Letter to the editor in response to the article of Dekkers and Søballe (Activities and impairments in the early stage of rehabilitation after Colles' fracture; Vol. 26, No. 11, June 3, 2004)

Aim.?To study psychological well-being (health-related quality of life) in a population of adults 20 years and over with hearing impairment (HI) and its relation to audiological factors, consequences of the HI, sense of humour, and use of communication strategies.

Subjects and methods.?Consecutive adults (n = 343) at the outpatient Unit of Audiology of a Norwegian university hospital answered the Psychological General Well-being inventory (PGWB), Hearing Disability and Handicap Scale (HDHS), Sense of Humour Questionnaire-6 (SHQ-6), and Communication Strategies Scale (CSS) in relation to an audiological examination and medical consultation.

Results.?Mean PGWB index for the whole sample was 81.4 (SD 14.3) and females reported a significantly lower psychological well-being. In multiple linear regression analyses well-being was negatively associated with high levels of activity limitation and participation restriction. PGWB index was positively associated with high sense of humour, but was neither explained by audiological factors nor use of communication strategies.

Conclusions.?Psychological well-being was associated with the outcome of a standard HI assessment of activity limitation and participation restriction, but not with degree of HI and use of communication strategies.     

Quality of life in older Chinese-speaking adults with hearing impairment

Purpose: General and hearing-specific health-related quality of life (HRQoL) was examined in elderly Chinese with hearing impairment. Methods: Sixty-four Chinese speakers aged ≥65 years and did not use hearing aids were evaluated using Chinese versions of the Short-Form 36 health survey (SF-36) and the Hearing Handicap Inventory for the Elderly (Screening Version) (HHIE-S). Results on the SF-36 were compared to norms obtained in a general elderly Chinese population. The relationships between HRQoL and degree of hearing impairment, and between SF-36 and HHIE-S were also evaluated. Results: Elderly Chinese speakers with hearing impairment rated six of the eight scales of the SF-36 poorer, compared to a general elderly Chinese population. When average hearing impairment in the better ear exceeded 40 dB HL, SF-36 ratings were poorer than those with better hearing. Poorer better ear hearing was significantly related to poorer ratings on the Vitality scale of the SF-36 and the three scales of the HHIE-S, after controlling for age, gender and number of coexisting chronic health problems. Ratings on SF-36 and HHIE-S did not correlate. Conclusion: Elderly Chinese who are hearing impaired experienced poorer general and hearing-specific HRQoL, and HRQoL is reduced further among those with greater hearing impairment.

Implications for Rehabilitation

• Hearing impairment adversely affects communication and is associated with social isolation.

• Older Chinese with hearing impairment report poorer physical functioning, role limitations due to physical problems, vitality, social functioning, role limitations due to emotional problems and general mental health than the general population.

• Degree of hearing impairment seems to exhibit lesser differential effects on self-reported quality of life among older Chinese, compared to those reported in Western societies.

• Treatment to improve communication should be evaluated for its impact on disease-specific and health-related quality of life.

     

Self-reported hearing difficulties, communication strategies and psychological general well-being (quality of life) in patients with acquired hearing impairment

Purpose. The aims were to (i) translate the Amsterdam Inventory for Auditory Disability and Handicap (AIADH) into Swedish and evalute its usefulness, (ii) describe hearing difficulties and psychological well-being (quality of life) and (iii) explore variables related to psychological well-being in a Swedish population.

Method. Seventy-nine consecutive patients, referred to the hearing clinic for hearing examination and audiological rehabilitation, formed the study sample. Along with pure-tone audiometry, the AIADH, the Psychological General Well-being index and the Communication Strategies Scale were used.

Results. Men had significantly worse hearing on the high frequencies (2, 3, 4 and 6 kHz) than women but their quality of life was significantly higher than for women. Men scored significantly lower on 'auditory localization' and adopted non-verbal communication strategies less often than women. A stepwise regression analysis showed that 'maladaptive behaviours' and 'intelligibility in quiet' explained 48% of the variance in quality of life.

