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Nödvändigheten av förändring i audiologisk praktik

This presentation discusses the need for change in audiological practice to provide more patient-oriented rehabilitation for individuals with hearing loss. It explores barriers and supports for patient-centered care and the use of International Classification of Functioning, Disability and Health (ICF) Core Sets for hearing loss as a tool for patient assessment. The presentation also addresses the focus on technology, non-adherence to treatment, and the shift towards a new paradigm of Patient-Centered Audiological Rehabilitation. The findings from a global web survey and the ICF Core Sets project are presented, highlighting the importance of reducing the number of ICF categories for a practical clinical approach.

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Nödvändigheten av förändring i audiologisk praktik

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  1. 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

  2. Min presentation Bakgrund 2. Hinder och stöd för en mer patientorienterad audiologisk rehabilitering (PCAR) 3. ICF Core Sets för vuxna med hörselnedsättning: ett stöd för PCAR

  3. Bakgrund Fokus på teknik (amplification) Icke följsamhet (non-adherence) Mot ett nytt paradigm (Patient Centered Audiological Rehabilitation)

  4. Global websurvey (n=209)

  5. ICF (WHO, 2001) Internationell klassifikation av funktionstillstånd, funktionshinder och hälsa International classification of functioning, disability and health (WHO, 2001).

  6. ICF Internationell klassificering av funktion och hälsa

  7. ICF Core Sets for Hearing Loss - - - b230 b2300 b2301 b2304 - - s250 s2502 s2600 - - d115 d310 d3504 - - e1251 e1501 e310 e410 - - - ICF Core Sets 1454 st

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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 Systematisk litteraturöversikt

  13. 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.

  14. Search in 9 databases Adults, English, 2002-2007, acceptable study design, correct focus, correct target group Abstract checking Reading articles in full text Retrieve outcome measures or outcome (qualitative studies) Linking to ICF according to established linking rules Procedure

  15. 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) Instrument

  16. Resultat och slutsatser Resultat: De flestainstrumentenhandlade om taluppfattning (speech recognition). 51 olika instrument användes. Småurvalochkönoftainterapporterat. Slutsats: Kunskapenfragmenterad (ingenhelhetssyn). Ingenenighet om hurhurpatientensupplevelser, behovochfunktionskallkartläggas.

  17. De vanligastekategoriernahandlade om listening, hearing functions ochauditory perception. Kategorierrelaterade till kommunikationvarovanliga. Den fysiskaomgivningen, somljudochhörelhjälpmedelärviktiga men lite uppmärksamhet mot den socialaomgivningen (t.ex. attityder).

  18. Fokusgrupper i Sydafrika, Nederländerna & Sverige 36 deltagare.

  19. Sarah Granberg, Marieke Pronk, Kerstin Möller, Claes Möller & Berth Danermark Patient perspective in the ICF Core Sets Project for Hearing Loss. (Ready to submit)

  20. 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?

  21. 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.

  22. 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)

  23. En internetbaserad cross-sectional survey. Stratifieraturval (63 expertformuläranalyserades). Experterfrånalla sex WHO världsregioner (Africa, the Americas, Eastern Mediterranean, Europe, South-East Asia and Western Pacific) Inklusionskriterium: professionellasomärdirektinvolveradeimålgruppensrehabilitering; minst 5 årspraktik; behärskarengelska, svenska, danskaellernorska.

  24. Slutsatser Mestomnämndakategorivarinom - Aktivitet & Delaktighet: interaction. - Externafaktorer: physical environment (t.ex. hörapparat (e1251) ellerstörandeljud (e2501). Internafaktorer:confidence (b1266), emotional functions (b152). Studienvisarviktenavettholistisktperspektiv.

  25. 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)

  26. Instruments ICF Extended Checklist, HHIA/HHIE WHOQoL Comorbidity Totalt 200 patienter (40 från varje klinik)

  27. Detaljanalys ännu ej gjord

  28. Konsensus Konferensen (4-6 maj, 2012) 21 experter, inkluderande4 personer med hörselnedsättning, från14 olikaländer, (alla sex WHO world regions), olikaprofessionerinomdetaudiologiskafältet(e.g., audiolog, speech/ language pathology, rehabilitation sciences, audiological medicine, psychology, otorhinolaryngology, hearing device specialty/technical audiology).

  29. Participants (n=21) 24 % 20 % 10 % 10 % 14 % 24% Source: WHO http://www.who.int/about/regions/en/index.html

  30. 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)

  31. Preparatory studies (n= 202 2nd level ICF categories) Consensus conference Brief Core set (n=27) Comprehensive Core set (n=117)

  32. 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)

  33. Tack föruppmärksamheten

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