Auditory Disablements: An Update: Discapacidad auditiva: Una actualization

Representing and organizing information to describe the lived experience of health from a personal factors perspective in the light of the International Classification of Functioning, Disability and Health (ICF): a discussion paper

PURPOSE

To discuss the representation and organization of information describing persons' lived experience of health from a personal factors perspective in the light of the International Classification of Functioning, Disability and Health, using spinal cord injury as a case in point for disability.

METHODS

The scientific literature was reviewed, discussion rounds conducted, and qualitative secondary analyses of data carried out using an iterative inductive-deductive approach.

RESULTS

Conceptual considerations are explicated that distinguish the personal factors perspective from other components of the International Classification of Functioning, Disability and Health. A representation structure is developed that organizes health-related concepts describing the internal context of functioning. Concepts are organized as individual facts, subjective experiences, and recurrent patterns of experience and behavior specifying 7 areas and 211 concept groups.

CONCLUSIONS

The article calls for further scientific debate on the perspective of personal factors in the light of the International Classification of Functioning, Disability and Health. A structure that organizes concepts in relation to a personal factors perspective can enhance the comprehensiveness, transparency and standardization of health information, and contribute to the empowerment of persons with disabilities. Implications for rehabilitation The present study collected data from scientific literature reviews, discussion rounds and qualitative secondary analyses in order to develop a representation and organization of information describing persons' lived experience of health from a personal factors perspective in the light of the International Classification of Functioning, Disability and Health. The following representation structure for health-related information from a personal factors perspective was developed: (i) Individuals facts (i.e., socio-demographical factors, position in the immediate social and physical context, personal history and biography), (ii) subjective experience (i.e., feelings, thoughts and beliefs, motives), and (iii) recurrent patterns of experience (i.e., feelings, thoughts and beliefs) and behavior. With this study, we aim to stimulate further scientific discussion about the personal factors component in the International Classification of Functioning, Disability and Health, including its application and subsequent validation for potential implementation into clinical practice.

Third-Party Disability in Spouses of Older People With Hearing Impairment

Hearing impairment is the most common communication disability in older people. The wide-ranging impact of hearing impairment means that not only does the person with hearing impairment experience the consequences, but his or her frequent communication partners do also. In this article, the authors discuss the impact of hearing impairment in older people on spouses with normal hearing using the conceptualization of “third-party disability” created by members of the World Health Organization (WHO, 2001, p. 251). Results of a series of studies conducted by the authors demonstrate that spouses experience a range of activity limitations and participation restrictions due to their partner’s hearing impairment, including a variety of stresses involving lifestyle changes, communication difficulties, and emotional consequences. In this article, the authors highlight the important role of family-centered intervention in audiologic rehabilitation for older adults and emphasize the need to increase inclusion of spouses and significant others in the rehabilitation process.

Problems in functioning from the patient perspective using the International Classification of Functioning, Disability and Health (ICF) as a reference

We conducted a qualitative, multicenter study using a focus group design to explore the lived experiences of persons with any kind of primary sleep disorder with regard to functioning and contextual factors using six open-ended questions related to the International Classification of Functioning, Disability and Health (ICF) components. We classified the results using the ICF as a frame of reference. We identified the meaningful concepts within the transcribed data and then linked them to ICF categories according to established linking rules. The six focus groups with 27 participants yielded a total of 6986 relevant concepts, which were linked to a total of 168 different second-level ICF categories. From the patient perspective, the ICF components: (1) Body Functions; (2) Activities & Participation; and (3) Environmental Factors were equally represented; while (4) Body Structures appeared poignantly less frequently. Out of the total number of concepts, 1843 concepts (26%) were assigned to the ICF component Personal Factors, which is not yet classified but could indicate important aspects of resource management and strategy development of those who have a sleep disorder. Therefore, treatment of patients with sleep disorders must not be limited to anatomical and (patho-)physiological changes, but should also consider a more comprehensive view that includes patient's demands, strategies and resources in daily life and the contextual circumstances surrounding the individual.

Incidence, persistence, and progression of tinnitus symptoms in older adults: the Blue Mountains Hearing Study

OBJECTIVE

Temporal population-based data on tinnitus are lacking. We used a representative older population-based cohort to establish 5-yr incidence, persistence, and progression of tinnitus symptoms.

