Hearing aid effectiveness after aural rehabilitation - individual versus group (HEARING) trial: RCT design and baseline characteristics
Hearing impairment is the most common body system disability in veterans. In 2008, nearly 520,000 veterans had a disability for hearing loss through the Department of Veterans Affairs (VA). Changes in eligibility for hearing aid services, along with the aging population, contributed to a greater than 300% increase in the number of hearing aids dispensed from 1996 to 2006. In 2006, the VA committed to having no wait times for patient visits while providing quality clinically-appropriate care. One approach to achieving this goal is the use of group visits as an alternative to individual visits. We sought to determine: 1) if group hearing aid fitting and follow-up visits were at least as effective as individual visits, and 2) whether group visits lead to cost savings through the six month period after the hearing aid fitting. We describe the rationale, design, and characteristics of the baseline cohort of the first randomized clinical trial to study the impact of group versus individual hearing aid fitting and follow-up visits.
Participants were recruited from the VA Puget Sound Health Care System Audiology Clinic. Eligible patients had no previous hearing aid use and monaural or binaural air-conduction hearing aids were ordered at the evaluation visit. Participants were randomized to receive the hearing aid fitting and the hearing aid follow-up in an individual or group visit. The primary outcomes were hearing-related function, measured with the first module of the Effectiveness of Aural Rehabilitation (Inner EAR), and hearing aid adherence. We tracked the total cost of planned and unplanned audiology visits over the 6-month interval after the hearing aid fitting.
A cohort of 659 participants was randomized to receive group or individual hearing aid fitting and follow-up visits. Baseline demographic and self-reported health status and hearing-related measures were evenly distributed across the treatment arms.
Outcomes after the 6-month follow-up period are needed to determine if group visits were as least as good as those for individual visits and will be reported in subsequent publication.
- Veterans Benefits Administration Annual Benefits Report Fiscal Year 2008 [http://www.vba.va.gov/REPORTS/abr/2006_abr.pdf]
- Dunlop RJ, Beck LB, Dennis KC, Gonzenbach SA, Abrams HB, Berardino JT, Styer SA, Hall A: Support personnel in VA audiology. Audiology Today 2006,18(1):24–25.
- Abrams HB, Hnath-Chisolm T, Guerreiro SM, Ritterman SI: The effects of intervention strategy on self-perception of hearing handicap. Ear Hear 1992,13(5):371–377. CrossRef
- Abrams H, Hnath Chisolm TH, McArdle R: A cost-utility analysis of adult group audiologic rehabilitation: Are the benefits worth the cost? J Rehabil Res Dev 2002,39(5):549–448.
- Andersson G, Melin L, Scott B, Lindberg P: An evaluation of a behavioural treatment approach to hearing impairment. Behav Res Ther 1995,33(3):283–292. CrossRef
- Andersson G, Melin L, Scott B, Lindberg P: A two-year follow-up examination of a behavioural treatment approach to hearing tactics. Br J Audiol 1995,29(6):347–354. CrossRef
- Beynon GJ, Thornton FL, Poole C: A randomized, controlled trial of the efficacy of a communication course for first time hearing aid users. Br J Audiol 1997,31(5):345–351.
- Chisolm TH, Abrams HB, McArdle R: Short- and long-term outcomes of adult audiological rehabilitation. Ear Hear 2004,25(5):464–477. CrossRef
- Hallberg LR, Barrenas ML: Group rehabilitation of middle-aged males with noise-induced hearing loss and their spouses: evaluation of short- and long-term effects. Br J Audiol 1994,28(2):71–79. CrossRef
- Hawkins DB: Effectiveness of counseling-based adult group aural rehabilitation programs: A systematic review of the evidence. Journal of the American Academy of Audiology 2005,16(7):485–493. CrossRef
- Hickson L, Worrall L: Beyond hearing aid fitting: improving communication for older adults. Int J Audiol 2003,42(Suppl 2):2S84–91.
