Nödvändigheten av förändring i audiologisk praktik
Inspiration til fremtidens rehabilitering af
mennesker med hørenedsættelser
Köpenhamn
21 februari 2014
Berth Danermark
Örebro universitet
Institutet för handikappvetenskap
Min presentation
1. Bakgrund
2. Hinder och stöd för en mer
patientorienterad audiologisk
rehabilitering (PCAR)
3. ICF Core Sets för vuxna med
hörselnedsättning: ett stöd för PCAR
Bakgrund
Fokus på teknik (amplification)
Icke följsamhet (non-adherence)
Mot ett nytt paradigm (Patient Centered
Audiological Rehabilitation)
Global websurvey (n=209)
ICF (WHO, 2001)
Internationell klassifikation av
funktionstillstånd, funktionshinder och
hälsa
International classification of functioning,
disability and health (WHO, 2001).
ICF
Internationell klassificering av funktion och hälsa
ICF Core Sets for Hearing Loss
b230
b2300
b2301
b2304
s250
s2502
s2600
d115
d310
d3504
e1251
e1501
e310
e410
-
1454 st
ICF
Core Sets
Bakgrund: ICF Core Sets Project
Endast delar av ICF:s kategorier är
relevanta för specifika
hälsoförhållanden eller funktioner
Syftet är att reducera ICF:s mer än 1.400
kategorier till ett kliniskt hanterbart antal
Comprehensive ICF Core Set
List of ICF categories that includes as few
categories as possible to be practical, but
as many as necessary to describe the
typical spectrum of problems in
functioning of patients with a specific
condition in a comprehensive,
multidisciplinary assessment
Brief ICF Core Set
List of ICF categories that serves as a
minimum data set that will be reported in
every clinical study to provide a
standardized description of the burden of
disease
Danermark, B.,Cieza, A., Gagné, J-P.,
Gimigliano, F., Granberg, S., Hickson, L.,
Kramer, S.E., McPherson, B.,Möller, C.,
Russo, I., Strömgren, J-P.,Stucki, G., and
Swanepoel, D. (2009)
International Classification of Functioning,
Disability and Health Core Sets for Hearing
Loss: A discussion paper and invitation.
International Journal of Audiology. Vol. 49
Issue 4, p256-262
Systematisk litteraturöversikt
• Syfte: identifiera parametrar citerade i studier
av personer med hörselnedsättning
• ”Länka” dessa parametrar till ICF:s koder
• Studier med brukare över 18 år
• Kvantitativa och kvalitativa studier
• Publicerat på engelska
Två artiklar publiserade
Sarah Granberg, Jennie Dahlström, Claes Möller, Kim Kähäri &
Berth Danermark
The ICF Core Sets for Hearing Loss -Researcher Perspective, Part I:
Systematic Review of Outcome Measures Identified in Audiological Research
International Journal of Audiology. Early Online.
Sarah Granberg, Kerstin Möller, Åsa Skagerstrand, Claes Möller &
Berth Danermark
The ICF Core Sets for Hearing Loss - Researcher Perspective, Part II: Linking
Outcome Measures to the International Classification of Functioning,
Disability and Health (ICF)
International Journal of Audiology. Early Online.
Procedure
Search in 9 databases
Abstract checking
Adults, English, 2002-2007,
acceptable study design, correct
focus, correct target group
Reading articles in full text
Retrieve outcome measures or
outcome (qualitative studies)
Linking to ICF according to
established linking rules
Instrument
• Patient- Reported Measure – Standardized (PT-S) (e.g. questionnaires
such as APHAB, SF-36)
• Health Professional- Reported Measure – Standardized (HP-S) (e.g.
Health professional evaluates the patient's performance)
• Standardized tests (e.g. Pure tone audiometry, Speech audiometry,
Cognitive tests)
• Technical measures (e.g. Tympanometry, ABR, Vemp)
• Laboratory measures (e.g. Blood lipids, Blood count, Immune tests)
• Imagine techniques (e.g. MRI, CT)
• Health Professional Observation (e.g. physical examination)
• Patient- Reported measures – Non Standardized (e.g. patient's answer to
single questions)
• Health care delivery indicators (e.g. treatment costs)
Resultat och slutsatser
Resultat: De flesta instrumenten handlade om
taluppfattning (speech recognition). 51 olika
instrument användes. Små urval och kön ofta inte
rapporterat.
Slutsats: Kunskapen fragmenterad (ingen helhetssyn).
Ingen enighet om hur hur patientens upplevelser,
behov och funktion skall kartläggas.
De vanligaste kategorierna handlade om listening,
hearing functions och auditory perception.
Kategorier relaterade till kommunikation var ovanliga.
Den fysiska omgivningen, som ljud och
hörelhjälpmedel är viktiga men lite uppmärksamhet
mot den sociala omgivningen (t.ex. attityder).
Fokusgrupper i Sydafrika,
Nederländerna & Sverige
36 deltagare.
Sarah Granberg, Marieke Pronk, Kerstin
Möller, Claes Möller & Berth Danermark
Patient perspective in the ICF Core
Sets Project for Hearing Loss.