Conclusion. Psychosocial consequences of hearing loss, such as lowered quality of life, cannot be predicted from audiometric data alone. The adverse relationship between maladaptive behaviour and quality of life emphasizes the relevance of developing training programs aiming to improve coping with the consequences of a hearing impairment.The AIADH may be useful in assessing self-reported difficulties among patients with hearing problems, but needs to be further developed in terms of psychometric evaluations and reliability testings based on a larger representative sample.     

Self-reported hearing difficulties,communication strategies and psychological general well-being (quality of life) in patients with acquired hearing impairment

Purpose. The aims were to (i) translate the Amsterdam Inventory for Auditory Disability and Handicap (AIADH) into Swedish and evalute its usefulness, (ii) describe hearing difficulties and psychological well-being (quality of life) and (iii) explore variables related to psychological well-being in a Swedish population.

Method. Seventy-nine consecutive patients, referred to the hearing clinic for hearing examination and audiological rehabilitation, formed the study sample. Along with pure-tone audiometry, the AIADH, the Psychological General Well-being index and the Communication Strategies Scale were used.

Results. Men had significantly worse hearing on the high frequencies (2, 3, 4 and 6 kHz) than women but their quality of life was significantly higher than for women. Men scored significantly lower on ‘auditory localization’ and adopted non-verbal communication strategies less often than women. A stepwise regression analysis showed that ‘maladaptive behaviours’ and ‘intelligibility in quiet’ explained 48% of the variance in quality of life.

Conclusion. Psychosocial consequences of hearing loss, such as lowered quality of life, cannot be predicted from audiometric data alone. The adverse relationship between maladaptive behaviour and quality of life emphasizes the relevance of developing training programs aiming to improve coping with the consequences of a hearing impairment.The AIADH may be useful in assessing self-reported difficulties among patients with hearing problems, but needs to be further developed in terms of psychometric evaluations and reliability testings based on a larger representative sample.     

Health-related and subjective quality of life of older adults with visual impairment

Purpose.?To document health-related quality of life (HRQOL) and subjective quality of life (SQOL) and explore their correlates in older adults seeking services for visual impairment (VI).

Method.?A convenience sample of 64 participants (79.3?±?5.9 years) with VI was interviewed at home. HRQOL was measured with the Visual Function Questionnaire-25 and SQOL with the Quality of Life Index. The potential correlates were as follows: personal factors (sociodemographic characteristics, co-morbidity, depressive symptoms, activity level), environmental factors (technical aids, social support) and participation in daily activities and social roles (level and satisfaction).

Results.?Compared to normative data from previous studies of older adults, the participants had lower HRQOL but similar SQOL. Greater level of participation in social roles, higher perceived activity level, use of a writing aid and greater satisfaction with participation in social roles together explained better HRQOL (R²?=?0.66). Fewer depressive symptoms, greater satisfaction with participation in social roles and with social support and fewer co-morbidities together explained better SQOL (R²?=?0.70).

Conclusions.?HRQOL of older adults with VI is mainly explained by level of participation correlates, while their SQOL is mainly explained by depressive symptoms and satisfaction variables. The results also underscore the importance of social roles for HRQOL and SQOL of this population.     

Daily life consequences of hearing loss in the elderly

Purpose.?To assess the daily life consequences of hearing loss in older adults and to explore the influences of hearing loss, subjective assessment of health and general life satisfaction, gender, age and marital status.

Method.?Eighty-four participants, each older than 65 years, were consecutively recruited from a hospital waiting list for outpatient hearing aid fitting. All participants were assessed by pure-tone audiometry. Daily life consequences of hearing loss were measured using the Hearing Disability and Handicap Scale, which assesses perceived activity limitation and participation restriction. Another questionnaire was used to measure self-assessed health and life satisfaction.

Results.?Adjusted linear regression analysis showed that activity limitation was significantly associated with increased hearing loss (p == 0.028) and decreased health (p == 0.009), and participation restriction with lower estimated life satisfaction (p ≤ 0.001). Gender, age and marital status were not determinant factors for perceived activity limitation or participation restriction.

Conclusions.?Daily life consequences of hearing loss, health conditions and general life satisfaction are closely related. These findings indicate that health factors and psychosocial aspects should be emphasised as a natural part of audiological rehabilitation.     

