The primary objective of this study is to determine the (long term) effect of intervention with a CI in adult participants with progressive postlingual moderate/severe-to-profound sensorineural hearing loss on societal related outcomes (participation; communication profile; autonomy; cognition; listening effort; work; productivity loss; income; medical consumption; third party quality of life; quality of life, and capability). The secondary objective is to determine the effect of CI waiting time between referral and CI surgery on the same societal related outcomes, in the adults with postlingual moderate/severe-to-profound sensorineural hearing loss.
Cochlear implantation (CI) is a surgical intervention to improve the hearing of patients with profound hearing loss. Due to the improvements in CI-technology and knowledge regarding surgery and CI fitting, speech recognition with CI has improved over the past decades. This has led to relaxation of the audiological implantation criteria. Whereas CI was initially indicated for patients with total deafness, currently also patients with moderate/severe-to-profound hearing loss are eligible for CI. Moderate/severe-to-profound hearing loss has a negative effect on the patients' functioning. Because often hearing loss in adults is progressive, resulting in a decline in speech recognition, the disability might progress during this waiting time to a state in which societal participation can become even more difficult: the hearing loss might affect social participation, autonomy, work/occupational status and quality of life. However empirical data on this is not yet available. Timely intervention, like cochlear implantation may prevent societal drop out. The societal impact of cochlear implantation for patients who are (currently) eligible for CI is unknown. It is imperative to obtain this data in order to secure treatment for those who need it. This multicenter cohort observational study is set up to investigate the impact of moderate/severe-to-profound hearing loss on societal related outcomes, defined as participation; communication profile; autonomy; cognition; listening effort; work; productivity loss; income; medical consumption; third party quality of life; quality of life, and capability. The primary aim is to investigate the effect of hearing rehabilitation with cochlear implantation on these societal related outcomes. Castoredc (Castor electronic data capture) will be used for capturing research data. Questionnaires will be constructed in castors' online survey service and administered to participants online. IBM SPSS Statistics and R studio software will be used for the statistical analysis. Descriptive analysis will be conducted to assess the baseline characteristics and the continuous variables will be summarized with mean ± SD or median (interquartile range) (if not normally distributed) and categorical variables with percentage (numbers). The statistical analysis for the primary objective, the differences in baseline(T0) and T2/T3/T4 for the primary outcome variables, we will use general linear models with the outcome (differences) as independent variable. To investigate the complete pattern in time of the effects we will use mixed models, in which time is an additional explanatory categorical variable. For the secondary objective the effect between baseline(T0) and T1, short before CI surgery will be investigated. General linear models with the outcome (differences) as independent variable.
Study Type
OBSERVATIONAL
Enrollment
156
Radboudumc
Nijmegen, Gelderland, Netherlands
RECRUITINGMaastricht UMC+
Maastricht, Limburg, Netherlands
RECRUITINGAmsterdam UMC
Amsterdam, North Holland, Netherlands
RECRUITINGLeids UMC
Leiden, South Holland, Netherlands
RECRUITINGUMC Utrecht
Utrecht, Netherlands
RECRUITINGChange in Participation
Sub-scales ('family role', 'Social life and relationships' and 'work and education') of The Impact on Participation and Autonomy questionnaire (IPA).There are 4 response options for each of the 32 items about participation and autonomy. These response options range from 'very good' (score=0) to 'bad' (score =4). There are 3 response options for the items about problem experiences. These range from 'no problem' (score=0) to 'big problem'(score=2). The scores of the 32 options will be summarized per sub-scale.
Time frame: T0 (baseline), T1 (pre-operative, if waiting time > 6 months), T2 (1 year post CI surgery), T3 (2 years post CI surgery), T4 (3 years post CI surgery)
Change in Autonomy
Sub-scales ('Autonomy indoors' and 'Autonomy outdoors') of The Impact on Participation and Autonomy questionnaire (IPA)
Time frame: T0 (baseline), T1 (pre-operative, if waiting time > 6 months), T2 (1 year post CI surgery), T3 (2 years post CI surgery), T4 (3 years post CI surgery)
Change in Communication profile
Amsterdam questionnaire for Hearing and Work. Subscales derived from the Communication Profile for Hearing Impaired (CPHI) questionnaire: 'use of communication strategies' consists of: Maladaptive Behaviors; Verbal Strategies and Non-verbal Strategies 'Personal adjustment to hearing impairment' consists of: Self-acceptance; Acceptance of loss; Stress an Withdrawal.
Time frame: T0 (baseline), T1 (pre-operative, if waiting time > 6 months), T2 (1 year post CI surgery), T3 (2 years post CI surgery), T4 (3 years post CI surgery)
Change in Work experience and status
Amsterdam questionnaire for Hearing and Work.Three scales: Subscales originated from the Vragenlijst Beleving en Beoordeling van de Arbeid (VBBA) \[Questionnaire on Experience and appreciation of labor\]. Subscale are: participation \['inspraak'\], relationship with co-workers \[relatie met collega's\], Need for recovery \[herstelbehoefte\].
Time frame: T0 (baseline), T1 (pre-operative, if waiting time > 6 months), T2 (1 year post CI surgery), T3 (2 years post CI surgery), T4 (3 years post CI surgery)
Change in Work capabilities
List Work Capabilities. Sum score of total capability set for work. Because people want to achieve personal important goals and values in their work the List Work Capabilities (LWC) measures sustainable employability based on seven important labor values that are identified in previous studies. The scope of the LWC is not on health or broader economic indicators such as (sick leave) costs and benefits, rather it investigates values that the employee can realize in their specific work context.