- Norman M, George CR, Downie A, Milligan J: Evaluation of a communication course for new hearing aid users. Scand Audiol 1995,24(1):63–69. CrossRef
- Northern J, Beyer CM: Reducing hearing aid returns through patient education. Audiology Today 1999, 11:10–11.
- Lesner SA, Thomas-Frank S, Klinger MS: Assessment of the effectiveness of an adult audiologic rehabilitation program using a knowledge-based test and a measure of hearing aid satisfaction. J Acad Rehab Audiol 2001, 34:29–40.
- Preminger JE: Should significant others be encouraged to join adult group audiologic rehabilitation classes? J Am Acad Audiol 2003,14(10):545–555. CrossRef
- Smaldino SE, Smaldino JJ: The influence of aural rehabilitation and cognitive style disclosure on the perception of hearing handicap. J Acad Rehab Audiol 1988, 21:57–64.
- Taylor KS, Jurma WE: Study suggests that group rehabilitation increases benefit of hearing aid fittings. Hearing J 1999,52(9):48–54.
- Hickson L, Worrall L, Scarinci N: A randomized controlled trial evaluating the Active Communication Education program for older people with hearing impairment. Ear and Hearing 2007,28(2):212–230. CrossRef
- Brickley GJ, Cleaver VC, Bailey S: An evaluation of a group follow-up scheme for new NHS hearing aid users. Br J Audiol 1996,30(5):307–312. CrossRef
- Effects of group composition in audiologic rehabilitation programs for hearing impaired elderly [http://www.audiologyonline.com]
- Collins MP, Souza PE, O'Neill S, Yueh B: The effectiveness of group vs. individual hearing aid visits. Journal of Rehabilitation Research and Development 2007,44(5):739–749. CrossRef
- Yueh B, McDowell JA, Collins MP, Souza PE, Loovis CF, Deyo RA: Development and Validation of the Effectiveness of Auditory Rehabilitation (EAR) Scales. Arch Otolaryngol Head Neck Surg 2005, 131:851–856. CrossRef
- Ventry IM, Weinstein BE: The hearing handicap inventory for the elderly: a new tool. Ear Hear 1982,3(3):128–134. CrossRef
- Weinstein BE, Ventry IM: Audiometric correlates of the Hearing Handicap Inventory for the elderly. J Speech Hear Disord 1983,48(4):379–384.
- Weinstein BE: Age-related hearing loss: how to screen for it, and when to intervene. Geriatrics 1994,49(8):40–45. quiz 46–47
- Weinstein B: The quantification of hearing aid benefit in the elderly: the role of self-assessment measure. Acta Otolaryngol 1991,476(suppl):257–261. CrossRef
- Newman CW, Jacobson GP, Hug GA, Weinstein BE, Malinoff RL: Practical method for quantifying hearing aid benefit in older adults. J Am Acad Audiol 1991,2(2):70–75.
- Demorest ME, Erdman SA: Development of the communication profile for the hearing impaired. J Speech Hear Disord 1987,52(2):129–143.
- Demorest ME, Erdman SA: Scale composition and item analysis of the Communication Profile for the Hearing Impaired. J Speech Hear Res 1986,29(4):515–535.
- Demorest ME, Erdman SA: Retest stability of the communication profile for the hearing impaired. Ear Hear 1988,9(5):237–242. CrossRef
- Demorest ME, Erdman SA: Factor structure of the communication profile for the hearing impaired. J Speech Hear Disord 1989,54(4):541–549.
- Fan VS, Au D, Heagerty P, Deyo RA, McDonell MB, Fihn SD: Validation of case-mix measures derived from self-reports of diagnoses and health. J Clin Epidemiol 2002,55(4):371–380. CrossRef
- Ware JE Jr, Kosinski M, Keller SD: How to score the SF-12 physical & mental health summary scales Boston, Massachusetts: Quality Metric Incorporated and The health Assessment Lab 1998.
