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Auditory Rehabilitation Programs for Adults—Are They Effective?
Study Overview
Objective. To determine the effectiveness of adult auditory rehabilitation programs that focus on the use of communication strategies.
Design. Nonsystematic review of the literature.
Methods. The authors used the PubMed database to search for systematic reviews investigating the effectiveness of auditory training and auditory rehabilitation programs. Auditory training involves the patient participating in a program of training designed to enhance speech perception. Training is typically provided on a repeated basis over a number of sessions and involves practice with listening and recognition of speech-based material. Auditory rehabilitation programs can be delivered to groups or individuals and usually have a focus on supplementing information about hearing loss and hearing aids with advice and/or practice with communication strategies and the management of psychosocial aspects of hearing loss.
Main outcome measures. A variety of outcomes were measured in the individual studies.
Results. One systematic review of individual auditory training and 2 systematic reviews of group auditory rehabilitation were identified. Sweetow and Palmer [1] found that auditory training in which speech was broken down into its parts was associated with improvements in the perception of speech in the presence of background noise and better use of active listening strategies. With regard to rehabilitation programs, Hawkins [2] found evidence of short-term reduction in perceived hearing handicap but less evidence of effectiveness for other outcomes. A more recent review by Chisolm and Arnold [3] included only randomized studies that examined the effect of the program on social participation and quality of life. References for the included studies were given but the summary results of this review were not included in this paper.
Conclusion. The authors conclude that there is some evidence that auditory rehabilitation programs are associated with improvements in social participation and quality of life but they acknowledge that more evidence is required.
Commentary
Adult acquired hearing loss is a common long-term condition which in the majority of cases is not remediable by surgical or medical intervention. It is the second leading cause of years lived with a disability [4]. Intervention options for people with hearing loss include hearing aid fitting and/or participation in a rehabilitative program that might include information about hearing and communication and practice or experience with listening or communication tasks [5,6]. Poorly managed hearing loss is associated with negative consequences including depression and cognitive decline [7,8]. Identifying effective management options for hearing loss can reduce these consequences and improve quality of life. In the current paper, Cardemil et al review the evidence for the effectiveness of adult auditory rehabilitation. They note that hearing aids alone cannot ameliorate all of the difficulties caused by age-related hearing loss, where cognitive factors play a significant role. They provide a rationale for why communication-based training in auditory rehabilitation has been recommended as a substitute or supplement to hearing aid fitting. That is, such training addresses the cognitive and communication difficulties that exist in addition to the hearing loss.
This paper summarises the findings of 3 systematic reviews: one on individual auditory rehabilitation and 2 on group rehabilitation. There was heterogeneity among the programs and the methods used to assess their effectiveness were variable. The reviewers conclude that there appears to be some short-term benefit to auditory rehabilitation programs but effect sizes, where effects are seen, are small and more research is needed to establish the effectiveness of these programs.
A limitation of this review is that it was nonsystematic and did not critically appraise the quality of the included systematic reviews. One weakness of the systematic reviews presented is that they did not consider interactions between content and delivery of interventions and comparisons. Individual auditory rehabilitation and group rehabilitation are typically delivered over many sessions in contrast to control groups, which often receive “standard care” delivered over a single or limited number of sessions. Therefore, where an effect exists it is unclear whether the “active ingredient” contributing to the effect is the rehabilitative content delivered or the number of sessions over which it is provided. This is a possible confounding factor not acknowledged or discussed in these systematic reviews.
In addition, any discussion which seeks to assess effectiveness should define outcomes of interest or at least review the range of outcomes that have been studied and how they are relevant to the problem being addressed. There is a lack of consensus on what the important clinical outcomes are for hearing health care [9] and a dearth of research on longer-term outcomes; this could have been explored.
Applications for Clinical Practice
This summary of 3 systematic reviews highlights the need for further research in this area. Studies that measure long-term outcomes (1 year or more) and that are appropriately powered are needed. In addition, the possible interaction between different potentially active components of complex interventions must be acknowledged. Health care professionals and policy makers need to be aware of these factors when reviewing evidence and making decisions that impact on clinical practice.
—Fiona Barker, Department of Health Care Management and Policy, University of Surrey, Guildford, UK
1. Sweetow R, Palmer CV. Efficacy of individual auditory training in adults: a systematic review of the evidence. J Am Acad Audiol 2005;16:494–504.
