Validation of the Brief International Classification of Functioning, Disability and Health (ICF) core set for hearing loss: an international multicentre study

Hearing and Functioning in Everyday Life Questionnaire: Psychometric Evaluation and Revision

PURPOSE

The aim of the current study was to explore the construct validity and internal consistency reliability of the International Classification of Functioning, Disability and Health (ICF)-based original English version of the Hearing and Functioning in Everyday Life Questionnaire (HFEQ) and to revise the HFEQ based on the results.

METHOD

This study used a cross-sectional survey design. The data were collected using an online survey. Adults with self-reported hearing disability (n = 513) from the United States were included. The ICF components of body functions, activity and participation, and environmental factors were tested as the underlying structure of the HFEQ using confirmatory factor analysis and then adjusted by triangulation with previous content validation.

RESULTS

The results of the current study confirmed the ICF components of body functions, activity and participation, and environmental factors as underlying constructs of the HFEQ. However, after triangulation with previous content validation, fine adjustments were made. The revised version of the HFEQ includes two removed items and a fine-tuned factor structure.

CONCLUSION

The results confirm that the structure of the HFEQ aligns with the ICF, and the overall results indicate that HFEQ has acceptable construct validity and internal consistency.

Development of ICF core set to profile communicative competence in dyadic communication among adults who use communication devices in Taiwan

PURPOSE

This study aimed to develop an ICF core set to profile communicative competence in dyadic communication among adults who use communication devices in Taiwan.

MATERIALS AND METHODS

The study was conducted following the release of a manual by the World Health Organisation (WHO) on how to develop the International Classification of Functioning, Disability and Health (ICF) core set in three phases: Preparatory Phase, Phase I, and Phase II. The Preparatory Phase helped collect and sort second-level ICF codes into a candidate list based on different perspectives, including the Systematic Literature Review Phase (i.e., researchers' perspectives), Empirical Multi-Center Study Phase (i.e., clinical perspectives), Qualitative Study Phase (i.e., perspectives of individuals with a health condition), and Expert Survey Phase (i.e., health professionals' perspectives). An ICF core set was developed from the candidate list in Phase I through the Delphi technique, and the content validity of this core set was assessed in Phase II.

RESULTS

Altogether, 94 s-level ICF codes in the candidate list from the Preparatory Phase were included in the three rounds of the Delphi technique for Phase I. Finally, these 94 s-level ICF codes were validated and included in the core set for Phase II, including 28 in Body Functions (b), 0 in Body Structures (s), 42 in Activities and Participation (d), and 24 in Environmental Factors (e).

CONCLUSIONS

The developed ICF core set provides an evaluation tool to profile communicative competence in dyadic communication among adults using communication devices. This core set identifies the gap and future opportunities for further examining the care providers' roles, together with exploring the environmental facilitators and barriers. The implications concerning rehabilitation, limitations, and the way forward are discussed.Implications to RehabilitationThis core set was first developed in the context of Taiwan from the perspectives of adults and professionals who used communication devices to profile communicative competence in dyadic communication.This core set, which can be utilised across health care disciplines, can serve as the foundation for more holistic evaluation, profiling levels of communicative competence in daily dyadic communication among adults who use communication devices.Rehabilitation providers may decide, based on this core set, if communication devices should be proposed for adults again in order to minimise the abandonment of subsidised communication devices.Levels of communicative competence in daily dyadic communication among adults who use communication devices can be profiled through this ICF core set.

Multicentre cross-sectional study assessing content validity of the International Classification of Functioning, disability and health core set for post-acute musculoskeletal conditions in primary care physiotherapy services

OBJECTIVE

To assess content validity of the comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for post-acute musculoskeletal conditions in primary care physiotherapy services.

DESIGN

Multicentre cross-sectional study.

SUBJECTS

Patients with musculoskeletal disorders referred to primary care physiotherapy services.

METHODS

Structured interviews were conducted using categories from the ICF Core Set, and their relevance was assessed using a visual analogue scale. An ICF category had to represent a problem for at least 5% of the sample in order to be validated.

RESULTS

The study sample comprised 274 patients. All categories in the ICF Core Set were confirmed. Body functions related to pain and movement were the most commonly impaired, with ICF categories "b280 Sensation of pain" and "b710 Mobility of joint functions" having the highest prevalence (87.2% and 84.7%, respectively). Activity limitations and participation restrictions were concentrated in chapters "d4 Mobility" (63.5% for "d430 Lifting and carrying objects") and "d2 General tasks and demands" (59.5% for "d240 Handling stress and other psychological demands"). The most relevant environmental factors were "e225 Climate" (55.8%) and "e580 Health services, systems and policies" (39.4%).

CONCLUSION

The ICF Core Set for post-acute musculoskeletal conditions shows appropriate content validity for primary care physiotherapy services.