Time frame: T0 (baseline), T1 (pre-operative, if waiting time > 6 months), T2 (1 year post CI surgery), T3 (2 years post CI surgery), T4 (3 years post CI surgery)
Change in Productivity Costs Questionnaire
The Productivity Cost Questionnaire (PCQ). Health problems often have a negative impact on the capacity for patients to maintain paid or unpaid work. From a societal perspective this productivity loss has an impact and should therefore be measured in a validated manner. The PCQ consists of 3 modules: absenteeism, presenteeism and Productivity loss at unpaid work.
Time frame: T0 (baseline), T1 (pre-operative, if waiting time > 6 months), T2 (1 year post CI surgery), T3 (2 years post CI surgery), T4 (3 years post CI surgery)
Change in Medical Consumption Questionnaire
In economic evaluations it is important to include direct costs within the healthcare system. These costs are directly related to prevention, diagnostics, therapy, rehabilitation and care of a disease or disorder. Patients are involved in their resource (health care) consumption and are therefore a reliable source of information. The consumption of health care in a variety of costs components will be investigate by the use of the medical consumption questionnaire.
Time frame: T0 (baseline), T1 (pre-operative, if waiting time > 6 months), T2 (1 year post CI surgery), T3 (2 years post CI surgery), T4 (3 years post CI surgery)
Change in Capability
ICECAP-A. The ICECAP-A is a measure of capability for adults. The ICECAP focuses on wellbeing defined in a broader sense, rather than health. It is a questionnaire that comprises 5 attributes. Attachment, Stability, Achievement, Enjoyment, Autonomy.
Time frame: T0 (baseline), T1 (pre-operative, if waiting time > 6 months), T2 (1 year post CI surgery), T3 (2 years post CI surgery), T4 (3 years post CI surgery)
Change in Generic Quality of Life (EQ5D-5L)
EuroQol five-dimension scale questionnaire (EQ5D-5L)
Time frame: T0 (baseline), T1 (pre-operative, if waiting time > 6 months), T2 (1 year post CI surgery), T3 (2 years post CI surgery), T4 (3 years post CI surgery)
Change in Generic Quality of Life (HUI-3)
Health Utility Index Mark 3 (HUI-3)
Time frame: T0 (baseline), T1 (pre-operative, if waiting time > 6 months), T2 (1 year post CI surgery), T3 (2 years post CI surgery), T4 (3 years post CI surgery)
Change in Third Party Hearing loss related quality of life measured by Hearing Impairment Impact-Significant Other Profile (HII-SOP).
The HII-SOP is a 20-item scale with three subscales: 1) Emotions that arise when having a spouse with hearing loss as well as the impact of the hearing loss on the marital relationship, 2) The impact of the hearing loss on the social life of the spouse, and 3) the communication strategies used by the spouse
Time frame: T0 (baseline), T1 (pre-operative, if waiting time > 6 months), T2 (1 year post CI surgery), T3 (2 years post CI surgery), T4 (3 years post CI surgery)
Change in Disease specific Quality of Life measured by Nijmegen Cochlear Implant Questionnaire (NCIQ)
Comprising of subdomains; Basic sound perception; Advanced sound perception; Speech production; Self-esteem; Activity limitations; Social interaction.
Time frame: T0 (baseline), T1 (pre-operative, if waiting time > 6 months), T2 (1 year post CI surgery), T3 (2 years post CI surgery), T4 (3 years post CI surgery)
Change in Income (source)
Questions investigating the sources of income and selecting income brackets.
Time frame: T0 (baseline), T1 (pre-operative, if waiting time > 6 months), T2 (1 year post CI surgery), T3 (2 years post CI surgery), T4 (3 years post CI surgery)
Change in Cognition
Repeatable Battery for the Assessment of Neuropsychological Status for Hearing impaired (RBANS-H).This cognitive test assesses five cognitive domains; Immediate Memory, Visuospatial/constructional, Language, Attention and Delayed Memory. Within these domains there are 12 subtests. Subdomain scores and total scores will be calculated at various time points. This tests will be conducted in participants included in one of the centers.
Time frame: Once between study inclusion and surgery (pre-operative), 1 year post surgery, and (if participant is over 65 years old) 2 years post surgery.
Change in Listening effort
Listening effort will be assessed in a sub-population of participants under 65 by using pupillometry
Time frame: 4 weeks after surgery and 1 year after surgery.
Change in Linguistic skills by Vocabulary test
Adaptive Vocabulary test STAIRS4WORDS developed by the Max Planck Institute for Psycholinguistics.
Time frame: Once between inclusion and surgery.
Change in Tinnitus
Measured by the THI (Tinnitus Handicap Inventory)
Time frame: T0 (baseline), T1 (pre-operative, if waiting time > 6 months), T2 (1 year post CI surgery), T3 (2 years post CI surgery), T4 (3 years post CI surgery)
Change in quality of life score post-intervention
Measured by The Glasgow Benefit Inventory (GBI)
Time frame: T2 (1 year post CI surgery), T3 (2 years post CI surgery), T4 (3 years post CI surgery)
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