- Spitzer RL, Kroenke K, Williams JB: Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 1999,282(18):1737–1744. CrossRef
- Kroenke K, Spitzer RL, Williams JB: The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001,16(9):606–613. CrossRef
- Dillion H: NAL-NL1: a new procedure for fitting non-linear hearing aids. Hearing J 1999.,52(4): 10, 12, 14, 16
- Yueh B, Souza PE, McDowell JA, Collins MP, Loovis CF, Hedrick SC, Ramsey SD, Deyo RA: Randomized trial of amplification strategies. Arch Otolaryngol Head Neck Surg 2001,127(10):1197–1204.
- Souza PE, Yueh B, Sarubbi M, Loovis CF: Fitting hearing aids with the Articulation Index: impact on hearing aid effectiveness. J Rehabil Res Dev 2000,37(4):473–481.
- Cox RM, Alexander GC: Measuring Satisfaction with Amplification in Daily Life: the SADL scale. Ear Hear 1999,20(4):306–320. CrossRef
- Cox RM, Alexander GC: Validation of the SADL questionnaire. Ear Hear 2001,22(2):151–160. CrossRef
- Cox RM, Alexander GC, Beyer CM: Norms for the international outcome inventory for hearing aids. J Am Acad Audiol 2003,14(8):403–413.
- Fischer D, Stewart AL, Bloch DA, Lorig K, Laurent D, Holman H: Capturing the patient's view of change as a clinical outcome measure. JAMA 1999,282(12):1157–1162. CrossRef
- Juniper EF, Guyatt GH, Willan A, Griffith LE: Determining a minimal important change in a disease-specific Quality of Life Questionnaire. J Clin Epidemiol 1994,47(1):81–87. CrossRef
- Jaeschke R, Singer J, Guyatt GH: Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials 1989,10(4):407–415. CrossRef
- Yueh B, Collins M, Souza P, Heagerty P, Loovis C, Hedrick SC: Long-term effectiveness in a randomized trial of hearing loss screening. American Auditory Society Bulletin 2005,30(1):31–32. (abs)
- Weinstein BE, Spitzer JB, Ventry IM: Test-retest reliability of the Hearing Handicap Inventory for the Elderly. Ear Hear 1986,7(5):295–299. CrossRef
- Hulley SB, Cummings SR, Browner WS, Grady D, Newman TB: Designing Clinical Research. An Epidemiologic Approach 3 Edition Philadelphia, PA: Lippincott Williams & Wilkins 2006.
- Ross M: Redefining the hearing aid selection process. Audiology Today 1999,11(2):8.
- Group Hearing Aid Orientation Programs
- Abrahamson J: Group audiologic rehabilitation. Seminars in Hearing 2000, 21:227–235. CrossRef
- Warner-Czyz AD: Clinical application of adult audiologic rehabilitation programs. Seminars in Hearing 2000, 21:235–245. CrossRef
- Spitzer JB: Toward contemporary models of adult audiologic rehabilitation. Seminars in Hearing 2000,21(3):205–212. CrossRef
- Abrahamson JE: Patient education and peer interaction facilitate hearing aid adjustment. High Performance Hearing Solutions, Vol 1: Counselling (Supplement to The Hearing Review) 1997, 1:19–22.
- Clancy DE, Cope DW, Magruder KM, Huang P, Wolfman TE: Evaluating concordance to American Diabetes Association standards of care for type 2 diabetes through group visits in an uninsured or inadequately insured patient population. Diabetes Care 2003,26(7):2032–2036. CrossRef
- Ickovics JR, Kershaw TS, Westdahl C, Rising SS, Klima C, Reynolds H, Magriples U: Group prenatal care and preterm birthweight: Results from a matched cohort study at public clinics. Obstretrics & Gynecology 2003,102(5, part 1):1051–1057. CrossRef
- Trento M, Passera P, Tomalino M, Bajardi M, Pomero F, Allione A, Vaccari P, Molinatti GM, Porta M: Group visits improve metabolic control in type 2 diabetes: A 2-year follow-up. Diabetes Care 2001,24(6):995. CrossRef
- Beck A, Scott J, Williams P, Robertson B, Jackson D, Gade G, Cowan P: A randomized trial of group outpatient visits for chronically ill older HMO members: the Cooperative Health Care Clinic. J Am Geriatr Soc 1997,45(5):543–549.
