Hughes Sarah E, Watkins Alan, Rapport Frances, Boisvert Isabelle, McMahon Catherine M, Hutchings Hayley A
Patient and Population Health and Informatics, Swansea University Medical School, Singleton Park, Swansea, United Kingdom.
Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.
Ear Hear. 2021;42(6):1699-1711. doi: 10.1097/AUD.0000000000001059.
Listening effort may be defined as the attentional and cognitive resources needed to understand an auditory message, modulated by motivation. Despite the use of hearing devices such as hearing aids or cochlear implants (CIs), the requirement for high listening effort remains a challenge for individuals with hearing loss. The Listening Effort Questionnaire-Cochlear Implant (LEQ-CI) is a hearing-specific patient-reported outcome measure (PROM), which has been designed for use in the CI candidacy and rehabilitation process to assess perceived listening effort in everyday life in adults with severe-profound hearing loss. The LEQ-CI has been developed in line with international consensus-based standards for best practice in PROM construction. The aim of this study was to improve the measurement precision of the LEQ-CI and to assess its psychometric measurement properties.
A field test was undertaken with 330 CI patients from five National Health Service auditory implant centers in the United Kingdom. Participants were adults (≥18 years of age), had a severe-profound hearing loss, and met the UK candidacy criteria for cochlear implantation specified by the National Institute for Health and Care Excellence (NICE). Participants completed and returned an anonymized 29-item (each with a 5- or 7-point response option), draft version of the LEQ-CI (LEQ-CI29) and a demographic questionnaire. Rasch analysis was undertaken using Winsteps software and the partial credit model to assess rating scale function and item fit. Results informed refinements to produce a 21-item version (LEQ-CI21), which underwent a further Rasch analysis.
The sample was predominantly female: 60.3% (n = 191). Median age of participants was 66 (range 21 to 89) years, with 7.3% (n = 24) of respondents being CI candidates and 92.7% (n = 306) being CI recipients. Mean duration of implantation was 3.8 (SD = 4.8) years. Initial Rasch analysis of the LEQ-CI29 revealed poor rating scale functioning. Collapsing the 5- and 7-point rating scales to 3- and 4-point scales and removing eight items produced a 21-item PROM (LEQ-CI21). Rasch analysis of the LEQ-CI21 showed good fit to the Rasch measurement model. No items showed misfit and dimensionality analysis supported the existence of a single Rasch dimension, defined as perceived listening effort in daily life. Person reliability was 0.91 and the person separation index was 3.28, establishing four levels of person ability. The item separation index was 9.69, confirming the item hierarchy. No items showed differential item functioning for gender or age. The item difficulty range was -0.81 to 1.05, the person ability range for nonextreme persons was -3.54 to 2.49, and the mean person ability was -0.31.
Overall, the LEQ-CI21 was found to meet the Rasch model criteria for interval-level measurement. The LEQ-CI21 is the first PROM to be developed specifically for the measurement of perceived listening effort and one of the first patient-reported outcome measures for use with CI patients to be developed using Rasch analysis. The LEQ-CI21 has the potential to be used as a research tool and in clinical practice to evaluate perceived listening effort in daily life. Further psychometric evaluation of the LEQ-CI21 is planned.
听力努力可定义为理解听觉信息所需的注意力和认知资源，并受动机调节。尽管使用了助听器或人工耳蜗（CI）等听力设备，但对于听力损失患者而言，高听力努力需求仍是一项挑战。《人工耳蜗听力努力问卷》（LEQ-CI）是一种针对听力的患者报告结局指标（PROM），旨在用于人工耳蜗植入候选和康复过程，以评估重度至极重度听力损失成人在日常生活中的感知听力努力。LEQ-CI是根据基于国际共识的PROM构建最佳实践标准制定的。本研究的目的是提高LEQ-CI的测量精度，并评估其心理测量特性。
对来自英国五个国民保健服务（NHS）听觉植入中心的330名CI患者进行了现场测试。参与者为成年人（≥18岁），患有重度至极重度听力损失，且符合英国国家卫生与临床优化研究所（NICE）规定的人工耳蜗植入候选标准。参与者完成并返回了一份匿名的29项（每项有5分或7分的回答选项）LEQ-CI草案版本（LEQ-CI29）和一份人口统计学问卷。使用Winsteps软件和部分计分模型进行拉施分析，以评估评分量表功能和项目拟合度。根据结果进行改进，生成了一个21项版本（LEQ-CI21），并对其进行了进一步的拉施分析。
样本中女性占主导：60.3%（n = 191）。参与者的年龄中位数为66岁（范围21至89岁），其中7.3%（n = 24）的受访者为人工耳蜗植入候选者，92.7%（n = 306）为人工耳蜗植入接受者。平均植入时间为3.8（标准差 = 4.8）年。对LEQ-CI29的初步拉施分析显示评分量表功能不佳。将5分和7分评分量表合并为3分和4分评分量表，并删除8个项目，生成了一个21项的PROM（LEQ-CI21）。对LEQ-CI21的拉施分析显示其与拉施测量模型拟合良好。没有项目显示拟合不佳，维度分析支持存在一个单一的拉施维度，定义为日常生活中的感知听力努力。个人信度为0.91，个人分离指数为3.28，确定了四个个人能力水平。项目分离指数为9.69，证实了项目层次结构。没有项目显示出性别或年龄的项目功能差异。项目难度范围为-0.81至1.05，非极端人群的个人能力范围为-3.54至2.49，平均个人能力为-0.31。
总体而言，发现LEQ-CI21符合区间水平测量的拉施模型标准。LEQ-CI21是首个专门为测量感知听力努力而开发的PROM，也是首批使用拉施分析为CI患者开发的患者报告结局指标之一。LEQ-CI21有潜力用作研究工具和临床实践中评估日常生活中感知听力努力的工具。计划对LEQ-CI21进行进一步的心理测量评估。
