Summary of findings 3. Combined self‐management support/delivery system design interventions for adults with hearing loss who use hearing aids.
| Combined self‐management support/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: combined self‐management support/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 | Combined SMS/DSD interventions | |||||
|
Adherence Number of people fitted with hearing aid/number of people who use the aids Follow‐up: 5 to 8 weeks |
943 per 1000 |
1000 per 1000 (943 to 1000) |
RR 1.06 (1 to 1.12) |
162 (1 study) |
⊕⊕⊝⊝ low1 | — |
| Daily hours of hearing aid use Self‐reported or data‐logged average hours of use per day. Scale from: 0 to 12 hours Follow‐up: 1+ years | The mean daily hours of hearing aid use in the intervention groups was 0.04 higher (0.64 lower to 0.73 higher) than in the control groups | — | 69 (2 studies) | ⊕⊝⊝⊝ very low2 | Participants in the intervention groups wore their hearing aids for 2 to 3 minutes more per day than those in the control group. This is not a clinically significant difference. | |
| Adverse effects | No studies identified | |||||
| Quality of life Validated self‐report measures. IOI‐HA item 7 scale from: 1 to 5 Follow‐up: 1+ years | The mean quality of life in the intervention groups was 0.32 higher (0.17 lower to 0.8 higher) than in the control groups, measured on item 7 of the IOI‐HA (Cox 2002) | — | 69 (2 studies) | ⊕⊕⊝⊝ low3 | The minimally important difference for this subscale of the IOI‐HA is 0.32 for those with mild‐moderate hearing loss and 0.28 for those with moderate‐severe hearing loss (Smith 2009). | |
| Self‐reported hearing handicap Validated self‐report measures Follow‐up: 1+ years | The mean self‐reported hearing handicap in the intervention groups was 0.31 standard deviations lower (1.06 lower to 0.44 higher) than in the control groups | — | 88 (3 studies) | ⊕⊝⊝⊝ very low4 | Using the classification suggested by Cohen 1988 a SMD of 0.31 represents a moderate effect size. | |
| Hearing aid benefit Validated self‐report measures (IOI‐HA item 4). Scale from: 1 to 5 Follow‐up: 1+ years | The mean hearing aid benefit in the intervention groups was 0.3 higher (0.02 to 0.58 higher) than in the control groups, measured on item 4 of the IOI‐HA (Cox 2002) | — | 69 (2 studies) | ⊕⊕⊝⊝ low3 | This is a statistically significant difference. However, the minimally important difference for this subscale of the IOI‐HA is 0.39 for those with mild‐moderate hearing loss and 0.32 for those with moderate‐severe hearing loss (Smith 2009), so this does not represent a clinically important difference. | |
| Use of verbal communication strategy Validated self‐report measures (verbal subscale of the CPHI (Demorest 1987)). Scale from: 0 to 5 Follow‐up: 1+ years | The mean use of verbal communication strategy in the intervention groups was 0.3 higher (0.2 lower to 0.8 higher) than in the control groups | — | 34 (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; DSD: delivery system design; IOI‐HA: International Outcome Inventory for Hearing Aids; RR: risk ratio; SMD: standardised mean difference; SMS: self‐management support | ||||||
| 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 concerns regarding consistency (single study) and indirectness of the evidence (short‐term evidence only). 2Downgraded due to very serious concerns regarding imprecision (small sample size) and serious concerns regarding inconsistency (heterogeneity). 3Downgraded due to very serious concerns regarding imprecision (small sample size). 4Downgraded due to very serious concerns regarding imprecision (small sample size, risk of skewed data in two of the studies) and serious concerns regarding limitations in study design (high risk of bias in one study) and inconsistency (heterogeneity). 5Downgraded due to very serious concerns regarding imprecision (small sample size) and indirectness (lack of a global measure of communication, participants were all first‐time hearing aid users, we do not know whether equivalent benefit could be gained in people already fitted with hearing aids).