(Ready to submit)
Följande frågor användes för att stimulera samtal:
1. How does your hearing loss affect you? (Probe: How does it affect your
health, your feelings?)
2. If you think about your body, in which parts are your problems?
3. If you think about your daily life, how does your hearing loss affect the
things you can and cannot do?
4. If you think about your environment and where you work and live, what
and/or whom do find helpful and supportive?
5. If you think about your environment and where you work and live, what
and/or who makes it difficult for you?
6. If you think about yourself and about your hearing loss – what helps you to
handle your hearing loss?
7. If you think about yourself and about your hearing loss – what makes it
difficult for you to handle your hearing loss?
The results clearly show that participation and participation
restrictions (i.e. involvement in life situations/problems of
involvement in life situations) are important.
The study emphasize the importance of investigating functioning
beyond body functions to reflect the life experiences of a person
with hearing loss
A comprehensive system that conceptualizes the wide variety of
life domains involved in the lives of adults with hearing loss, such
as ICF, is helpful when assessing functioning and/or disability in a
holistic manner.
Expert perspective
Sarah Granberg, De Wet Swanepoel, Ulrika
Englund, Claes Möller, & Berth Danermark
The ICF Core Sets For Hearing Loss Project:
An International Expert Survey On
Functioning, Disability and Contextual
Factors of Adults With Hearing Loss Using
the International Classification of
Functioning, Disability and Health (ICF)
(Ready to submit)
En internetbaserad cross-sectional survey. Stratifierat
urval (63 expertformulär analyserades).
Experter från alla sex WHO världsregioner (Africa, the
Americas, Eastern Mediterranean, Europe, South-East
Asia and Western Pacific)
Inklusionskriterium: professionella som är direkt
involverade i målgruppens rehabilitering; minst 5 års
praktik; behärskar engelska, svenska, danska eller
norska.
Slutsatser
Mest omnämnda kategori var inom
- Aktivitet & Delaktighet: interaction.
- Externa faktorer: physical environment (t.ex. hörapparat
(e1251) eller störande ljud (e2501).
- Interna faktorer: confidence (b1266), emotional functions
(b152).
Studien visar vikten av ett holistiskt perspektiv.
Study IV; Multicentre study
• Syfte: Vilka är de områden av funktion, funktionsnedsättning och
omgivande faktorer som skall ingå I ett patientperspektiv?
5 kliniker
•
•
•
•
•
Jiangsu Province Hospital, Nanjing Medical University, China (n=30)
All India Institute of Speech & Hearing, Mysore, India (n=40)
Dpto de Fonoaudiologia Fac.de Odontologia de Bauru, Brazil (n=40)
University of Pretoria, Pretoria, South Africa (n=40)
Örebro University hospital, Örebro, Sweden (n=30)
Instruments
ICF Extended Checklist,
HHIA/HHIE
WHOQoL
Comorbidity
Totalt 200 patienter
(40 från varje klinik)
Detaljanalys ännu ej gjord
Konsensus Konferensen
(4-6 maj, 2012)
21 experter, inkluderande 4 personer med
hörselnedsättning, från 14 olika länder, (alla sex
WHO world regions), olika professioner inom det
audiologiska fältet (e.g., audiolog, speech/
language pathology, rehabilitation sciences,
audiological medicine, psychology,
otorhinolaryngology, hearing device
specialty/technical audiology).
Participants (n=21)
24
%
20
%
14
%
10
% 10
%
Source: WHO
http://www.who.int/about/regions/en/index.html
24
%
Consensus conference
The task, to decide:
as few categories as possible,
but as many as necessary
to describe functioning of persons with hearing loss in a
multidisciplinary setting (comprehensive core set) and in
clinical encounters/clinical studies (brief core set)
Preparatory studies
(n= 202 2nd level ICF categories)
Consensus conference
Brief Core set
Comprehensive Core set
(n=27)
(n=117)
Brief ICF Core Set for Hearing Loss
(body functions & body structures)
b126
Temperament and personality functions
b140
Attention functions
b144
Memory functions
b152
Emotional functions
b210
Seeing functions
b230
Hearing functions
b240
Sensations associated with hearing and vestibular function
s110
Structure of brain
s240
Structure of external ear
s250
Structure of middle ear
s260
Structure of inner ear
Brief ICF Core Set for Hearing Loss
(Activity& Participation and Environmental factors)
d115
Listening
d240
Handling stress and other psychological demands
d310
Communication – with- receiving- spoken messages
d350
Conversation
d360
Using communication devices and techniques
d760
Family relationships
d820
School education
d850
Remunerative employment
d910
Community life
e125
Products and technology for communication
e250
Sound
e310
Immediate family
e355
Health professionals
e410
Individual attitudes of immediate family members
e460
Societal attitudes
e580
Health services, systems and policies
Hur går vi vidare?
Operationalisering av de 27 kategorierna
En validerings- och implementeringsstudie
Start januari 2014 – en multi-centre studie (12
kliniker)
Mål: ett testat och validerat protokoll klart för
kliniskt bruk (maj 2015)
Tack för uppmärksamheten