Hearing and Functioning in Everyday Life Questionnaire: Development and Validation of an ICF-Based Instrument

OBJECTIVES

Self-assessment instruments are commonly used in audiological rehabilitation. However, several studies highlight the lack of multidimensionality in existing outcome measures, with the consequence that they only partially capture aspects of functioning in everyday life for people living with hearing loss. This study aimed to develop and investigate the content validity of a self-assessment instrument based on the validated Brief International Classification of Functioning, Disability, and Health Core Set for Hearing Loss.

DESIGN

The design was a two-part instrument development study. The first part focused on the item-generation process of the instrument, named the Hearing and Functioning in Everyday Life Questionnaire (HFEQ) during an experts' workshop. The second part focused on international content validation of the instrument using group interviews. Strategic sampling was used and 30 adults with hearing loss from India, South Africa, and the United States participated in the group interviews.

RESULTS

The expert's workshop resulted in the first version of the HFEQ containing 30 items. The results from group interviews show that the content of the HFEQ was considered to be valid concerning its relevance, comprehensiveness, and comprehensibility. A majority (73%) of the HFEQ items were perceived by the participants as relevant and easy to comprehend. For the remaining 27% of the items, the content was perceived to be relevant in all countries, but some terms and expressions were reported to require rewording or clearer examples. These modifications will be made in the next step of the development process.

CONCLUSION

Content validation of the HFEQ demonstrates promising results, with participants perceiving the content as relevant and comprehensible. Further psychometric validation is required to investigate other psychometric properties, such as construct validity and reliability. The HFEQ has the potential to become a valuable new instrument for assessing everyday functioning in people with hearing loss in audiological rehabilitation and in research.

The development of a Self-Rated ICF-based questionnaire (HEAR-COMMAND Tool) to evaluate Hearing, Communication, and Conversation disability: Multinational experts' and patients' perspectives

Objective

An instrument that facilitates the advancement of hearing healthcare delivery from a biomedical model to a biopsychosocial one that underpins the International Classification of Functioning, Disability, and Health framework (ICF) brief and comprehensive Core Sets for Hearing Loss (CSHL) is currently unavailable. The objective is to describe the process of developing and validating a new questionnaire named the HEAR-COMMAND Tool created by transferring the ICF CSHL into a theory-supported, practically manageable concept.

Design

A team from Germany, the USA, the Netherlands, and Egypt collaborated on development. The following ICF domains were considered; "Body Functions" (BF), "Activities and Participation" (AP), and "Environmental Factors" (EF). The development yielded English, German, and Arabic versions. A pilot validation study with a total of 109 respondents across three countries, Germany, Egypt, and the USA was conducted to revise the item terminology according to the feedback provided by the respondents.

Results

The questionnaire included a total of 120 items. Ninety items were designed to collect information on the functioning and 30 items inquiring about demographic information, hearing status, and Personal Factors. Except for the "Body Structures" (BS) domain, all the categories of the brief ICF CSHL were covered (a total of 85% of the categories). Moreover, the items covered 44% of the comprehensive ICF CSHL categories including 73% of BF, 55% of AP, and 27% of EF domains. Overall, the terminology of 24 ICF-based items was revised based on the qualitative analysis of the respondents' feedback to further clarify the items that were found tod be unclear or misleading. The tool highlighted the broad connection of HL with bodily health and contextual factors.

Conclusions

The HEAR-COMMAND Tool was developed based on the ICF CSHL and from multinational experts' and patients' perspectives with the aim to improve the execution of audiological services, treatment, and rehabilitation for adult patients with HL. Additional validation of the tool is ongoing. The next step would be to pair the tool with BS categories since it was excluded from the tool and determine its effectiveness in guiding hearing health care practitioners to holistically classify categories influencing hearing, communication, and conversation disability.

Enhancing Person-Centered Audiologic Rehabilitation: Exploring the Use of an Interview Tool Based on the International Classification of Functioning, Disability, and Health Core Sets for Hearing Loss

Health care interventions that are intended to improve hearing should be based on the results of individual patient assessments. To improve these assessments, the feasibility of an International Classification of Functioning, Disability, and Health (ICF)-based interview tool was tested in a single clinical setting in Sweden. Audiologists participating in the study used the interview tool during a four-week testing period and provided written reflections after each session. The use of this tool was also evaluated in a focus group interview that took place after the completion of the project. The results of this study identified both process-related and structure-related factors that were highly relevant to the implementation of this interview tool. Overall, the findings revealed that the use of this interview tool promoted person-centered care in encounters focused on clinical audiological rehabilitation. Specifically, the ICF-based holistic approach permitted the audiologists to acquire more comprehensive patient narratives. The use of the ICF interview tool facilitated patient participation and permitted the audiologist to collect more substantial and meaningful information from each patient.

Conformities and gaps of clinical audiological data with the international classification of functioning disability and health core sets for hearing loss

OBJECTIVE

The International Classification of Functioning Disability and Health (ICF) is a classification of health and health-related domains created by the World Health Organization and can be used as a standard to evaluate the health and disability of individuals. The ICF Core Set for Hearing Loss (CSHL) refers to the ICF categories found to be relative to Hearing Loss (HL) and the consequences of it on daily life. This study aimed to adapt the content of a database gathered in Hörzentrum Oldenburg gGmbH that included HL medical assessments and audiological data to the ICF.