Impact of visual impairment on the lives of young adults in the Netherlands: a concept-mapping approach

Purpose: While the impact of visual impairments on specific aspects of young adults’ lives is well recognised, a systematic understanding of its impact on all life aspects is lacking. This study aims to provide an overview of life aspects affected by visual impairment in young adults (aged 18–25 years) using a concept-mapping approach.

Method: Visually impaired young adults (n?=?22) and rehabilitation professionals (n?=?16) participated in online concept-mapping workshops (brainstorm procedure), to explore how having a visual impairment influences the lives of young adults. Statements were categorised based on similarity and importance. Using multidimensional scaling, concept maps were produced and interpreted.

Results: A total of 59 and 260 statements were generated by young adults and professionals, respectively, resulting in 99 individual statements after checking and deduplication. The combined concept map revealed 11 clusters: work, study, information and regulations, social skills, living independently, computer, social relationships, sport and activities, mobility, leisure time, and hobby.

Conclusions: The concept maps provided useful insight into activities influenced by visual impairments in young adults, which can be used by rehabilitation centres to improve their services. This might help in goal setting, rehabilitation referral and successful transition to adult life, ultimately increasing participation and quality of life.

• Implications for rehabilitation

• Having a visual impairment affects various life-aspects related to participation, including activities related to work, study, social skills and relationships, activities of daily living, leisure time and mobility.

• Concept-mapping helped to identify the life aspects affected by low vision, and quantify these aspects in terms of importance according to young adults and low vision rehabilitation professionals.

• Low vision rehabilitation centres should focus on all life aspects found in this study when identifying the needs of young adults, as this might aid goal setting and rehabilitation referral, ultimately leading to more successful transitions, better participation and quality of life.

     

Application of the International Classification of Functioning,Disability and Health (ICF) in clinical practice

Purposes: We first aimed to describe demographic and audiological characteristics of adults referred to a university hospital for hearing aid (HA) fitting and rehabilitation. Our second aim was to employ an inventory that assesses life consequences of hearing impairment (HI) in terms of perceived activity limitation and participation restriction for the first time in a Norwegian adult outpatient population. A third aim was to study life consequences by audiological and demographic characteristics.

Subjects and methods: During one year consecutive patients (n?=?343) were requested to answer the Hearing Disability and Handicap Scale (HDHS) assessing activity limitation and participation restriction in relation to an audiological examination and medical consultation. The mean threshold of hearing (MTH) was ascertained by pure tone thresholds at 0.5?–?1?–?2?–?4 kHz in the better ear.

Results: Activity limitation and participation restriction were both higher for HA experienced than HA naïve subjects ( p?2) was 43.4% with MTH, perceived duration, and severity of hearing problems as predictor variables. Correspondingly, the explained adjusted variance of participation restriction was 28.4% for a model with MTH, age, gender and perceived severity of hearing problems as predictors.

Conclusions: As a standard supplement to audiometric tests, HDHS may be successfully applied as a clinical tool among similar hearing impaired outpatients in order to assess activity limitation and participation restriction as part of audiological rehabilitation.     

Use of the ICF to investigate impairment,activity limitation and participation restriction in people using ankle-foot orthoses to manage mobility disabilities

Purpose: This study investigated differences in impairment, activity limitation, participation restrictions and psychological distress between participants using ankle-foot orthoses (AFOs) as recommended, participants who did not use AFOs as recommended and participants who did not know recommendations for use. Method: Adults (n?=?157) fitted with an AFO by an NHS Orthotic Service in Scotland completed a postal questionnaire that measured impairment, activity limitations participation restrictions and psychological distress using scales from the RAND 36-Item Health Survey 1.0 and the Hospital Anxiety and Depression Scale (HADS). Results: 41% of participants used their AFOs as recommended, 32% did not use their AFOs as recommended and 27% did not know the recommendations for use. Participants using AFOs as recommended reported lower levels of impairment and activity limitations, indicated by higher energy levels (p?=?0.005), higher physical functioning (p?=?0.005), lower role-limitations due to emotional problems (p?=?0.001) and lower levels of anxiety (p?=?0.003) compared to people not using AFOs as recommended. Conclusion: Health professionals need to ensure whether patients understand the recommendations for use of their AFO. Additionally, the results of the study support the value of evaluating patients’ psychological well-being to gain a better understanding of AFO use.

