Introduction
Methods
Search strategy and data identification
Analytic strategy
Data extraction
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Study characteristics—country, type of hearing impairment, disease or treatment stage, any treatment given, study design;
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Participant characteristics—number of participants, age, gender, ethnicity, missing data;
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Instruments used—EQ-5D/SF-6D/HUI3, other generic measures of health-rated quality of life, condition-specific health-related quality of life measures and clinical measures of disease severity, patient’s own health state valuations (e.g. Visual Analogue Scale (VAS), Time trade-off (TTO) and Standard Gamble (SG));
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Health state utility values—mean of utility index, scoring algorithm;
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Construct and convergent validity—methods of assessment and results;
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Responsiveness—methods of assessment and results.
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Reliability—methods of assessment and results.
Quality assessment of studies
Assessment of validity
Assessment of responsiveness
Assessment of reliability
Presentation of data
Results
Search results
Quality assessment and characteristics and of included studies
Author, Year | Country | Hearing disorder | Intervention | Study design | Number of participants | Mean age (SD or range) | Female (%) |
---|---|---|---|---|---|---|---|
Barton et al. [24] | United Kingdom | Hearing impaired | Hearing aid (analogue vs. digital signal processing) | Prospective before–after study | 609 | 68.4 | 43 % |
Barton et al. [41] | United Kingdom | Hearing impaired | Cochlear implant | Cross-sectional | 3,272 | 6 (at CI implantation) | N/R |
Damen et al. [43] | The Netherlands | Post-lingual deaf adults. | Cochlear implant | Prospective before and after. | 37 (G1) 17 (G2) 29 (G3) | 55.1 (SD 16, G1), 50.5 (SD 21.9, G2), 61.5 (SD 13.1, G3) | 54 % (G1), 50 % (G2), 32 % (G3) |
Gruters et al. [30] | The Netherlands | Hearing impaired | Hearing aid | 337 | 69.6 (SD 8.9) | 40 % | |
Hol et al. [38] | The Netherlands | Conductive or mixed hearing loss | Bone-anchored hearing aid | Prospective before–after study | 56 | 52.9 (total, 24–82), 47.9 (ACHA, 24–73), 62 (CBHA, 42–82) | 61 % (total), 67 % (ACHA), 55 % (CBHA) |
The Netherlands | First-time hearing aid users | Hearing aid | Prospective before–after study | 126 | 69 (29–96) | 50 % | |
Palmer et al. [42] | Canada and United States | Severely to profoundly hearing-impaired adults | Cochlear implant | Prospective before–after study | 62 | 56 (CI, SD 15.4), 49 (non-CI, SD 14.5) | 54 % (CI) 84 % (non-CI) |
Finland | First-time hearing aid user over 60 | Hearing aid | Prospective before–after study | 101 | 77 (Median, 61–87) | 50 % | |
Lee et al. [33] | South Korea | Post-lingual deaf adults | Cochlear implant | Retrospective before–after study | 26 | 49.6 (SD 10.9) | 36.4 % |
Bichey et al. [29] | USA | Large vestibular aqueduct syndrome | Cochlear implant vs. hearing aid | Retrospective before–after study | 20 | 44.3 (Median, CI, 9.9–75.6); 22.5 (Median, HA, 8.6–65.1) | N/R |
