A Clinically Valuable Interaction in the Midst of COVID-19 and Beyond: A Viewpoint on the Importance of Patient-Centered Outcomes in Rehabilitative Audiology

Purpose In this article, we describe the problems that patients and audiologists face today during the COVID-19 pandemic when accessing and delivering hearing health care. Additionally, we introduce a proactive rehabilitative counseling approach to hearing aid follow-up care now and how it may continue in future practice. Method Combining current literature, clinical practice, and results from a recent dissertation study, decision trees were created to guide patient engagement and prioritize follow-up care. Results The central focus is on patient-centered communication needs and self-efficacy. The benchmark for the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids questionnaire is set at an 80% composite score, with further interpretation of subscales to identify the format and focus of subsequent clinical interactions. Follow-up care can be delivered remotely during the COVID-19 pandemic and in hybrid formats combining remote and in-person services in the future. Conclusions Audiology follow-up appointments may be elective, but patients are still in need of clinician interaction to help mitigate social isolation. We suggest that audiologists reach out to proactively manage communication needs of patients through increased access to rehabilitative audiology.

A Client Oriented Scale of Improvement in Tinnitus for Therapy Goal Planning and Assessing Outcomes

There is a need to develop methods to help clinicians work with clients to select and personalize tinnitus therapies. The use of validated measures to determine treatment success is also essential for research and clinical practice. A goal planning method widely used in audiologic rehabilitation is the client oriented scale of improvement (COSI). A modified version of the COSI has been used to identify tinnitus treatment goals and outcomes (client oriented scale of improvement in tinnitus [COSIT]).The aims of this study were to identify treatment goals in a clinic sample and ascertain the convergent validity of the COSIT to three widely used standardized questionnaires.A retrospective evaluation of client treatment goals using thematic analysis and correlational analysis of secondary research data comparing the COSIT to tinnitus handicap questionnaire (THQ), tinnitus handicap inventory (THI), and tinnitus functional index (TFI).One hundred and twenty-two adult patients and research participants attending the University of Auckland Hearing and Tinnitus Clinic.Specific treatment goals were categorized into 11 themes. The most common treatment goals (>10% of responses) were: (1) Reducing tinnitus’ effects on Hearing. (2) Improved wellbeing and being less depressed. (3) Coping with or controlling the tinnitus. (4) Managing the effect of the environment (context) on tinnitus. (5) Improving sleep. (6) Understanding tinnitus. Individuals differed in their complaints and priorities for treatment. The COSIT showed moderate convergent validity with the THQ, THI, and TFI indicating that the total scores measured similar constructs.The COSIT is a pragmatic method for determining tinnitus treatment goals and priorities in a format that should be familiar to audiologists.

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.

The Relationship Between Hearing Aid Self-Efficacy and Hearing Aid Satisfaction

Purpose The purpose of this study was to investigate the relationship between self-efficacy for hearing aids (HAs) and satisfaction with HAs in a group of adult HA owners. Method Forty-seven adults acquiring HAs (new and experienced owners) completed a demographic questionnaire, the Hearing Handicap Questionnaire (Gatehouse & Noble, 2004), and received an audiometric evaluation prior to HA fitting. Twelve weeks following the completion of the HA fitting, they completed the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids (Smith & West, 2006) and the Satisfaction with Amplification in Daily Life (Cox & Alexander, 1999) questionnaires. Results There were no significant differences between experienced and new HA owners in terms of self-efficacy or HA satisfaction. The majority of participants had adequate self-efficacy for basic HA handling and adjustment to HAs. Fewer participants had adequate self-efficacy for aided listening and advanced handling of HAs. HA self-efficacy was related to HA satisfaction in three domains: positive effect and negative features of HAs and service and cost. Conclusion Many HA owners do not have adequate self-efficacy in important HA-related domains. Clinical intervention to improve self-efficacy for HAs may help improve HA satisfaction.

Connected Audiological Rehabilitation: 21st Century Innovations

Background: Tele-audiology provides a means to offer audiologic rehabilitation (AR) in a cost-, resource-, and time-effective manner. If designed appropriately, it also has the capability of personalizing rehabilitation to the user in terms of content, depth of detail, etc., thus permitting selection of the best content for a particular individual. Synchronous/real-time data collection, store and forward telehealth, remote monitoring and mobile health using smartphone applications have each been applied to components of audiologic rehabilitation intervention (sensory management, instruction in the use of technology and control of the listening environment, perceptual and communication strategies training, and counseling). In this article, the current state of tele-audiological rehabilitation interventions are described and discussed. Results: The provision of AR via tele-audiology potentially provides a cost-effective mechanism for addressing barriers to the routine provision of AR beyond provisions of hearing technology. Furthermore, if designed appropriately, it has the capability of personalizing rehabilitation to the user in terms of content, depth of detail, etc., thus permitting selection of the best content for a particular individual. However, effective widespread implementation of tele-audiology will be dependent on good education of patients and clinician alike, and researchers must continue to examine the effectiveness of these new approaches to AR in order to ensure clinicians provide effective evidence-based rehabilitation to their patients. Conclusions: While several barriers to the widespread use of tele-audiology for audiologic rehabilitation currently exist, it is concluded that through education of patients and clinicians alike, it will gain greater support from practitioners and patients over time and will become successfully and widely implemented.