Dual sensory impairment in the older patient: a randomized controlled trial to the effectiveness of a Dual Sensory Loss-protocol

The primary outcomes will be measurde by the effects of the intervention on:

hearing-aid use, hearing-aid satisfaction, skills, compliance and

communication. The change in these primary outcomes will be measured using

several questions and tasks; examples are:

1. Specific tasks that will show the ability of the person and/or proxy to use

and manage the hearing-aid will be tested. The

patient and/or proxy will be asked to show how to put the hearing-aid in the

ear and getting it out properly, how to make sure

that the working mechanisms function properly, how to control the volume, and

how to clean, manage and change batteries.

Each task that is completed successfully will be rated by the research

assistant.

2. Communication improvement will be measured with the Communication Strategies

scale [11]. This scale consists of

statements on the patients* attitudes towards communication (e.g. watching a

person*s face facilitates communication, I am

aware of the benefits of speech reading and significant others take my hearing

loss into account). The attitudes are rated on a

five-point scale. Some statements will be changed to *dual sensory loss*

instead of *hearing loss*.

3. Communication Strategies domain of the Dutch Communication Profile for the

Hearing Impaired (CPHI) [17] will be used to

assess change in outcomes. The Communication Strategies of the CPHI consist of

three scales: Maladaptive Behavior (9

items, e.g. dominate conversation, avoid social situations, avoid

conversations, pretend to understand); Verbal Strategies (8

items, e.g. ask for repeat twice, explain hearing loss, ask people to speak up)

and Nonverbal Strategies (8 items, e.g. position

myself to hear, stay in well-lit areas at parties, watch person*s face).

The secundary outcomes will be measured by the effects of the intervention on

coping, social participation and perceived quality of life.

Change in the secondary outcomes (coping, social participation and quality of

life) will be measured with four questionnaires:

1. The Personal Adjustment domain of the CPHI (Mokkink et al, 2009) will be

used to assess change in adjustment to hearing loss. The Personal Adjustment

domain of the CPHI consist of four scales: Self-Acceptance (8 items, e.g. get

upset when can*t follow conversation, feel foolish when misunderstand),

Acceptance of Loss (9 items, e.g. try to hide hearing problem, rather miss

conversation than admit hearing loss), Stress and Withdrawal (15 items, e.g.

feel threatened by communication situations, feeling tense and anxious when

can*t understand, feel left out of conversations, don*t enjoy going places with

friends).

2. The Dutch Activity Inventory which is based on Massof*s Activity Inventory

and was recently translated and validated (Massof et al, 2005 and Bruijning et

al 2009). The D-AI can be used to assess rehabilitation needs and outcomes in

the ICF-domains. In this study, two ICF domains of the D-AI will be assessed,

namely Interpersonal Interactions and Relationships (6 rehabilitation goal

items, e.g. recognition and communication, interaction with partner, family,

relatives and friends); Community, Social and Civil Life (14 rehabilitation

goal items, e.g. follow the news, having visitors, social events, attend

cultural events, dining out, creative activities). For every goal will be asked

how important and how difficult the goal is on a 4 point-scale (not important -

very important) and a 5-point scale respectively (not difficult - impossible to

do without assistance). Multiplying both scores will provide a priority list of

rehabilitation goals. After the intervention it is expected that priorities

have diminished, either because the rehabilitation goal became less important,

or the goal became less difficult because of the intervention.

3. The Low Vision Quality Of Life questionnaire (LVQOL) will be used to assess

the vision-related quality of life outcomes of patients (Wolffsohn and Cochrane

(2000) and Van Nispen et al, 2009). The LVQOL consists of four scales: Basic

Aspects of vision (5 items, e.g. problems watching television, glare),

vision-related Mobility (5 items, e.g. crossing a street with traffic, getting

around outdoors), Adjustment to vision loss (4 items, e.g. frustrated about not

being able to do tasks because of vision, not able to visit friends or family),

reading and fine work (7 items, e.g. reading labels on medicine bottles,

reading newspaper, finding out the time, writing).

4. The Reaction of Others scale of the Hearing Handicap and Disability

Inventory (HHDI) (van den Brink, 1995) will be used to measure attitudes of

significant others towards the impairment of their partner or family member

(Kramer et al, 2004). Examples of items are I leave the impaired person out of

conversation when he/she cannot understand what is being said, I avoid starting

conversations with my impaired partner, I have the patience to repeat every

word if necessary.





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Brink RHS van den. Attitude and illness behavior in hearing impaired elderly.

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Bruijning JE, van Nispen RMA, Van Rens GHMB. Feasibility of the Dutch Activity

Inventory (D-AI): A pilot study., accepted pending revisions in Ophthalmic

Epidemiology, Dec 2009.

Kramer SE, Allessie GH, Dondorp AW, Zekveld AA, Kapteyn, TS. A home education

program for older adults with hearing

impairment and their significant others: a randomized trial evaluating short-

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Massof RW, Hsu CT, Baker FH, Barnett GD, Park WL, Deremeik JT et al. Visual

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