Cheng et al. [37] | USA | Profoundly deaf | Cochlear implant | Retrospective study | 78 (VAS group), 40 (TTO group), 22(HUI3 group)* 22(HUI3 group)* | 7.5 (VAS), 7.4 (TTO), 10 (HUI3) 38.3 (parents) | 46 % (child), 89 % (parent) |
Sach and Barton [40] | United Kingdom | Hearing-impaired children and their parents | Unilateral cochlear implant | Retrospective before–after study | 222* | 9.26 (SD 3.63) | 49.1 % |
Lovett et al. [27] | United Kingdom | Profoundly deaf. | Cochlear implant (bilateral and unilateral) | Cross-sectional observational study | 50 | 7.2 | 40 % (unilateral) 53 % (bilateral) |
Smith-Olinde et al. [28] | USA | Permanent childhood hearing loss | Cochlear implant | Cross-sectional study | 146 | 7.3 (SD 1.9) | 48.5 % |
Measures and clinical indicators used in the studies included
Author, Year | Generic utility measures | Direct valuations | Rating scales | Hearing-specific measures | Clinical indicators | ||
---|---|---|---|---|---|---|---|
EQ-5D | HUI3 | SF-6D | TTO | VAS | – | – | |
Barton et al. [24] | √ | √ | √ | – | – | – | – |
Barton et al. [41] | √ | AHL | |||||
Gruters et al. [30] | √ | √ | – | – | – | – | BEPTA |
Lee et al. [33] | √ | √ | – | √ | √ | – | – |
Bichey et al. [29] | – | √ | – | – | – | – | PTA |
Cheng et al. [37]* | – | √ | √ | √ | – | – | |
Damen et al. [43] | – | √ | – | – | – | NCIQ | NVA and AN test |
Lovett et al. [27] | – | √ | – | – | √ | SSQ | – |
Palmer et al. [42] | – | √ | – | – | – | – | NU-6; Audiologic mean score for CID sentence recognition. |
Smith-Olinde et al. [28] | – | √ | – | – | – | – | BEPTA |
Hol et al. [38] | √ | – | – | – | EQ-VAS | HHDI | – |
Joore et al. [31] | Index and responses | – | – | – | VAS and EQ-VAS | ADPI | – |
Joore et al. [32] | Index and responses | – | – | – | VAS and EQ-VAS | – | – |
Vuorialho et al. [36] | Index and responses | – | – | – | √ | HHIE-S | BEHL, SRT, WRS |
Joore et al. [34] | √ | – | – | – | √ and EQ-VAS | – | – |
Joore et al. [35] | √ | – | – | – | √ and EQ-VAS | HHIE-S and hearing aid satisfaction/use | – |
Sach and Barton [40] | √ | – | – | – | EQ-VAS and quality of life VAS | – | – |
Vuorialho et al. [39] | √ | – | – | – | EQ-VAS | HHIE-S, hearing aid satisfaction | – |
Reliability of GPBMs in hearing impairment
Construct validity of GPBMs in hearing impairment
Study | Instrument | Assessment | Methods | Summary of results |
---|---|---|---|---|
Barton et al. [24] | HUI3/EQ-5D/SF-6D | Convergence | Correlations between measures | Moderate to strong correlations were found between HUI3, EQ-5D and SF-6D. |
Barton et al. [41] | HUI3 | Known groups(severity) Convergence | HUI3 scores and severity groups defined by AHL level | HUI3 mean scores were different between moderate, severe, profound1, profound2 and implanted groups (significance not reported) CI (grouped by age at implantation and duration of use), AHL, gender were significant predictor of HUI3 (p < 0.01) |
Bichey et al. [29] | HUI3 | Known groups (severity) | HUI3 scores and PTA (presented by CI and HA group | HUI3 mean scores: 0.82 (CI) versus. 0.62 (HA) Consistent with PTA. No statistical test reported. |
