokken scale analysis (MSA), a type of nonparametric item response theory, and develops updated tools with optimal psychometric properties.

DESIGN

In a longitudinal study of age-related hearing loss, 1447 adults completed the HHIE/A and audiometric testing at baseline. Discriminant validity of the emotional consequences and social/situational effects subscales of the HHIE/A was assessed, and nonparametric item response theory was used to explore dimensionality of the items of the HHIE/A and to refine the scales.

RESULTS

The HHIE/A items form strong unidimensional scales measuring self-perceived hearing handicap, but with a lack of discriminant validity of the two distinct subscales. Two revised scales, the 18-item Revised Hearing Handicap Inventory and the 10-item Revised Hearing Handicap Inventory-Screening, were developed from the common items of the original HHIE/A that met the assumptions of MSA. The items on both of the revised scales can be ordered in terms of increasing difficulty.

CONCLUSIONS

The results of the present study suggest that the newly developed Revised Hearing Handicap Inventory and Revised Hearing Handicap Inventory-Screening are strong unidimensional, clinically informative measures of self-perceived hearing handicap that can be used for adults of all ages. The real-data example also demonstrates that MSA is a valuable alternative to classical psychometric analysis.

Three cases of hearing impairment with surprising subjective improvements after prayer. What can we say when analyzing them?

AIM

to enhance the understanding of documented mismatches between 'subjective' experiences and 'objective' data in three cases of self-reported instantaneous healing of hearing impairment upon prayer.

METHOD

description of three cases taken out of a larger retrospective case-based study of prayer healing in the Netherlands. In this larger study multiple reported healings were investigated using both medical files and patients' narratives through in-depth interviews. A subset of three cases with dramatic subjective reduction of hearing impairment upon prayer was studied. These patients underwent extensive additional investigations at the audiology center of the Amsterdam University Medical Centre. All data was evaluated by an interdisciplinary medical assessment team, subsequent analysis was transdisciplinary.

RESULTS

the three case histories with self-reported healing after prayer demonstrated a clear mismatch between subjective experiences and objective findings. No measurable improvements were found in four different audiological testing methods. However, in-depth interviews, hetero-anamnesis and a validated questionnaire all confirmed the healings. The medical assessment team could not label these healings as 'medically remarkable' because of absence of measurable 'objective' changes, but they did consider them as 'remarkable in a broader sense'. On expert consultation no equivalents of mismatches to this extent could be found. The healing experiences of our participants involved their entire being with profound positive effects in different domains of their lives, and a perception of a benevolent God who acted upon them. There was a distinctive pattern, labelled by the participants as a healing of mind, soul and body.

CONCLUSIONS

The subjective-objective incongruities that were found were not well understood. We noticed a paradox: the 'objective' measurements did not reflect hearing abilities in daily life where-as 'subjective experiential' data did. The latter could be 'objectified' and validated in various ways. In fact, a rigid distinction between 'objective' and 'subjective' was not relevant here, nor a hierarchy among them. A model leaving room for different causations (horizontal epistemology) complied best with the multi dimensionality we came across.

Validating the Foot and Ankle Outcome score for measuring foot dysfunction among hallux valgus surgery patients using item response theory

BACKGROUND

There is an absence of high quality research validating instruments that measure foot and ankle related quality of life among hallux valgus (bunion) patients' perspectives. The Foot and Ankle Outcome Scale is a patient-reported outcome instrument, that when administered to patients with symptomatic hallux valgus, provides a patient-centric perspective of their foot function. The aim of this study is to assess the psychometric properties of the instrument's five subscales among preoperative bunion surgery patients.

METHODS

The Foot and Ankle Outcome Scale instrument measures Pain, Symptoms, Activities of Daily Living, Sport and Recreational Activities and Foot/Ankle Related Quality of Life. Preoperative data is collected from a sample of patients scheduled for surgical treatment of their condition in Vancouver, Canada. Classical and item response theory methods are used to report on reliability, validity and differential item functioning among subgroups.

RESULTS

This study included 249 surveys, representing an overall response rate of 44.1% among 564 eligible patients. The instrument demonstrated high reliability for all subscales, though 18 items across subscales, exhibited poor discrimination between item levels. Four items score differently according to patients' sex and one item scored differently by age.

CONCLUSIONS

The instrument measures five domains of health important to bunion patients. These findings suggest that the current instrument can be used with an understanding of its limitations, including redundant questions and sex-based differences. Future research should revise a number of items. The results highlight the importance of the psychometric analyses of instruments in specific patient populations.

