ONLINE REHABILITATION OF HEARING-IMPAIRED Elisabet Sundewall Thorén, M.Sc.1; Gunilla Wänström, M.Sc.2; Marie Öberg, PhD3, Gerhard Andersson, PhD4, Thomas Lunner, PhD1, 4 1 Eriksholm Research Centre, Oticon A/S, 2Linköping University Hospital, 3Dep. of Technical Audiology, Linköping University, 4Dep. of Learning & Behaviour, Linköping University
Evaluation of the effectiveness of online rehabilitation for adult experienced hearing-aid users
INTRODUCTION The aim of the study was to evaluate online rehabilitation for adult hearing-aid users. The emphasis in the rehabilitation program was on hearing, hearing aids and communication strategies. It further more included professional guidance by an audiologist and contact with hearing impaired peers. The study was evaluated in a randomized controlled trial.
Background & Hypothesis BACKGROUND Studies in adjacent fields (tinnitus, anxiety and panic disorders) have shown promising results when using the Internet as a way of supervising and treating patients (1, 2). By using the Internet in the audiological rehabilitation process, it is possible in a cost-effective way to include additional rehabilitation components by informing and guiding hearing aid users about such topics as communication strategies, hearing tactics, and how to handle hearing aids (3-8).
HYPOTHESIS Our hypothesis was that; participants taking part in online rehabilitation program would perceive a significant reduction of their activity limitations and participation restrictions when compared to the participants in a control group when measured by the primary outcome measure The Hearing Handicap Inventory for the Elderly (HHIE; 9).
RECRUITMENT Advertisements were published in national Swedish daily newspapers in order to reach possible study participants. The inclusion criteria were; hearing Impairment and subjectively reported, significant communication difficulties (defined as HHIE > 20), used hearing-aids for at least one year, were over 18 years old, had had Swedish as a first language and had access to a computer and the Internet.
Methods A Randomized Controlled Trial Reported interest, completed screening questions, provided T0 data, HHIE score > 20 points
Telephone interview
Randomization N = 76 / Age = 69.3 (8.3) / HTL = 42 (21) dBHL
Procedure
Online rehab program (Fig 1)
5 weeks, 5 Modules - same procedure each week
Intervention group N = 38 Age = 69.4 (6.3) HTL = 24 (21) dBHL
5th week
Control group N = 38 Age = 69.2 (10.1) HTL = 42 (22) dBHL Waiting list
Finished with the online rehabilitaion
>
5 weeks later
5 weeks later
Provided T1 data
1 week st
Quiz
> Attend Discussion Forum
Professional Online Interaction
> Discussion & Conclusions Positive results of using online tools in the rehabilitation process THE RESULTS SUPPORT THE HYPOTHESIS; taking part in an online rehabilitation program, including professional guidance by an audiologist, significantly decreases participation restriction and activity limitation measured by the online questionnaire HHIE. Our results support the desire of creating online rehabilitative education with positive effects that are maintained.
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THE OUTCOME OF HHIE INDICATES that there is a long term effect of using online tools in the rehabilitation process of hearing impaired adults since a measurable decrease of participation restriction and activity limitation is observed 3 months after the online program was finished.
THE RESULTS SHOW that it is possible to successfully use online tools in the rehabilitation process of adult experienced hearing-aid users. THE EFFECTS on Activity Limitation and Participation Restriction after participating in Online rehabilitation are similar to the effects measured at hearing aid intervention for first time users(11,12).
3 months later
Provided T2 data
Provided T2 data
Statistical analysis of data using ANCOVA (Analysis of Covariance)
Reflections
>
Each week the participants were introduced to a new module. The theme of the modules emphasized on hearing, hearing aids and communication strategies(5,10) respectively. Each module included reading, written reflections, interaction with an audiologist as well as with peers, and finally completing a quiz in order to proceed to the following module.
1st -5th week
Results Measures of Participation Restriction and Activity Limitation FIG.2. RESULTS FROM HHIE; T0 = Before the study, T1 = After the study, T2 = 3 months follow-up *** p < .001
Hearing Handicap Inventory for the Elderly, HHIE (0-100 points)
FIG.1. ONLINE REHABILITATION PROGRAM
Description of the included elements in the 5 week program
3 months later
>
Reading (Book & ACE)
Provided T1 data
60 More of Activity Limitation and Participation Restriction
50
*** ***
40
30
20
10 Less of Activity Limitation and Participation Restriction
Control Group Intervention Group
0 1 T0
T12
3 T2
Information For additional information please contact Elisabet S Thorén Eriksholm Research Centre
[email protected]
IN COOPERATION WITH
eriksholm.com REFERENCES: 1. Andersson G. (2009). Using the internet to provide cognitive behaviour therapy. Behav Res Ther, 47:175–180. 2. Kaldo-Sandström V, Larsen HC & Andersson G. (2004). Internet-based Cognitive-behavioral self-help treatment of tinnitus: clinical effectiveness and predictors of outcome. American Journal of Audiology, 13:185-192. 3. Öberg M, Bohn U, Larsson T, Hickson L. (2011). Evaluation of the Active Communication Education (ACE) program in two Swedish samples. First International Conference on Cognitive Hearing Science for Communication, Linköping, Sweden. 4. Kramer S, Hella G, Allessie M, Dondorp AW, Zekveld AA & Kapteyn TS. (2005). A home education program for older adults with hearing impairment and their significant others: A randomized trial evaluating short- and long-term effects. Int J Audiol, 44:255-264. 5. Hickson L, Worrall L, Scarinci N. (2007) A randomized controlled trial evaluating the Active Communication Education program for older people with hearing impairment. Ear Hear, 28:212–230. 6. Abrams HB, Chisolm TH, McArdle R. (2002) A cost-utility analysis of adult group audiologic rehabilitation: are the benefits worth the cost? J Rehabil Res Dev, 39:549–558. 7. Thorén, E, Svensson, M, Törnqvist, A, Andersson, G, Carlbring, C, Lunner, T. (2011). Rehabilitative Online Education versus Internet Discussion Group for Hearing Aid Users: A Randomized Controlled Trial. J Am Acad Audiol, 22:274–285. 8. Sundewall Thorén E, Svensson M, Törnqvist A, Andersson G, Carlbring P, Lunner T. (2009). Online self-help via discussion forum. International Symposium on Auditory and Audiological Research, ISAAR. Elsinore, Denmark. 9. Ventry IM, Weinstein BE. (1982). The hearing Handicap Inventory for the Elderly: a new tool. Ear Hear, 3:128-134. 10. Elberling C,& Worsøe K. (2005). När ljuden blir svagare – om hörsel och hörapparater. ISBN 87-991307-08. Boarding A/S, Herlev, Denmark. 11. McArdle R, Chisholm TH, Abrams HB, Wilson RH, Doyle PJ. (2005). The WHO-DAS II: Measuring Outcomes of Hearing Aid Intervention for Adults. Trends in Amplification, 9:127-143. 12. Öberg M, Andersson G, Wänström G, Lunner T. (2008). The effects of a sound-awareness intervention: a randomized controlled trial. Audiol Med, 6:129-140.