Damen et al. [43] | HUI3 | Convergence | Spearman rho correlations between mean score of different measures at the follow-up | Correlation coefficients: 0.33 (HUI3 and AN test, p < 0.05) 0.39 (HUI3 and NVA test, p < 0.05) 0.48 (NCIQ and AN test, p < 0.05) 0.32 (NCIQ and NVA test, p < 0.05) |
Lovett et al. [27] | HUI3 | Known groups (severity) | HUI3 index scores and SSQ, VAS scores presented by unilateral and bilateral implantation groups | A significant difference (p < 0.05) in favour of bilateral (SSQ); No significant (p = 0.2) differences detected (HUI3 and VAS) |
Palmer et al. [42] | HUI3 | Known groups (severity) | HUI3 index scores presented by CI and non-CI implant groups at enrolment, 6 months and 12 months after CI implant. | Difference between CI and non-CI groups by HUI3: Not significant (baseline) and significant (p < 0.1) difference (0.76 for CI and 0.58 for non-CI) at both 6 and 12 months after intervention. |
Smith-Olinde et al. [28] | HUI3 | Known groups (severity) | HUI3 utility index presented by 4 groups defined by the degree of hearing loss | Both HUI3 and QWB scores declined with the degree of hearing loss where a greater extent for HUI3 than QWB. No statistical significance was presented |
Gruters et al. [30] | EQ-5D (UK and Dutch tariff), HUI3 | Known groups (age gender and severity) Convergence | Utility scores compared between age, gender (EQ-5D) and clinically distinctive groups (HUI3) Agreements between utility scores by Kendall’s Tau correlation and ICC | Significant differences detected: Age and gender (by EQ-5D); Clinical groups (by HUI3). Kendall’s Tau correlations: 0.36–0.41 (between EQ-5D with UK or Dutch tariff and HUI2, HUI3) ICC: 0.44–0.51 (between utility measures) |
Sach and Barton [40] | EQ-5D | Known groups (through regressions) | Multiple linear regression was estimated between the child’s EQ-5D scores and CAP, as well as other variables) | Statistically significant coefficients (p < 0.05) for children with/without additional disabilities, gender, more severe deaf condition (measured by CAP); Non-statistical significant coefficients (p > 0.05) for children having mild deaf (in the top three levels of the CAP) and other socio-economic factors. |
‘Known group’ differences
Convergence
Responsiveness of GPBMs in hearing impairment
Study | Instruments | Methods | Results | ||||
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Mean change | SD | ES | SRM | ||||
Gruters et al. [30] | EQ-5D (UK and Dutch tariff), HUI2 and HUI3 | Mean change of scores after hearing aid fitting, ES and SRM | EQ-5D United Kingdom | 0.01 | 0.13 | 0.05 | 0.05 |
EQ-5D Dutch | 0.00, | 0.12 | 0.03 | 0.02 | |||
HUI2 | 0.07** | 0.13 | 0.64 | 0.55 | |||
HUI3 | 0.12** | 0.18 | 0.57 | 0.66 |
Measure | Before CI | After CI | Mean change | |||
---|---|---|---|---|---|---|
Lee et al. [33] | EQ-5D, QWB, VAS, HUI3 | Paired t-test for change of scores after CI for EQ-5D, QWB,VAS, HUI and its dimensions. | EQ-5D | 0.52 | 0.78 | 0.26* |
VAS | 0.27 (0.11–0.18) | 0.6 (0.45–0.75) | 0.33* | |||
QWB | 0.45 (0.3–0.6) | 0.61 (0.47–0.75) | 0.16* | |||
HUI | 0.29 (0.16–0.42) | 0.65 (0.55–0.76) | 0.36* | |||
Vision | 0.99 (0.98–1) | 0.99 (0.98–1) | 0 | |||
Hearing | 0.68 (0.63–0.74) | 0.87 (0.85–0.9) | 0.19* | |||
Speech | 0.95 (0.9–1) | 0.99 (0.97–1) | 0.04 | |||