2. Hawkins DB. Effectiveness of counseling-based adult group aural rehabilitation programs: a systematic review of the evidence. J Am Acad Audiol 2005;16:485–93.
3. Chisolm TH, Arnold M. Evidence about the effectiveness of aural rehabilitation programs for adults. In: Wong L, Hickson L, editors. Evidence-based practice in audiology. San Diego: Plural; 2012.
4. World Health Organisation. Facts about deafness. 2012. Accessed 6 Nov 2014 at www.who.int/pbd/deafness/facts/en/.
5. Laplante-Levesque A, Hickson L, Worrall L. Rehabilitation of older adults with hearing impairment: a critical review. J Aging Health 2010;22:143–53.
6. Pronk M, Kramer SE, Davis AC, Stephens D, Smith PA, Thodi C, et al. Interventions following hearing screening in adults: a systematic descriptive review. Int J Audiol 2011;50:594–609.
7. Lin FR. Hearing loss and cognition among older adults in the United States. J Gerontol A Biol Sci Med Sci 2011;66:1131–6.
8. Saito H, Nishiwaki Y, Michikawa T, et al. Hearing handicap predicts the development of depressive symptoms after 3 years in older community-dwelling Japanese. J Am Geriatr Soc 2010;58:93–7.
9. Humes LE, Krull V. Hearing aids for adults. In: Wong L, Hickson L, editors. Evidence-based practice in audiology. San Diego: Plural; 2012.
Study Overview
Objective. To determine the effectiveness of adult auditory rehabilitation programs that focus on the use of communication strategies.
Design. Nonsystematic review of the literature.
Methods. The authors used the PubMed database to search for systematic reviews investigating the effectiveness of auditory training and auditory rehabilitation programs. Auditory training involves the patient participating in a program of training designed to enhance speech perception. Training is typically provided on a repeated basis over a number of sessions and involves practice with listening and recognition of speech-based material. Auditory rehabilitation programs can be delivered to groups or individuals and usually have a focus on supplementing information about hearing loss and hearing aids with advice and/or practice with communication strategies and the management of psychosocial aspects of hearing loss.
Main outcome measures. A variety of outcomes were measured in the individual studies.
Results. One systematic review of individual auditory training and 2 systematic reviews of group auditory rehabilitation were identified. Sweetow and Palmer [1] found that auditory training in which speech was broken down into its parts was associated with improvements in the perception of speech in the presence of background noise and better use of active listening strategies. With regard to rehabilitation programs, Hawkins [2] found evidence of short-term reduction in perceived hearing handicap but less evidence of effectiveness for other outcomes. A more recent review by Chisolm and Arnold [3] included only randomized studies that examined the effect of the program on social participation and quality of life. References for the included studies were given but the summary results of this review were not included in this paper.
Conclusion. The authors conclude that there is some evidence that auditory rehabilitation programs are associated with improvements in social participation and quality of life but they acknowledge that more evidence is required.
Commentary
Adult acquired hearing loss is a common long-term condition which in the majority of cases is not remediable by surgical or medical intervention. It is the second leading cause of years lived with a disability [4]. Intervention options for people with hearing loss include hearing aid fitting and/or participation in a rehabilitative program that might include information about hearing and communication and practice or experience with listening or communication tasks [5,6]. Poorly managed hearing loss is associated with negative consequences including depression and cognitive decline [7,8]. Identifying effective management options for hearing loss can reduce these consequences and improve quality of life. In the current paper, Cardemil et al review the evidence for the effectiveness of adult auditory rehabilitation. They note that hearing aids alone cannot ameliorate all of the difficulties caused by age-related hearing loss, where cognitive factors play a significant role. They provide a rationale for why communication-based training in auditory rehabilitation has been recommended as a substitute or supplement to hearing aid fitting. That is, such training addresses the cognitive and communication difficulties that exist in addition to the hearing loss.
This paper summarises the findings of 3 systematic reviews: one on individual auditory rehabilitation and 2 on group rehabilitation. There was heterogeneity among the programs and the methods used to assess their effectiveness were variable. The reviewers conclude that there appears to be some short-term benefit to auditory rehabilitation programs but effect sizes, where effects are seen, are small and more research is needed to establish the effectiveness of these programs.