• Implications for Rehabilitation

• Participants who reported using AFOs as recommended had significantly lower levels of impairment, activity limitations and anxiety compared to those who did not use their AFO as recommended.

• In this study, 27% of participants did not know recommendations for use of AFOs. Health professionals should give consideration as to how information, regarding wearing instructions and use of AFOs, is provided to people who are prescribed AFOs.

• Psychological outcomes in orthotics are rarely assessed. However, this study demonstrates there is a value in measuring psychological outcomes in orthotic management.

     

Triangulated Proxy Reporting: a technique for improving how communication partners come to know people with severe cognitive impairment

Purpose: This paper explains and demonstrates the pilot application of Triangulated Proxy Reporting (TPR); a practical technique for enhancing communication around people who have severe cognitive impairment (SCI).

Methods and results: An introduction explains SCI and how this impacts on communication; and consequently on quality of care and quality of life. This is followed by an explanation of TPR and its origins in triangulation research techniques. An illustrative vignette explicates its utility and value in a group home for a resident with profound multiple disabilities. The Discussion and Conclusion sections propose the wider application of TPR for different cohorts of people with SCIs, their communication partners and service providers.

Conclusions: TPR presents as a practical technique for enhancing communication interactions with people who have SCI. The paper demonstrates the potential of the technique for improving engagement amongst those with profound multiple disabilities, severe acquired brain injury and advanced dementia and their partners in and across different care settings.

• Implications for Rehabilitation

• Triangulated Proxy Reporting (TPR) shows potential to improve communications between people with severe cognitive impairments and their communication partners.

• TPR can lead to improved quality of care and quality of life for people with profound multiple disabilities, very advanced dementia and severe acquired brain injury, who otherwise are very difficult to support.

• TPR is a relatively simple and inexpensive technique that service providers can incorporate into practice to improving communications between clients with severe cognitive impairments, their carers and other support professionals.

     

Acoustic characteristics of vowels produced by Greek intelligible speakers with profound hearing impairment II: The influence of stress and context

Purpose: The present paper examines the influence of stress and context on selected acoustic characteristics of vowels produced by six adult Greek intelligible speakers with profound hearing impairment and six speakers with normal hearing (three males and three females in each group).

Method: F1, F2 and F3 formant frequencies and the duration of vowels are measured in words of the form /^′pVCV/ with V = /i, ?, ?, ?, u/ and C = /p, t, k, s/. Variation in these parameters due to context and stress is reported for the two genders. A co-articulatory measure and three measures that examine the area of the vowel space and differences along the F1 and F2 axes are calculated.

Result: The results show a reduction of the vowel space in the unstressed condition for both groups, while vowel duration was found to be significantly longer in this condition for the speakers with hearing impairment. In addition, smaller C-to-V carryover co-articulatory effects were found for the speakers with hearing impairment.

Conclusion: Findings are discussed within the framework of perceptual and production constraints in hearing impairment and with reference to current models of co-articulation.     

The effect of ice skating on psychological well-being and sleep quality of children with visual or hearing impairment

Abstract

Purpose: Physical exercise and sports have a key role in preventing physical and psychiatric problems in children. However, children with a disability often experience difficulty participating in physical activity due to a lack of suitable opportunities. Participation in an accessible sport is particularly important for these children, but studies examining which sports are beneficial for which disability groups are rare. In this study, we assessed the effects of ice skating on the psychological well-being, self-concept, and sleep quality of children with hearing or visual impairment. Method: Forty students (20 visually impaired and 20 hearing impaired) aged 8–16 were included in a regular ice skating programme for three months. We examined the sleep quality, self-concept, and behavioural and emotional states of the children before and after participating in the programme. Results: There was a significant improvement in self-concept, behavioural and emotional problems, and sleep quality (p?<?0.05 for each) of the children with hearing impairment. Although the sleep quality (p?=?0.019) and emotional problem scores (p?=?0.000) of the visually impaired children improved; self-concept, peer relations and hyperactivity scores of these children worsened (p?<?0.05 for each). Conclusion: Ice skating is one of the popular sport alternatives that gives children the opportunity to exercise and have fun together. The results of this study revealed that regular ice skating programmes may have positive effects on the psychological well-being of children with hearing impairment. Despite some positive effects, caution must be use when including visually impaired children in ice skating programmes. Generalization of the study's outcomes is limited as the study group were residential students enrolled in special education institutions for children who are blind or deaf.

