Summary of findings 2. Delivery system design interventions for adults with hearing loss who use hearing aids.
| Delivery system design interventions for adults with hearing loss who use hearing aids | ||||||
| Patient or population: adults with hearing loss who use hearing aids Settings: outpatient clinic Intervention: delivery system design interventions | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Delivery system design interventions | |||||
| Adherence Number of people fitted with hearing aid/number of people who use the aids Follow‐up: 0 to 12 months | 948 per 1000 | 967 per 1000 (938 to 995) | RR 1.02 (0.99 to 1.05) | 686 (2 studies) | ⊕⊕⊝⊝ low1 | — |
| Daily hours of hearing aid use Average self‐reported or data‐logged hours of use per day. Scale from: 0 to 12 hours Follow‐up: 0 to 12 months | The mean daily hours of hearing aid use in the intervention groups was 0.06 lower (1.06 lower to 0.95 higher) than in the control groups. On average the intervention groups used their hearing aids for under a minute per day less than the control groups | — | 700 (4 studies) | ⊕⊝⊝⊝ very low2 | Participants in the intervention groups wore their hearing aids for 3 to 4 minutes less each day on average than those in the control group. This is not a clinically significant difference | |
| Adverse effects Number of outstanding complaints Follow‐up: 1+ years | 571 per 1000 | 429 per 1000 (286 to 640) | RR 0.75 (0.5 to 1.12) | 98 (1 study) | ⊕⊝⊝⊝ very low3 | — |
| Quality of life | No studies identified | |||||
| Self‐reported hearing handicap Validated self‐report measure HHIE scale from: 0 to 100 (Ventry 1982) Follow‐up: 0 to 12 months | The mean self‐reported hearing handicap in the intervention groups was 0.7 lower (5.22 lower to 3.81 higher) than in the control groups (on this scale from 0 to 100, a lower score indicates less hearing handicap) | — | 628 (2 studies) | ⊕⊝⊝⊝ very low4 | The minimal important difference on this scale is reported to be 18.7 for face‐to‐face administration and 36 for pencil and paper (Weinstein 1986) | |
| Hearing aid benefit Validated self‐report measure. Outer EAR scale from: 0 to 100 Follow‐up: mean 6 months | The mean hearing aid benefit in the intervention group was 1.8 higher (3.1 lower to 6.7 higher) than in the control group (on this scale from 0 to 100, a higher score indicates more hearing aid benefit) | — | 582 (1 study) | ⊕⊝⊝⊝ very low4 | While we were unable to reference a minimal important difference for this scale, a mean difference of 1.8 on a scale from 0 to 100 is unlikely to be a clinically significant change | |
|
Communication Validated self‐report measure: verbal subscale of the CPHI scale from 0 to 5 (Demorest 1987) Follow‐up: 0 to 12 months |
The mean reported use of verbal communication strategy in the intervention group was 0.10 higher (0.40 lower to 0.20 higher) than in the control group (higher score indicates increased use of verbal communication strategy) | — | 588 (1 study) |
⊕⊝⊝⊝ very low5 | The minimal important difference for this subscale of the CPHI is 0.93 at the 0.05 level (Demorest 1988) | |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; CPHI: Communication Profile for the Hearing Impaired; HHIE: Hearing Handicap Inventory for the Elderly; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1Downgraded due to very serious concerns regarding indirectness of the evidence (only short‐ to medium‐term evidence and the majority of the participants were military veterans). 2Downgraded due to very serious concerns regarding indirectness (short‐ to medium‐term data and military veteran participants) and serious concerns about limitations in study design (unclear risk of bias) and imprecision (standard deviations imputed in the largest study). 3Downgraded due to very serious concerns regarding indirectness (short‐ to medium‐term data and military veteran participants) and serious concerns regarding limitations in study design (unclear risk of bias) and imprecision (small sample size, wide CIs). 4Downgraded due to very serious concerns regarding indirectness (short‐ to medium‐term data and military veteran participants) and serious concerns about imprecision (standard deviations imputed). 5Downgraded due to very serious concerns regarding indirectness (short‐ to medium‐term outcomes, military veteran participants and the lack of a global communication outcome measure) and serious concerns about imprecision (standard deviations imputed).