A limitation of this review is that it was nonsystematic and did not critically appraise the quality of the included systematic reviews. One weakness of the systematic reviews presented is that they did not consider interactions between content and delivery of interventions and comparisons. Individual auditory rehabilitation and group rehabilitation are typically delivered over many sessions in contrast to control groups, which often receive “standard care” delivered over a single or limited number of sessions. Therefore, where an effect exists it is unclear whether the “active ingredient” contributing to the effect is the rehabilitative content delivered or the number of sessions over which it is provided. This is a possible confounding factor not acknowledged or discussed in these systematic reviews.
In addition, any discussion which seeks to assess effectiveness should define outcomes of interest or at least review the range of outcomes that have been studied and how they are relevant to the problem being addressed. There is a lack of consensus on what the important clinical outcomes are for hearing health care [9] and a dearth of research on longer-term outcomes; this could have been explored.
Applications for Clinical Practice
This summary of 3 systematic reviews highlights the need for further research in this area. Studies that measure long-term outcomes (1 year or more) and that are appropriately powered are needed. In addition, the possible interaction between different potentially active components of complex interventions must be acknowledged. Health care professionals and policy makers need to be aware of these factors when reviewing evidence and making decisions that impact on clinical practice.
—Fiona Barker, Department of Health Care Management and Policy, University of Surrey, Guildford, UK
Study Overview
Objective. To determine the effectiveness of adult auditory rehabilitation programs that focus on the use of communication strategies.
Design. Nonsystematic review of the literature.
Methods. The authors used the PubMed database to search for systematic reviews investigating the effectiveness of auditory training and auditory rehabilitation programs. Auditory training involves the patient participating in a program of training designed to enhance speech perception. Training is typically provided on a repeated basis over a number of sessions and involves practice with listening and recognition of speech-based material. Auditory rehabilitation programs can be delivered to groups or individuals and usually have a focus on supplementing information about hearing loss and hearing aids with advice and/or practice with communication strategies and the management of psychosocial aspects of hearing loss.
Main outcome measures. A variety of outcomes were measured in the individual studies.
Results. One systematic review of individual auditory training and 2 systematic reviews of group auditory rehabilitation were identified. Sweetow and Palmer [1] found that auditory training in which speech was broken down into its parts was associated with improvements in the perception of speech in the presence of background noise and better use of active listening strategies. With regard to rehabilitation programs, Hawkins [2] found evidence of short-term reduction in perceived hearing handicap but less evidence of effectiveness for other outcomes. A more recent review by Chisolm and Arnold [3] included only randomized studies that examined the effect of the program on social participation and quality of life. References for the included studies were given but the summary results of this review were not included in this paper.
Conclusion. The authors conclude that there is some evidence that auditory rehabilitation programs are associated with improvements in social participation and quality of life but they acknowledge that more evidence is required.
Commentary
Adult acquired hearing loss is a common long-term condition which in the majority of cases is not remediable by surgical or medical intervention. It is the second leading cause of years lived with a disability [4]. Intervention options for people with hearing loss include hearing aid fitting and/or participation in a rehabilitative program that might include information about hearing and communication and practice or experience with listening or communication tasks [5,6]. Poorly managed hearing loss is associated with negative consequences including depression and cognitive decline [7,8]. Identifying effective management options for hearing loss can reduce these consequences and improve quality of life. In the current paper, Cardemil et al review the evidence for the effectiveness of adult auditory rehabilitation. They note that hearing aids alone cannot ameliorate all of the difficulties caused by age-related hearing loss, where cognitive factors play a significant role. They provide a rationale for why communication-based training in auditory rehabilitation has been recommended as a substitute or supplement to hearing aid fitting. That is, such training addresses the cognitive and communication difficulties that exist in addition to the hearing loss.
This paper summarises the findings of 3 systematic reviews: one on individual auditory rehabilitation and 2 on group rehabilitation. There was heterogeneity among the programs and the methods used to assess their effectiveness were variable. The reviewers conclude that there appears to be some short-term benefit to auditory rehabilitation programs but effect sizes, where effects are seen, are small and more research is needed to establish the effectiveness of these programs.