DESIGN

Two thousand six participants of the Blue Mountains Hearing Study (1997-1999) had complete tinnitus data, and of these, 1214 participants were followed up at 5-yr examinations in 2002-2004. Presence of prolonged tinnitus was assessed by a positive response to a single question administered by an audiologist. Incident tinnitus was defined in participants who were free of tinnitus symptoms at the baseline study in 1997-1999 but who reported tinnitus symptoms at the 5-yr follow-up in 2002-2004. Progression of tinnitus was defined as the increase in annoyance of tinnitus symptoms from baseline to the 5-yr follow-up study. Persistence of tinnitus symptoms was defined as the presence of tinnitus symptoms at both the baseline and follow-up examinations. Hearing impairment was measured as the pure-tone average (PTA) of audiometric hearing thresholds at 500, 1000, 2000, and 4000 Hz (PTA0.5-4 kHz), defining bilateral hearing loss as PTA0.5-4 kHz >25 dB HL.

RESULTS

Five-year incidence of tinnitus was 18.0%. A significant age trend was observed for the 5-yr incidence (p = 0.005), with incident tinnitus decreasing with age. Hearing loss increased the risk of developing incident tinnitus, age-sex adjusted odds ratio 2.13 (95% confidence interval, 1.40 to 3.24). Most (55.5%) incident tinnitus cases reported symptoms that were only mildly annoying. Tinnitus at baseline persisted in 81.6% of participants. Of those reporting mildly annoying tinnitus at baseline, 39.6% progressed to moderately annoying and 5.9% to severely annoying tinnitus. At the follow-up, a higher frequency of participants with persistent tinnitus (old cases) reported their symptoms as very/extremely annoying compared with the new (incident) cases of tinnitus (p = 0.01). A high proportion (85.2%) of subjects receiving tinnitus treatment (mainly medications and hearing aid) at baseline still reported tinnitus at 5-yr examinations.

CONCLUSIONS

Incident tinnitus was frequent, with nearly one in five older adults suffering from this condition after 5 yrs. Tinnitus symptoms persisted in more than three-quarters of the cohort, during the 5 yrs. Longitudinal data are an important contribution to the research evidence base to support timely intervention and effective management of this frequent symptom.

Alzheimer's disease-associated disability: An ICF approach

PURPOSE

The aim of the study is to provide a description of dementia-associated disability in Alzheimer's disease (AD) patients through the International Classification of Functioning, Disability and Health (ICF).

METHOD

Twenty-six AD patients at different stages of disease participated in the study. Mini Mental State Examination (MMSE) and Global Deterioration Scale (GDS) were used to stage the degree of cognitive impairment and the stage of disease, respectively. All subjects were classified using the ICF categories in the more detailed four-level version. Correlation between compromised ICF items and both MMSE and GDS scores were calculated through Spearman Rho test.

RESULTS

Mental functions were impaired in all the subjects examined. Data on activity and participation showed that not only domestic life, self care, and mobility but also communication and interaction and social relationships are compromised in AD patients. Three main areas appeared as the most relevant facilitators: products and technology, support and relationship and services, systems and policies. ICF codes were generally correlated with both MMSE and GDS: subjects who appeared more compromised on MMSE and GDS showed higher impairment of functions, activity limitation, and participation restriction.Conclusion. ICF is a useful tool to describe health status in AD patients in that it underlines important aspects of daily living generally not considered by activity of daily living scales such as communication, social relationships, and recreation and leisure.

Occupational performance: Comparing normally-hearing and hearing-impaired employees using the Amsterdam Checklist for Hearing and Work

This study compares the occupational performance of employees with and without hearing impairment, and aims to identify occupational difficulties specifically related to hearing loss. The Amsterdam Checklist for Hearing and Work was administered to 150 hearing-impaired employees and 60 normally-hearing colleagues. A multivariate analysis of variance was performed to test group effects, and to examine differences between means. Factors predicting sick-leave were identified by regression analyses. A significant group effect (p < 0.01) was found. Hearing-impaired employees differed from normally-hearing colleagues in their perception of 'environmental noise', 'job control' and the 'necessity to use hearing activities' at work. Also, sick-leave due to distress occurred significantly more often in the hearing impaired group (p < 0.05). 'Hearing impairment', 'job demand', and the requirement to 'recognize/distinguish between sounds' were the strongest risk-factors for stress related sick-leave. The importance of hearing functions besides speech communication is discussed. Implications for rehabilitation are suggested. In future research, hearing loss should be considered as a risk factor for fatigue and mental distress which may lead to sick-leave.

The impact of cochlear implants from the perspective of significant others of adult cochlear implant users

OBJECTIVE

To explore the benefits and shortcomings of cochlear implants as perceived by a cochlear implant user's significant other in the context of the World Health Organization's International Classification of Functioning, Disability and Health (ICF).