DESIGN

ICF linking rules were applied to these assessment methods including medical interviews, ear examinations, pure-tone audiometry, Adaptive Categorical Loudness Scaling, and speech intelligibility test.

STUDY SAMPLE

1316 subjects.

RESULTS

In total, 44% of the brief and 18% of the comprehensive CSHL categories were addressed. The hearing functions were broadly evaluated. "Activities and Participation" and "Environmental Factors" were poorly examined (17% and 12% of the comprehensive CSHL categories, respectively).

CONCLUSIONS

The HL correlation with day-to-day activities limitation, performance restriction, and environmental conditions were poorly addressed. This study showed the essence of incorporating these methodologies with approaches that assess the daily-life challenges caused by HL in rehabilitation.

Best Practices in the Development, Translation, and Cultural Adaptation of Patient-Reported Outcome Measures for Adults With Hearing Impairment: Lessons From the Cochlear Implant Quality of Life Instruments

This manuscript summarizes available evidence-based best practices in the development, translation, and cultural adaptation of one type of outcome measure for adults with hearing impairment, patient-reported outcome measures (PROMs). It presents the development of the Cochlear Implant Quality of Life (CIQOL) instruments and the ongoing translation and cultural adaptation of the CIQOL-35 Profile from English to French as case studies and discusses useful lessons for selecting, developing, translating, culturally adapting, and using PROMs. Relevant best practice guides are introduced, described and their steps are illustrated with examples. Future trends in hearing-related PROMs, including computerized adaptive testing, patient-reported experience measures (PREMs), economic evaluation and allocation of scarce resources, and PROMs in low-resource settings, are discussed. The manuscript concludes on the lessons that can be learned from implementation science for the successful and sustainable integration of PROMs in clinical practice.

Experienced hearing aid users' perspectives of assessment and communication within audiology: a qualitative study using digital methods

OBJECTIVE

To explore experienced hearing aid users' perspectives of audiological assessments and the patient-audiologist communication dynamic during clinical interactions.

DESIGN

A qualitative study was implemented incorporating both an online focus group and online semi-structured interviews. Sessions were audio-recorded and transcribed verbatim. Iterative-inductive thematic analysis was carried out to identify themes related to assessment and communication within audiology practice.

STUDY SAMPLES

Seven experienced hearing aid users took part in an online focus group and 14 participated in online semi-structured interviews (age range: 22 - 86 years; 9 males, 11 females).

RESULTS

Themes related to assessment included the unaided and aided testing procedure and relating tests to real world hearing difficulties. Themes related to communication included the importance of deaf aware communication strategies, explanation of test results and patient centred care in audiology.

CONCLUSION

To ensure hearing aid services meet the needs of the service users, we should explore user perspectives and proactively adapt service delivery. This approach should be ongoing, in response to advances in hearing aid technology. Within audiology, experienced hearing aid users' value (1) comprehensive, relatable hearing assessment, (2) deaf aware patient-audiologist communication, (3) accessible services and (4) a personalised approach to recommend suitable technology and address patient specific aspects of hearing loss.

The Reliability and Validity of the Brief ICF Core Set in Patients with Chronic Obstructive Pulmonary Disease

Purpose

To analyze the reliability and validity of the Brief international classification of functioning, disability and health (ICF) core set for chronic obstructive pulmonary disease (COPD).

Patients and Methods

A cross-sectional study was conducted in four tertiary hospitals in Tianjin, China. A total of 100 patients with COPD were selected to evaluate functioning and disability involving body functions, body structures, activities and participation as well as environmental factors of the Brief ICF core set for COPD. Internal consistency was calculated by Cronbach's α. Content validity was examined using the content validity index (CVI), scale-level CVI/universal agreement, and scale-level CVI/average agreement (S-CVI/Ave). In addition, construct validity and convergent validity were also examined.

Results

The Brief ICF core set for COPD had a high internal consistency, 0.873 for the total scale, with values of 0.750, 0.640, and 0.843 for body functions, body structures, and activity and participation, respectively. The content validity was calculated by the CVI, scale-level CVI/universal agreement, and S-CVI/Ave at values of 0.80-1, 0.929, and 0.986, respectively. Meanwhile, the ICF core set for COPD had good convergent validity, correlating with the mMRC dyspnea score (r=0.690, P<0.01), and there were significant correlations between the ICF core set for COPD and COPD clinical severity grade (r=0.363, P<0.01). A four-factor model of functions and disability in the Brief ICF core set for COPD had the best fit according to confirmatory factor analysis (CFA).

Conclusion

The Brief ICF core set for COPD is a reliable and valid convenient instrument for assessing comprehensive problems in the functioning of patients with COPD, which can be used to design and to evaluate rehabilitation strategies.