Rationale, Theoretical Underpinnings, and Design of HEAR-aware: Providing Adults With Hearing Loss With Tailored Support to Self-Manage Their Hearing Problems via a Smartphone App, as an Alternative to Hearing Aids

Purpose An alarming two thirds of adults aged 50 years or over with hearing impairment who could benefit from hearing aids do not own any, leaving these adults with no support to self-manage their hearing problems. In the HEAR-aware project, it is hypothesized that self-management can be facilitated via a smartphone app if its educational content is tailored to a person's dynamic stage of readiness to take action on their hearing (stage of change) and to a person's dynamic acoustical situations (as measured via a wearable microphone) and associated challenges (as captured via ecological momentary assessment). As such, the HEAR-aware app would be an ecological momentary intervention. This research note describes the rationale and theoretical underpinnings of the app, as well as the rationale for planning a series of studies to develop and evaluate it. Study Designs After a preparatory phase, Study 1 includes qualitative group interviews to assess user needs. Next, a creative session will be held, in which all stakeholders involved will work toward a specified version of the app. Subsequently, prototypes of the app will be developed and pilot-tested (Pilot Studies 2A and 2B). Users' usage and ratings (usability and quality indicators) of the app's elements will be examined and processed in the app. Lastly, the effectiveness of the app's final version will be examined in a randomized controlled trial (Study 3). Discussion The project's merits and challenges will be discussed.

Analysis of data from the International Outcome Inventory for Hearing Aids (IOI-HA) using Bayesian Item Response Theory

OBJECTIVE

IOI-HA response data are conventionally analysed assuming that the ordinal responses have interval-scale properties. This study critically considers this assumption and compares the conventional approach with a method using Item Response Theory (IRT).

DESIGN

A Bayesian IRT analysis model was implemented and applied to several IOI-HA data sets.

STUDY SAMPLE

Anonymised IOI-HA responses from 13273 adult users of one or two hearing aids in 11 data sets using the Australian English, Dutch, German and Swedish versions of the IOI-HA.

RESULTS

The raw ordinal responses to IOI-HA items do not represent values on interval scales. Using the conventional rating sum as an overall score introduces a scale error corresponding to about 10 - 15% of the true standard deviation in the population. Some interesting and statistically credible differences were demonstrated among the included data sets.

CONCLUSIONS

It is questionable to apply conventional statistical measures like mean, variance, t-tests, etc., on the raw IOI-HA ratings. It is recommended to apply only nonparametric statistical test methods for comparisons of IOI-HA results between groups. The scale error can sometimes cause incorrect conclusions when individual results are compared. The IRT approach is recommended for analysis of individual results.

Hearing handicap in Asian patients with dementia

BACKGROUND

Hearing loss and hearing handicap may contribute to cognitive impairment and dementia. The purpose of this study was to analyze the association between hearing loss and hearing handicap with dementia in an Asian memory clinic parents.

METHODS

This study includes the data obtained from patients with mild dementia who attended the National University hospital memory clinic and non-demented healthy subjects among spouses and caregivers who are non-genetically related to our patients. All participants underwent comprehensive physical, medical, neuropsychological and audiological assessments (i.e. pure tone audiometry - PTA). Disabling hearing loss was defined as a hearing loss of >40 dB in the better ear on PTA. Amsterdam Inventory for Auditory Disability and Handicap (AIADH) questionnaire was administered through the verbal interview to measure their hearing handicap score. Linear regression models were used to investigate the association between hearing loss and hearing handicap with dementia. Mean differences (β) with 95% confidence intervals (CI) were calculated.

RESULTS

91 participants (65-90 years old) were recruited for this study; 39 of them were patients with dementia and 52 were non-demented healthy controls. 48.7% of the patients with dementia had disabling hearing loss, which is higher than the non-demented controls (25.0%) (p = 0.019). The significant association between hearing handicap (as measured by AIADH) and dementia was observed, which was independent of demographic factors and audiology related history and PTA average (β = -6.40; 95% CI =0.11.99, -0.81, p = 0.025). There was no independent association between hearing loss and dementia (p > 0.05).

CONCLUSION

A significant association between hearing handicap and dementia was found. The mechanism of this association requires further research and may involve higher order central processing disorder.

