与听力损失相关的健康相关生活质量变化。
Health-Related Quality of Life Changes Associated With Hearing Loss.
机构信息
Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
出版信息
JAMA Otolaryngol Head Neck Surg. 2020 Jul 1;146(7):630-638. doi: 10.1001/jamaoto.2020.0674.
IMPORTANCE
Utility is a single-value, preference-based measure of health-related quality of life that represents the desirability of a health state relative to being dead or in perfect health. Clinical, funding, and policy decisions rely on measured changes in utility. The benefit of hearing loss treatments may be underestimated because existing utility measures fail to capture important changes in quality of life associated with hearing loss.
OBJECTIVE
To develop a comprehensive profile of items that describe how quality of life is associated with hearing loss and its treatments that can be used to generate hearing-related quality of life measures, including a novel utility measure.
DESIGN, SETTING, AND PARTICIPANTS: This qualitative study, performed from August 1, 2018, to August 1, 2019, in tertiary referral centers, comprised a systematic literature review, focus groups, and semistructured interviews. The systematic review evaluated studies published from 1982 to August 1, 2018. Focus groups included 8 clinical experts experienced in the measurement, diagnosis, treatment, and rehabilitation of hearing loss. Semistructured interviews included 26 adults with hearing loss recruited from an institutional data set and outpatient hearing aid and otology clinics using stratified convenience sampling to include individuals of diverse ages, urban and rural residency, causes of hearing loss, severity of hearing loss, and treatment experience.
MAIN OUTCOMES AND MEASURES
A set of items and subdomains that collectively describe the association of hearing loss with health-related quality of life.
RESULTS
The literature search yielded 2779 articles from the MEDLINE, Embase, Cochrane, PsycINFO, and CINAHL databases. Forty-five studies including 1036 individuals (age range, 18-84 years) were included. The focus group included 4 audiologists and 4 otologists. Hour-long semistructured interviews were conducted with 26 individuals (13 women; median age, 54 years; range, 25-83 years) with a broad range of hearing loss causes, configurations, and severities. From all 3 sources, a total of 125 items were generated and organized into 29 subdomains derived from the World Health Organization's International Classification of Functioning, Disability and Health.
CONCLUSIONS AND RELEVANCE
The association of hearing loss with quality of life is multidimensional and includes subdomains that are not considered in the estimation of health utility by existing utility measures. The presented comprehensive profile of items can be used to generate or evaluate measures of hearing-related quality of life, including utility measures.
重要性
效用是一种单一值的、基于偏好的健康相关生活质量衡量标准，代表了相对于死亡或完全健康的健康状态的理想程度。临床、资金和政策决策依赖于测量的效用变化。由于现有效用衡量标准未能捕捉到与听力损失相关的生活质量的重要变化，听力损失治疗的益处可能被低估。
目的
开发一个全面的项目档案，描述听力损失及其治疗如何与生活质量相关联，这些项目可以用来生成与听力相关的生活质量衡量标准，包括一种新的效用衡量标准。
设计、地点和参与者：这项定性研究于 2018 年 8 月 1 日至 2019 年 8 月 1 日在三级转诊中心进行，包括系统文献回顾、焦点小组和半结构化访谈。系统综述评估了 1982 年至 2018 年 8 月 1 日期间发表的研究。焦点小组包括 8 名在听力损失的测量、诊断、治疗和康复方面经验丰富的临床专家。半结构化访谈包括 26 名从机构数据集中招募的听力损失成年人和门诊听力辅助和耳科诊所，采用分层便利抽样，包括不同年龄、城乡居住、听力损失原因、听力损失严重程度和治疗经验的个体。
主要结果和措施
一套项目和子领域，共同描述了听力损失与健康相关生活质量的关联。
结果
文献检索从 MEDLINE、Embase、Cochrane、PsycINFO 和 CINAHL 数据库中获得了 2779 篇文章。包括 1036 人（年龄范围 18-84 岁）在内的 45 项研究被纳入。焦点小组包括 4 名听力学家和 4 名耳科医生。对 26 名年龄在 25-83 岁之间、听力损失原因、类型和严重程度广泛的个体进行了长达 1 小时的半结构化访谈。来自所有 3 个来源的 125 个项目被生成，并组织成 29 个子领域，这些子领域源自世界卫生组织的《国际功能、残疾和健康分类》。
结论和相关性
听力损失与生活质量的关联是多维度的，包括现有效用衡量标准在估计健康效用时未考虑的子领域。所呈现的项目综合档案可用于生成或评估与听力相关的生活质量衡量标准，包括效用衡量标准。
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