Outcome Measures

When should outcomes be assessed?

- Assessment at the 2-4 week check appointment may be too soon - Self-reported outcomes are fairly stable after about 6 weeks - Prior to that, there may be a "Halo" effect. Satisfaction is greater and handicap is less right after the fitting than it is 3-12 months later. However, most companies only give you 60 days to return hearing aids.

T/F

Some practices consider low return rate to be validation of successful intervention. The authors disagree

the percentage of problems reported in the unaided condition minus the percentage of problems reported in the aided condition

benefit score

Why are outcome measures needed?

- To quantify the impact of the management or treatment scheme - To determine if the patient's communication ability is improved - To verify that we met our intervention goals - 3rd party payers require documentation of real-world benefit in addition to published lab results

Patient nominates specific communicative areas of difficulty at the intake evaluation to guarantee relevancy. The list of problems is ranked and prioritized.

Client Oriented Scale of Improvement (COSI)

Profile of Aided Loudness (PAL)

Determines if the goal of maintaining "normal" loudness has been achieved 12 items in 3 categories: Soft, average, and loud sounds

- Measures benefit while minimizing the personality effects of the patient (focusing more on the actual device) - Focuses on measuring differences between devices or technologies -speech cues, listening effort, pleasantness, quietness, convenience, and use

Device Oriented Subjective Outcome (DOSO)

Patient directly estimates degree of benefit in a variety of situations. Only requires one administration after the fitting.

Direct Change Measure

- includes 7 standard questions covering 4 standard situations and up to 4 situations nominated by the patient - initial disability, handicap, use, benefit, satisfaction, and residual disability - performed face to face before and after fitting, there is also a computer version

GHAPB

A very short 7-item (daily use, benefit, residual activity limitations, satisfaction, residual participation limitations, impact on others, and QOL) universal survey with 2 sets of norms: mild-to-moderate loss and moderate-to-severe loss - significant others can also fill out this survey

International Inventory for Hearing Aids (IOI-HA)

- Designed to assess satisfaction, not benefit (positive effect, service and cost, negative features, and personal image) - Direct measure: Done after the rehabilitative program is complete - Paper and pencil or interview

Satisfaction and Amplification in Daily Life (SADL)

- designed to specifically look at binaural advantage - Sensitive to unilateral versus bilateral fitting differences - SSQ-B compares unaided to aided, while SSQ-C compares two aided conditions - Patient is scored on a scale of 1 to 10 "not at all" to "perfectly"(10 represents excellent performance for a given environment)

Speech, Spatial, and Qualities of Hearing Scale (SSQ)

Patient estimates degree of change resulting from use of hearing aids. The baseline (unaided state) measure is done before fitting and the aided (state) measure is done after

State measures

Does hearing loss effect quality of life? Do hearing aids improve quality of life?

Yes and yes!

measures ease of communication, reverberation, background noise, and aversive stimuli with a questionnaire that can be administered face-to-face, pencil and paper, or on a computer. *there must be 22% benefit on each scale to be significant

abbreviated profile of hearing aid benefit (APHAB) *patient can see previous responses *it is normal to have problems (even young, normal hearing individuals report them)

Some audiologists experience difficulty administering and scoring questionnaires

audiologists burden

What does Noble's data show about bilateral HA users?

bilateral HA users perform better than monaural patients in noisy or switching environments, but not in quiet Spatial hearing is improved with bilateral fittings and listening effort is reduced

Evaluates two or more dimensions simultaneously. Gives valid results with fewer trials Mueller thinks the use of speech materials is verification

modified simplex

SADL subscales: How troublesome are background noises and feedback, and can the aids be used on the telephone?

negative features

compare several stimuli along some defined dimension (eg. "Which is louder: A or B? B or C? A or C?").

paired comparisons

Patient may have difficulty completing questionnaires

patient burden

SADL subscales: How do the hearing aids look and how do others perceive them?

personal image

SADL subscales: Has the rehabilitation program decreased communication disability, improved self-confidence and sound quality?

positive effect

SADL subscales: Are the hearing aids reliable, are the costs reasonable, and is the clinician competent?

service and cost

"Rank these tones from softest to loudest."

stimulus ranking

Patient rates a stimulus on a set scale

stimulus rating

Directly measures and demonstrates how well speech (phonemes, syllables, words, sentences, quiet or noise) is heard with hearing aids, usually a major objective for patients

supplemental speech materials