Study protocol: The Dutch 20|30 Postmeningitis study: a cross-sectional follow-up of two historical childhood bacterial meningitis cohorts on long-term outcomes

Background

Bacterial meningitis (BM) is a serious, life-threatening infectious disease of the central nervous system that often occurs in young children. The most common severe to moderate sequelae following BM are sensorineural hearing loss, neuromotor disabilities and mental retardation, while subtle sequelae include academic and behavioral disabilities. It is largely unknown whether these more subtle sequelae persist into adolescence and adulthood. Therefore, this study will investigate the very long-term effects of childhood BM in later life. Better understanding of long-term effects and early identification of adverse outcomes after BM are essential for more timely interventions. Additionally, certain single nucleotide polymorphisms (SNPs) are associated with disease severity and might predict adverse sequelae. These include SNPs in genes encoding for pathogen recognition and immune response upon infection. Accordingly, a secondary objective of this study is to investigate the role of genetic variation in BM and use any insights to predict short- and long-term outcomes.

Methods

In the Dutch 20|30 Postmeningitis study, adolescents and young adults (n = 947) from two historical cohorts with a prior episode of BM during childhood will be enrolled into a cross-sectional follow-up investigation using mainly questionnaires that examine executive and behavioral functioning, health-related quality of life, subjective hearing, mood and sleeping disorders, academic performance, and economic self-sufficiency. The results will be compared to normative data by one-sample t-tests. Multivariable regression analysis will be used to assess for any associations with causative pathogens and severity of BM. Participants that complete the questionnaires will be approached to provide a swab for buccal DNA and subsequent sequencing analyses. Logistic regression models will be used to predict sequelae.

Discussion

The unique follow-up duration of this cohort will enable us to gain insights into the possible very long-term adverse effects of childhood BM and how these might impact on quality of life. The investigation of host genetic factors will contribute to the development of prediction models which will serve as prognostic tools to identify children who are at high risk of adverse outcome after BM.

Trial Registration

Dutch Trial Register NTR-6891. Retrospectively registered 28 December 2017.

Development and Refinement of Patient-Reported Outcome Measures for Hearing: A Brief Introduction to Nonparametric Item Response Theory

Purpose The purpose of this report was to demonstrate the value of incorporating nonparametric item response theory in the development and refinement of patient- reported outcome measures for hearing. Conclusions Nonparametric item response theory can be useful in the development and refinement of patient-reported outcome measures for hearing. These methods are particularly useful as an alternative to exploratory factor analysis to determine the number of underlying abilities or traits represented by a scale when the items have ordered-categorical responses.

Identifying the Essential Portions of the Skill Acquisition Process Using Item Response Theory

OBJECTIVE

Item response theory (IRT) was originally developed to make performance assessments more accurate. However, IRT analysis of the intraoperative performance of surgical trainees could help identify the elements that the trainees find difficult during the skill acquisition process. The aim of this study was to identify the essential portions of the skill acquisition process of a surgical procedure using the IRT.

DESIGN

The 24-item assessment checklist was used to evaluate a recorded intra-operative performance of a laparoscopic inguinal hernia repair. The scores were analyzed using IRT to calculate the difficulty and discrimination level of each item.

SETTING

Fifteen institutes.

PARTICIPANTS

Thirty surgical trainees.

RESULTS

A total of 123 assessments were analyzed. The item analysis showed the procedure specific item "traction of peritoneum (difficulty: -0.45; discrimination: 19.37)" and generic items "instrument handling (difficulty: -0.59; discrimination: 3.82)" and "flow of procedure (difficulty: 0.09; discrimination: 3.27)" to be key elements in the skill acquisition process of the procedure.

CONCLUSIONS

Key elements in the skill acquisition process of the procedure were quantitatively identified by applying the IRT analysis. This could lead to the use of IRT in designing and developing a more effective training curriculum.

Evidence-Based Interventions for Adult Aural Rehabilitation: That Was Then, This Is Now

More than a decade after Arthur Boothroyd published "Adult Aural Rehabilitation: What Is It and Does It Work?," the four cornerstones of adult aural rehabilitation are re-examined in terms of research that we and others in the field have undertaken. The focus is on novel advances in high-quality research relating to interventions to support self-management for hearing aids and other listening devices (sensory management), knowledge and skill (instruction), auditory and cognitive training (perceptual training), and motivational engagement (counseling). Much of this new research has a theoretical underpinning (e.g., behavior change theory) to better guide the development and evaluation of interventions, with a focus on self-management and patient-centered approaches. New and emerging technologies that support e- and m-health delivery of interventions provide greater personalization and interactivity to promote self-management of hearing loss. Looking to the future, there remains a requirement for a set of relevant and appropriate outcome measures to evaluate the effectiveness of interventions trialed in clinical studies. There is a continuing need for high-quality evidence, underpinned by contemporary theory, to increase the likelihood that translational adult aural rehabilitation research that aims to benefit patients will be applied in future clinical practice.