A limitation of this review is that it was nonsystematic and did not critically appraise the quality of the included systematic reviews. One weakness of the systematic reviews presented is that they did not consider interactions between content and delivery of interventions and comparisons. Individual auditory rehabilitation and group rehabilitation are typically delivered over many sessions in contrast to control groups, which often receive “standard care” delivered over a single or limited number of sessions. Therefore, where an effect exists it is unclear whether the “active ingredient” contributing to the effect is the rehabilitative content delivered or the number of sessions over which it is provided. This is a possible confounding factor not acknowledged or discussed in these systematic reviews.
In addition, any discussion which seeks to assess effectiveness should define outcomes of interest or at least review the range of outcomes that have been studied and how they are relevant to the problem being addressed. There is a lack of consensus on what the important clinical outcomes are for hearing health care [9] and a dearth of research on longer-term outcomes; this could have been explored.
Applications for Clinical Practice
This summary of 3 systematic reviews highlights the need for further research in this area. Studies that measure long-term outcomes (1 year or more) and that are appropriately powered are needed. In addition, the possible interaction between different potentially active components of complex interventions must be acknowledged. Health care professionals and policy makers need to be aware of these factors when reviewing evidence and making decisions that impact on clinical practice.
—Fiona Barker, Department of Health Care Management and Policy, University of Surrey, Guildford, UK
1. Sweetow R, Palmer CV. Efficacy of individual auditory training in adults: a systematic review of the evidence. J Am Acad Audiol 2005;16:494–504.
2. Hawkins DB. Effectiveness of counseling-based adult group aural rehabilitation programs: a systematic review of the evidence. J Am Acad Audiol 2005;16:485–93.
3. Chisolm TH, Arnold M. Evidence about the effectiveness of aural rehabilitation programs for adults. In: Wong L, Hickson L, editors. Evidence-based practice in audiology. San Diego: Plural; 2012.
4. World Health Organisation. Facts about deafness. 2012. Accessed 6 Nov 2014 at www.who.int/pbd/deafness/facts/en/.
5. Laplante-Levesque A, Hickson L, Worrall L. Rehabilitation of older adults with hearing impairment: a critical review. J Aging Health 2010;22:143–53.
6. Pronk M, Kramer SE, Davis AC, Stephens D, Smith PA, Thodi C, et al. Interventions following hearing screening in adults: a systematic descriptive review. Int J Audiol 2011;50:594–609.
7. Lin FR. Hearing loss and cognition among older adults in the United States. J Gerontol A Biol Sci Med Sci 2011;66:1131–6.
8. Saito H, Nishiwaki Y, Michikawa T, et al. Hearing handicap predicts the development of depressive symptoms after 3 years in older community-dwelling Japanese. J Am Geriatr Soc 2010;58:93–7.
9. Humes LE, Krull V. Hearing aids for adults. In: Wong L, Hickson L, editors. Evidence-based practice in audiology. San Diego: Plural; 2012.
1. Sweetow R, Palmer CV. Efficacy of individual auditory training in adults: a systematic review of the evidence. J Am Acad Audiol 2005;16:494–504.
2. Hawkins DB. Effectiveness of counseling-based adult group aural rehabilitation programs: a systematic review of the evidence. J Am Acad Audiol 2005;16:485–93.
3. Chisolm TH, Arnold M. Evidence about the effectiveness of aural rehabilitation programs for adults. In: Wong L, Hickson L, editors. Evidence-based practice in audiology. San Diego: Plural; 2012.
4. World Health Organisation. Facts about deafness. 2012. Accessed 6 Nov 2014 at www.who.int/pbd/deafness/facts/en/.
5. Laplante-Levesque A, Hickson L, Worrall L. Rehabilitation of older adults with hearing impairment: a critical review. J Aging Health 2010;22:143–53.
6. Pronk M, Kramer SE, Davis AC, Stephens D, Smith PA, Thodi C, et al. Interventions following hearing screening in adults: a systematic descriptive review. Int J Audiol 2011;50:594–609.
7. Lin FR. Hearing loss and cognition among older adults in the United States. J Gerontol A Biol Sci Med Sci 2011;66:1131–6.
8. Saito H, Nishiwaki Y, Michikawa T, et al. Hearing handicap predicts the development of depressive symptoms after 3 years in older community-dwelling Japanese. J Am Geriatr Soc 2010;58:93–7.
9. Humes LE, Krull V. Hearing aids for adults. In: Wong L, Hickson L, editors. Evidence-based practice in audiology. San Diego: Plural; 2012.