Ambulation | 0.99 (0.97–1) | 0.98 (0.96–1) | −0.1 | |||
Dexterity | 1 (1–1) | 1 (1–1) | 0 | |||
Emotion | 0.81 (0.7–0.92) | 0.95 (0.91–0.99) | 0.14* | |||
Cognition | 0.99 (0.97–1) | 0.98 (0.96–1) | −0.01 | |||
Pain | 0.96 (0.92–1) | 0.95 (0.91–0.99) | −0.01 |
ACHA (n = 36) | CBHA (n = 20) | ||||||
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Mean change | ES | Mean change | ES | ||||
Hol et al. [38] | EQ-5D, EQ-5D responses, VAS, HHDI and SF-36 | Change and ES of EQ-5D, EQ-5D responses, VAS, HHDI domains and SF–36 domains after BAHA (bone-anchored hearing aid). | Mobility | 0.02 | −0.04 | 0.15 | −0.3 |
Self-care | 0 | 0 | −0.1 | 0.28 | |||
Usual activity | −0.03 | 0.05 | −0.05 | 0.08 | |||
Pain | −0.02 | 0.04 | 0.15 | −0.28 | |||
Anxiety | 0.16 | −0.3 | −0.06 | 0.13 | |||
EQ-5D index | −0.01 | 0.06 | −0.01 | 0.05 | |||
VAS | 2.7 | 0.17 | −1.6 | 0.1 | |||
HHDI | |||||||
Disability | −5.0* | 0.79 | −10.2* | 1.42 | |||
Handicap | −5.4* | 0.86 | −5.6 | 0.79* | |||
SF-36 | |||||||
Physical functioning | −0.5 | 0.02 | 1.4 | −0.06 | |||
Role limitation (physical) | −2.6 | 0.06 | −3.8 | 0.09 | |||
R Role limitation (emotional) | −3.0 | 0.07 | −13.4 | 0.33 | |||
Mortality | −0.5 | 0.02 | 0.2 | −0.01 | |||
Mental health | 5.5 | −0.28 | 5.8 | −0.36 | |||
Social functioning | 5.2 | −0.19 | 1.6 | −0.09 | |||
Pain | 4.5 | −0.18 | −5.9 | 0.24 | |||
General health | −0.4 | −0.18 | −1.5 | 0.07 |
T0 | T1 | T2 | ||||
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EQ-5D responses, EQ-VAS, ADPI, hearing VAS, SF-36 social domain, AI(Amsterdam Inventory | Change of scores of different measures after hearing aid fitting | ADPI | ||||
Hearing VAS | 0.51 | 0.77* | 0.78* | |||
Detection of sound | 2.38 | 2.84* | 2.87* | |||
Intelligibility in quiet | 1.91 | 2.87* | 2.94* | |||
Intelligibility in noise | 1.95 | 2.51* | 2.35* | |||
Auditory localization | 2.15 | 2.62* | 2.66* | |||
Distinction of sound | 2.38 | 2.84* | 2.87* | |||
EQ-5D | ||||||
Mobility | 2.63 | 2.68 | 2.67 | |||
Self-care | 2.91 | 2.94 | 2.90 | |||
Daily activity | 2.81 | 2.78 | 2.78 | |||
Pain | 2.53 | 2.55 | 2.58 | |||
Feeling | 2.77 | 2.91* | 2.86 | |||
EQ-5D VAS | 0.69 | 0.71 | 0.71 | |||
SF-36 social dimension | 9.15 | 9.61 | 9.69* | |||
Visit received last month | 1.7 | 1.54 | 1.64 | |||
Visits paid last month | 2.59 | 2.71 | 2.64 | |||
AI | ||||||
Discrimination of sounds | 3.74 | 2.2* | 1.72* | |||
Intelligibility in noise | 7.67 | 2.83* | 2.67* | |||
Intelligibility in quiet | 7.17 | 2.64* | 2.48* | |||
Auditory localization | 5.1 | 3* | 2.23* | |||
Distinction of sound | 4.55 | 1.4* | 1.14* |
Before fitting | 6 months after fitting | 95 % CI of difference | ||||
---|---|---|---|---|---|---|
EQ-5D, VAS, HHIE, SRT and WRS | Mean change and statistical test (paired t-test or Wilcoxon signed ranks tests) for different measures after hearing aid | SRT | 37.9 | 26.4 | ||
WRS | 92.2 | 95.6 | ||||
HHIE-S | 28.7 | 12.7 | 14.2–17.8 ** | |||
VAS (SD) | 61 (17.9) | 65 (16.3) | (−7.1)–(−0.8)** | |||
EQ-5D index (SD) | 0.7 (0.19) | 0.7 (0.18) | ||||
% Reported problems in EQ-5D dimensions | ||||||
Mobility | 44.9 | 54.4 | ||||
Self-care | 19.4 | 15.3 | ||||
Usual activity | 45.9 | 43.9 | ||||
Pain | 71.4 | 62.2 | ||||
Anxiety | 17.4 | 20.4 |