Predictors of Entering a Hearing Aid Evaluation Period: A Prospective Study in Older Hearing-Help Seekers

This study aimed to determine the predictors of entering a hearing aid evaluation period (HAEP) using a prospective design drawing on the health belief model and the transtheoretical model. In total, 377 older persons who presented with hearing problems to an Ear, Nose, and Throat specialist (n = 110) or a hearing aid dispenser (n = 267) filled in a baseline questionnaire. After 4 months, it was determined via a telephone interview whether or not participants had decided to enter a HAEP. Multivariable logistic regression analyses were applied to determine which baseline variables predicted HAEP status. A priori, candidate predictors were divided into ‘likely’ and ‘novel’ predictors based on the literature. The following variables turned out to be significant predictors: more expected hearing aid benefits, greater social pressure, and greater self-reported hearing disability. In addition, greater hearing loss severity and stigma were predictors in women but not in men. Of note, the predictive effect of self-reported hearing disability was modified by readiness such that with higher readiness, the positive predictive effect became stronger. None of the ‘novel’ predictors added significant predictive value. The results support the notion that predictors of hearing aid uptake are also predictive of entering a HAEP. This study shows that some of these predictors appear to be gender specific or are dependent on a person’s readiness for change. After assuring the external validity of the predictors, an important next step would be to develop prediction rules for use in clinical practice, so that older persons’ hearing help-seeking journey can be facilitated.

Readability of Patient-Reported Outcome Measures in Adult Audiologic Rehabilitation

PURPOSE

The purpose of this study was to examine the readability of published patient-reported outcome measures (PROMs) designed for use in adult audiologic rehabilitation. The readability results were compared with the readability levels recommended for health information by health literacy experts.

METHOD

Reading grade levels were calculated using the Flesch-Kincaid Grade Level Formula (Flesch, 1948), Gunning Fog Index (Gunning, 1952), Simple Measure of Gobbledygook (McLaughlin, 1969), and FORCAST (Caylor, Sticht, Fox, & Ford, 1973) readability formulas for 10 published PROMs. Descriptive statistics were computed across the different PROM sections: instructions, items, response scale, and overall contents of the measure directed toward respondents.

RESULTS

The majority of the PROM sections exceeded the 6th grade reading level recommended by health literacy experts, regardless of the formula applied. All PROM sections exceeded the 6th grade reading level when calculated according to the FORCAST formula, the most appropriate readability formula for use with a nonnarrative text format, such as PROMs.

CONCLUSIONS

When developing or reevaluating PROMs designed for use in adult audiologic rehabilitation, researchers should consider ways to improve the readability of their measure, as poor readability may affect the validity of the empirical data collected using the PROM. Additionally, the adequate readability of audiologic PROMs is required if patient/family-centered care values are to be adhered to within the field of adult audiologic rehabilitation.

Evaluation of the Fecal Incontinence Quality of Life Scale (FIQL) using item response theory reveals limitations and suggests revisions

PURPOSE

The Fecal Incontinence Quality of Life Scale (FIQL) is a commonly used patient-reported outcome measure for fecal incontinence, often used in clinical trials, yet has not been validated in English since its initial development. This study uses modern methods to thoroughly evaluate the psychometric characteristics of the FIQL and its potential for differential functioning by gender.

METHODS

This study analyzed prospectively collected patient-reported outcome data from a sample of patients prior to colorectal surgery. Patients were recruited from 14 general and colorectal surgeons in Vancouver Coastal Health hospitals in Vancouver, Canada. Confirmatory factor analysis was used to assess construct validity. Item response theory was used to evaluate test reliability, describe item-level characteristics, identify local item dependence, and test for differential functioning by gender.

RESULTS

236 patients were included for analysis, with mean age 58 and approximately half female. Factor analysis failed to identify the lifestyle, coping, depression, and embarrassment domains, suggesting lack of construct validity. Items demonstrated low difficulty, indicating that the test has the highest reliability among individuals who have low quality of life. Five items are suggested for removal or replacement. Differential test functioning was minimal.

CONCLUSIONS

This study has identified specific improvements that can be made to each domain of the Fecal Incontinence Quality of Life Scale and to the instrument overall. Formatting, scoring, and instructions may be simplified, and items with higher difficulty developed. The lifestyle domain can be used as is. The embarrassment domain should be significantly revised before use.