A Cochrane systematic review of interventions to improve hearing aid use Fiona Barker f.barker@surrey.ac.uk Department of Healthcare Management and Policy
The context Hearing loss is a common long term condition
The problem Management often involves hearing aid fitting sometimes as part of a wider rehabilitative programme Up to 40% of people choose not to wear the hearing aid(s) they are given
The purpose of a literature review What does the research say? How was the research carried out? What is missing?
Hierarchy of evidence
Systematic review An attempt to collate and critically appraise all the evidence that fits prespecified eligibility criteria in order to answer a specific research question Identify Synthesise Appraise Cochrane Handbook 2011
8 stages of systematic reviewing Formulate the question Define inclusion/exclusion criteria Develop search strategy Select studies Extract data Assess study quality Analyse and interpret results Disseminate findings Uman LS Systematic reviewing and metaanalyses J Can Acad Child Adolesc Psychiatry 2011 Feb 20(1): 57-59
The review question A review of research about the types and effects of interventions that had the aim of improving the amount or quality of hearing aid use
Inclusion and exclusion criteria Population - adults with acquired hearing loss who were prescribed and fitted with a hearing aid in at least one ear Interventions any intervention intended to increase the use of prescribed hearing aids Comparisons randomised controlled trials comparing the intervention against standard care or another intervention Outcomes short, medium and long term
Interventions
Outcomes Primary Secondary Hearing aid use Patient reported outcomes Utilisation/coverage/access Quality of care Adverse effects Resource use Social outcomes [Equity] EPOC guidelines
Search strategy Included: Searching relevant electronic databases for Individual papers Reviews Conference abstracts Hand searching reference lists
Study selection 1. Collated titles and abstracts and read thro 2. Excluded any that did not meet inclusion criteria 3. Requested any remaining in full text 4. Excluded any that did not meet inclusion criteria 5. Contacted authors where possible re clarification/missing data 6. Obtained translations if needed 7. Used 2 reviewers to establish inter-rater reliability
Study selection 894 individual abstracts, reports, conference abstracts and reviews 35 studies involving 4505 participants
Data extraction Used 2 reviewers who extracted data independently Used a standard form based on our protocol to extract details of PICO
Assess study quality
Findings 1 17 of the 35 studies addressed the primary outcome of hearing aid use The 5 studies we could include in a meta-analysis showed no effect for any of the interventions on hearing aid use as measured by self-reported hours of use per day across the short, medium or long term There was a lack of data on adherence
Findings 2 All but 2 of the 35 studies could be classified as self-management support interventions We found no studies that assessed the effect of community resources, decision support or clinical information system interventions
Findings 3 Reported secondary outcomes included a variety of patient reported outcomes Hearing handicap Quality of life Hearing aid benefit Psychological outcomes Communication Satisfaction Speech perception Our analysis suggests that self-management support interventions improve short-term hearing handicap, some aspects of communication and speech perception but NOT quality of life, psychological outcome, hearing aid benefit or satisfaction.
Findings 4 In general long term outcome assessment was lacking but 2 small studies did show a small positive effect on long-term hearing aid benefit for 2 selfmanagement interventions Studies looking at domains outside patient reported outcomes were rare The risk of bias in the included studies was variable The overall quality of evidence for the outcomes was judged to be moderate, low or very low
Clinical implications There is some evidence to support the use of selfmanagement support interventions in hearing healthcare but it is limited The range of interventions, even within selfmanagement support, that have been tested is relatively narrow We cannot comment on medium to long term outcomes due to a lack of evidence
Research implications Long term outcomes Larger studies as effect size is likely to be small Using the CCM has highlighted large gaps in the evidence base in terms of intervention type Diversity in patient-reported outcome measurement Time for a core outcome set? Consider outcomes in addition to patient-reported outcomes Studies should consider adherence to therapy rather than (or in addition to) reported hours of use as an outcome Methodological and reporting rigour should be a priority
Details f.barker@surrey.ac.uk The protocol for this review is available via the Cochrane Library website: http://onlinelibrary.wiley.com/doi/10.1002/14651858.cd01 0342/full The full completed review is currently being peer reviewed and will be available shortly