STUDY DESIGN

An open-ended questionnaire concerning the perceived shortcomings and benefits of the implant was completed by the significant others of cochlear implants users.

SETTING

The study involved the participants of an adult cochlear implant program.

SUBJECTS

Significant others as selected by the cochlear implant user.

MAIN OUTCOME MEASURE

Nature of effects reported by the significant other relating to both the cochlear implant user and the significant other using the ICF domains.

RESULTS

Benefits experienced by the significant others included a decrease in communication burden and an increased participation in life activities. Those affecting the cochlear implant user were related to psychological issues, particularly an increase in confidence. Improved quality of life was reported for both partners. Reported shortcomings predominantly involved the cochlear implant user and were device related.

CONCLUSION

Because family and friends play an important role in how those with a profound hearing impairment cope with the impairment, it is important to acknowledge the impact that an intervention has on those supportive individuals. This study shows that a cochlear implant provides psychosocial and acoustic benefits for the significant other and the cochlear implant user. The ICF was able to accommodate both the auditory and nonauditory impact of the cochlear implant and the residual hearing difficulty.

Assessment and amelioration of hyperacusis in tinnitus patients

CONCLUSIONS

Tinnitus can be bothersome even without hyperacusis. The good correlation found in this study between the multiple-activity scale for hyperacusis (MASH) score and the overall annoyance of hyperacusis score supports the reliability of self-rating of hyperacusis. Objectives. A prospective study was undertaken to investigate the relationships between hyperacusis and tinnitus and to determine whether hyperacusis can be rapidly controlled over time.

MATERIAL AND METHODS

All tinnitus patients seen over a period of 16 months with surnames beginning with the letters A L (n = 249) were assessed during a structured interview using (i) a scale ranging from 0 to 10 for assessing the annoyance of tinnitus and the overall annoyance of hyperacusis and (ii) the newly introduced MASH.

RESULTS

The annoyance of tinnitus was greater in females. The prevalence of hyperacusis was high (79%). The annoyance of hyperacusis varied. Patients were categorized into five groups according to the hyperacusis annoyance score, as follows: no hyperacusis; mild hyperacusis (< or = 3); moderate hyperacusis (3.1-5.0); substantial hyperacusis (5.1-7.0); and severe hyperacusis (> or = 7.1). Individuals with severe hyperacusis were younger than those in the other groups. The correlation between the annoyance of tinnitus and the annoyance of hyperacusis was poor (r = 0.35). No audiometric difference was found between categories, whereas self-rated hearing deficiency increased with the annoyance of hyperacusis. A good correlation (r = 0.89) was found between the overall annoyance of hyperacusis and the MASH score. Changes over time, assessed in 32 patients investigated at least 3 times, showed more frequent improvement in hyperacusis (63%) than tinnitus (47%).

Prevalence and characteristics of tinnitus in older adults: the Blue Mountains Hearing Study

There have been few recent estimates of the prevalence of tinnitus from large population-based samples of older persons. Our study aimed to assess the prevalence and characteristics of prolonged tinnitus in a representative sample of 2015 adults aged 55-99 years, residing in the Blue Mountains, west of Sydney, Australia, during 1997-99. All participants underwent a detailed hearing examination by an audiologist, including comprehensive questions about hearing. After age adjustment, subjects reporting tinnitus had significantly worse hearing at both lower and higher frequencies (p < 0.001). This difference was more marked in younger than in older subjects (p < 0.05). Overall, 602 subjects (30.3%) reported having experienced tinnitus, with 48% reporting symptoms in both ears. Tinnitus had been present for at least 6 years in 50% of cases, and most (55%) reported a gradual onset. Despite tinnitus being described as mildly to extremely annoying by 67%, only 37% had sought professional help, and only 6% had received any treatment.

Deafblindness: a challenge for assessment--is the ICF a useful tool?

The International Classification of Functioning, Disability and Health (ICF) is considered to be a big step forward in relation to the possibilities for describing disabilities. The aim of this paper is to highlight some strengths and limitations in the ICF that have been found during a study of people with deafblindness. Thirty-two adults aged 19-92 years, totally deaf and blind, as well as those with some remaining vision and hearing, were included. Questionnaires and personal interviews were used. The participants had difficulties in activities and participation on almost all investigated items. The following five circumstances could not be taken account of: fast variation in functioning due to different personal and environmental factors; choosing not to do an activity because of a health condition; time loss impacting on quality of life; health risks related to particular impairments; and obligations. The ICF needs to address these questions and needs to be further developed.