- Zrebiec J: Tips for running a successful group. Diabetes Spectrum 2003.,16(2): 108, 104 pgs
- Noffsinger EB, Scott JC: Understanding today's group visit models. Group Practice Journal 2000.,48(2): 46–48, 50, 52–44, 56–48
- Terry K: Should doctors see patients in group sessions? Med Econ 1997.,74(1): 70, 75, 79–82 passim
- Masley S, Phillips S, Copeland JR: Group office visits change dietary habits of patients with coronary artery disease-the dietary intervention and evaluation trial (D.I.E.T.). J Fam Pract 2001,50(3):235–239.
- Scott JC, Conner DA, Venohr I, Gade G, McKenzie M, Kramer AM, Bryant L, Beck A: Effectiveness of a group outpatient visit model for chronically ill older health maintenance organization members: a 2-year randomized trial of the cooperative health care clinic. J Am Geriatr Soc 2004,52(9):1463–1470. CrossRef
- Coleman EA, Eilertsen TB, Kramer AM, Magid DJ, Beck A, Conner D: Reducing emergency visits in older adults with chronic illness. A randomized, controlled trial of group visits. Eff Clin Pract 2001,4(2):49–57.
- Sadur CN, Moline N, Costa M, Michalik D, Mendlowitz D, Roller S, Watson R, Swain BE, Selby JV, Javorski WC: Diabetes management in a health maintenance organization. Efficacy of care management using cluster visits. Diabetes Care 1999,22(12):2011–2017. CrossRef
- Coleman EA, Grothaus LC, Sandhu N, Wagner EH: Chronic care clinics: a randomized controlled trial of a new model of primary care for frail older adults. J Am Geriatr Soc 1999,47(7):775–783.
- Wagner EH, Grothaus LC, Sandhu N, Galvin MS, McGregor M, Artz K, Coleman EA: Chronic care clinics for diabetes in primary care. Diabetes Care 2001,25(4):695. CrossRef
- Mazzuca SA, Moorman NH, Wheeler ML, Norton JA, Fineberg NS, Vinicor F, Cohen SJ, Clark CM Jr: The diabetes education study: a controlled trial of the effects of diabetes patient education. Diabetes Care 1986,9(1):1–10. CrossRef
- Raz I, Soskolne V, Stein P: Influence of small-group education sessions on glucose homeostasis in NIDDM. Diabetes Care 1988,11(1):67–71. CrossRef
- Rickheim PL, Weaver TW, Flader JL, Kendall DM: Assessment of group versus individual diabetes education: A randomized study. Diabetes Care 2002,25(2):269–274. CrossRef
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6963/9/233/prepub
- Hearing aid effectiveness after aural rehabilitation - individual versus group (HEARING) trial: RCT design and baseline characteristics
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
BMC Health Services Research
- Online Date
- December 2009
- Online ISSN
- BioMed Central
- Additional Links
- Author Affiliations
- 1. Health Services Research & Development Center of Excellence, VA Puget Sound Health Care System, 1100 Olive Way,Suite 1400, 98101, Seattle, WA, USA
- 2. Rehabilitation Care Service, VA Puget Sound Health Care System, 1660 South Columbian Way, 98108, Seattle, WA, USA
- 3. Department of Communication Sciences and Disorders, Francis Searle Building 2-265, Northwestern University, 2240 Campus Drive Evanston, 60208, IL, USA
- 4. Department of Health Services, University of Washington, Box 358280 Health Services, 98195, Seattle, WA, USA
- 5. Department of Biostatistics, University of Washington, F-667 Health Sciences, 98195, Seattle, WA, USA
- 6. Department of Rehabilitation Medicine, University of Washington, BB-957 Health Sciences, 98195, Seattle, WA, USA
- 7. Department of Otolaryngology/Head & Neck Surgery, University of Minnesota, 420 Delaware Street SE, 55455, Minneapolis, MN, USA