• Implications for Rehabilitation

• Ice skating is a community-based sport and a popular leisure activity that can also have benefits for people with disabilities.

• Ice skating and children with hearing impairment:

• Self-concept, behavioural and emotional problems, and sleep quality of the children with hearing impairment significantly improved after ice skating.

• Ice skating programmes may be considered as a rehabilitation alternative for children with hearing impairment.

• Ice skating and children with visual impairment:

• Caution must be use when including children with visual impairment in ice skating programmes because of possible negative psychological outcomes.

• Balance exercises before starting the practices on ice should be considered for preventing some possible negative outcomes in children with visual impairment.

     

Assessing the impact of migraine on health-related quality of life: An additional use of the quality of well-being scale-self-administered

OBJECTIVES: To compare the interviewer-administered Quality of Well-being Scale (QWB) with a self-administered form (QWB-SA) for patients with migraine, and to compare the health status of migraineurs to other medical populations. BACKGROUND: With the increasing need to document the cost-effectiveness of treatment for migraine, limitations with both the Medical Outcomes Study Short Form-36 items and the QWB have been an impediment to research using cost-effectiveness as an outcome. Demonstrating the sensitivity of an alternative instrument which addresses these limitations would facilitate cost-effectiveness analyses on treatments for migraine. METHODS: Eighty-nine adults (87% women) known to suffer from migraine were asked to complete both the interviewer-administered QWB and the self-administered version (QWB-SA) on three occasions. The first occasion was on a day when no migraine was experienced in the previous 7 days. The second and third assessments were completed within 48 hours of the onset of a migraine. RESULTS: While both the QWB and the QWB-SA successfully distinguished migraine from nonmigraine days, more migraines were reported on the QWB-SA. Overall, both instruments showed similar patterns of patient dysfunction during a migraine attack. Each component of the QWB-SA successfully distinguished migraine from nonmigraine days, and the QWB-SA showed a linear sensitivity to pain intensity and disability during a migraine episode. Both instruments are able to detect a migraine's effect on multiple domains of quality of life. Study participants scored significantly lower on the QWB-SA during a migraine episode than several comparison medical populations. CONCLUSIONS: The QWB and the QWB-SA appear to have sensitivity to migraine severity, and the ability to quantitate an effect in multiple quality-of-life domains. Both measures can be used to calculate quality-adjusted life-years, thus facilitating cost-effectiveness and health policy work in this important clinical area.     

Perceptions of health-related quality of life of men and women living with coeliac disease

Women with long-standing coeliac disease express poorer health-related quality of life (HRQoL) than men do for unclear reasons. This led us to explore differences in their understanding of HRQoL using a phenomenographic approach. We interviewed 10 coeliac subjects (mean age 57 years, range 35-73) who had been on a gluten-free diet for 10 years and had scored either high or low in the Short Form 36 Health Survey (SF-36) General Health and Vitality scales. Three dimensions were revealed that pertained to their perception of HRQoL: bodily sensations, social consequences and coping strategies. Within these, the women experienced more bowel symptoms than men did, despite keeping to a strict diet. This item was the only one predicting the SF-36 scores. The women also described more distress caused by the restrictions in daily life, closely related to their controlling of food contents. The coeliac men took advantage of using a problem-oriented coping approach while the women seeking an emotionally oriented strategy showed less satisfaction with the outcome. We conclude that the intriguing difference in HRQoL between coeliac men and women may have some of its origin in the way living with the disorder is conceptualized and coped with. The results imply that in the management of coeliac patients, gender-related aspects need to be taken into account to improve treatment outcome.     