Pre-CI | Post-CI | Change | ||||
---|---|---|---|---|---|---|
Cheng et al. [37] | HUI3, VAS, TTO | Perceived change scores; Correlations between change scores | VAS | 0.59 | 0.86 | 0.27* |
TTO | 0.75 | 0.97 | 0.22* | |||
HUI3 | 0.25 | 0.64 | 0.39* | |||
Hearing | 0.65 | 0.86 | 0.22* | |||
Speech | 0.80 | 0.93 | 0.13* | |||
Emotion | 0.96 | 0.99 | 0.03 | |||
Cognition | 0.94 | 0.97 | 0.03 | |||
Ambulation | 0.98 | 0.99 | 0.01 | |||
Version | 0.98 | 0.98 | 0 | |||
Pain | 1 | 1 | 0 | |||
Dexterity | 0.99 | 0.99 | 0 | |||
(n = 78 (VAS) n = 40 (TTO) n = 22 (HUI3)) | ||||||
Pearson correlations between change scores: | ||||||
VAS/TTO: 0.57 (n = 49); VAS/HUI: 0.44 (n = 22); TTO/HUI:0.48 (n = 15) |
Group1(n = 37) | Group3 (n = 22) | |||||||
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Damen et al. [43] | HUI3, NCIQ | Statistically significant difference between scores of different instruments and their sub-domains pre-/after CI | NCIQ | Pre-CI− | 98CI+ | 04 CI+ | 98 CI− | 04 CI+ |
SPB | 3.2 | 65.5* | 60.7 | 10.0 | 63.5* | |||
SPA | 14.6 | 55.2* | 54.4 | 14.6 | 51.7* | |||
Speech | ||||||||
Production | 60.5 | 83.3* | 83.3 | 68.8 | 80.3** | |||
Self-esteem | 43.0 | 67.7* | 66.8 | 43.6 | 69.4* | |||
Activity | 50.0 | 75.1* | 73.6 | 45.0 | 71.7* | |||
Social | ||||||||
Interactions | 53.7 | 74.5 | 63.7* | 42.0 | 60.6* | |||
HUI 3 utility | 0.32 | 0.64* | 0.37 | 0.38 | 0.53** | |||
Vision | 93.9 | 93.7 | 95.7 | 93.7 | ||||
Hearing | 56.6 | 55.1 | 13.8 | 59.2* | ||||
Speech | 95.3 | 94.2 | 90.1 | 94.4 | ||||
Ambulation | 98.7 | 96.8 | 96.3 | 92.6 | ||||
Dexterity | 98.2 | 97.9 | 96.4 | 98.9 | ||||
Emotion | 94.9 | 91.5 | 90.0 | 97.6* | ||||
Cognition | 96.9 | 95.8 | 96.3 | 84.2 | ||||
Pain | 93.1 | 87.8* | 91.9 | 85.1 |
Unilateral(n = 20) | Bilateral(n = (30)) | Mann–Whitney test | |||||
---|---|---|---|---|---|---|---|
Median IQR | Median IQR | z |
p value | ||||
Lovett et al. [27] | HUI3, VAS, SSQ | Gain in scores of different measures | SSQ speech | ||||
Section | 5.88 | 7.53 | −2.06 | 0.04 | |||
SSQ | |||||||
Section | 4.85 | 7.47 | −3.71 | <0.001 | |||
SSQ qualities | |||||||
Section | 7.16 | 7.6 | −1.78 | 0.08 | |||
VAS | 0.9 | 0.91 | −1.41 | 0.16 | |||
HUI 3 | 0.78 | 0.83 | −0.13 | 0.91 |
Comparison between GPBMs
Responsiveness of EQ-5D
Responsiveness of HUI3
Discussion and conclusions
Known group (Severity) | Known group (case–control) | Known group (other) | Correlation | Responsive (change) | |||||
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Cons | Sig | Cons | Sig | Cons | Sig | Cons | Sig | ||
EQ-5D
| |||||||||
Grutters et al. [30] | √ | √ | Moderate | × | × | ||||
Sach and Barton [40] | Severe √ Mild × | √× | √ | √ | |||||
Lee et al. [33] | √ | √ | |||||||
Hol et al. [38] | × | × | |||||||
? | × | ||||||||
× | × | ||||||||
HUI 3
| |||||||||
Barton et al. [24] | √ | N/R | |||||||
Bichey et al. [29] | √ | N/R | |||||||
Grutters et al. [30] | √ | √ | Moderate | √ | √ | ||||
Palmer et al. [42] | √ | √ | |||||||
Smith-Olinde et al. [28] | √ | N/R | |||||||
Lee et al. [33] | √ | √ | |||||||
Cheng et al. [37] | √ | √ | |||||||
Damen et al. [43] | Moderate (sig) | √ | √ | ||||||
Lovett et al. [27] | √ | × | √ | × | |||||
SF-6D
| |||||||||
Barton et al. [24] | Moderate to strong |