Genetic mutations in patients with nonsyndromic hearing impairment of minority and Han Chinese ethnicities in Qinghai,China

ObjectiveMutations in GJB2, SLC26A4, and mitochondrial (mt)DNA 12S rRNA genes are the main cause of nonsyndromic hearing impairment. The present study analyzed these mutations in ethnic minority and Han Chinese patients with nonsyndromic hearing impairment from Qinghai, China.MethodsThe SNPscan assay was used to analyze mutation spectra and frequencies in the two patient groups.ResultsGJB2 mutations were detected in 9.5% (20/210) of minority patients and 20.88% (48/230) of Han Chinese patients. The most common Han Chinese GJB2 variants were c.235delC and c.299_300delAT, whereas c.235delC and c.109G > A were the most prevalent in minority patients. SLC26A4 mutations were detected in 5.71% (12/210) of minority patients and 14.35% (33/230) of Han Chinese patients, and mtDNA 12S rRNA mutations were detected in 4.28% (9/210) of minority patients and 9.13% (21/230) of Han Chinese patients.ConclusionsThese data indicate that the mutation frequencies of three deafness-associated genes were significantly higher in Han Chinese patients than in minority patients. Moreover, the GJB2 mutation spectrum was shown to differ between these two patient groups.     

帕金森病患者伴发认知障碍与非运动症状的相关性研究

目的探讨帕金森病(PD)患者伴发认知障碍与非运动症状(NMS)的相关性。方法根据认知障碍发生情况及严重程度,将175例PD患者分为无认知障碍组68例、轻度认知障碍(MCI)组92例和痴呆组15例,观察3组NMS总个数以及运动症状前、后期NMS个数,比较3组NMS各量表评分,分析PD伴发认知障碍患者蒙特利尔认知评估量表(Mo CA)评分与NMS发生的相关性。结果无认知障碍组、MCI组和痴呆组NMS总个数依次明显增多(P0.01);3组运动症状前期NMS个数比较无显著差异(P0.05),运动症状后期NMS个数依次增多(P0.01)。无认知障碍组、MCI组和痴呆组帕金森氏病综合评分量表(UPDRS)、匹茨堡睡眠质量指数量表(PSQI)、自主神经症状量表(SCOPA-AUT)评分依次显著升高(P0.05或P0.01);MCI组和痴呆组爱泼沃斯思睡量表(ESS)评分显著高于无认知障碍组(P0.01),但2组间比较无显著差异(P0.05);痴呆组汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)及不宁腿综合征严重程度评定量表(RLSRS)评分均显著高于MCI组和无认知障碍组(P0.05或P0.01),但MCI组和无认知障碍组比较无显著差异(P0.05)。相关性分析表明,PD伴发认知障碍患者的蒙特利尔认知评估量表(Mo CA)评分与UPDRS、ESS、PSQI、SCOPA-AUT评分呈明显负相关(P0.05)。结论 PD患者的NMS在运动障碍出现后随认知障碍的加重而加重;随着认知障碍的加重,PD伴发认知障碍患者整体精神和情绪状况、睡眠障碍及自主神经功能障碍越严重。     

The effectiveness of a multidisciplinary pain management programme managing chronic pain

The aim of this study was to develop and evaluate the effects of a multidisciplinary pain management programme on coping, health-related quality of life and pain intensity. Seventy-six outpatients suffering from chronic pain completed this eight-week programme with the primary aims to increase coping, as measured by the Ways of Coping Checklist, and health-related quality of life, as measured by the Short Form-36 Health Survey. Therapeutic dialogues and education, combined with physical activity, were given in order to increase understanding of and attention to non-medical factors that might affect pain perception. The programme was active, time-limited and structured on the basis of multidisciplinary pain management programmes based on a cognitive-behavioural approach. The findings suggest that this programme has the potential to improve coping skills and health-related quality of life. Additionally, pain intensity, as measured by the Visual Analogue Scale, was reduced. Age and disability were revealed as the prominent predictors of change after treatment. The differences in this sample indicated that the drop-outs tended to be older and reported more health problems, although these findings were non-significant. Clinical and research implications are discussed.