Are Group Aural Rehabilitation (AR) Programs Effective? - Part Two

By Mark Ross

March 2010

Editor: You probably know that one of my hot buttons is the tendency of too many audiologists and hearing aid dispensers to treat their clients like a giant ear that needs a hearing aid shoved in it, rather than as a person who needs a complete range of services to help them deal with the effects of hearing loss. I've long believed that group aural rehabilitation programs should be a standard offering of everyone who dispenses hearing aids. But are they effective? Here's Mark Ross to weigh in on the subject.

This article originally appeared in Hearing Loss Magazine, and is reprinted with the author's kind permission.

This is part two of two parts.

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Here's Part One!

Two kinds of evidence have been offered to support the notion and effectiveness of group AR programs. Support for the first type of evidence is inherent in the content of the typical group AR program; sometimes this is labeled "face validity" but I prefer to call it "common sense" (which may not be all that "common"). Consider this brief outline of a fairly typical group four-session AR program:

* At the first meeting, asking each hearing-impaired person and SO to note "the worst thing about having a hearing loss." At this point, these are just noted; possible solutions come later. People are surprised how often their problems are shared by others.

* Types of hearing loss; understanding the audiogram (basically this should be a review of the information covered during the hearing aid selection process).

* Using hearing aids effectively; introduction and explanation of special features.

* Overview of the various hearing assistive technologies other than hearing aids themselves (e.g., for telephones, TV listening, smoke alarms, special purpose devices).

* Introduction to speech reading and auditory relearning. Home training programs.

* And everything that comes up that relates to a hearing problem. Many of the issues that arise may require an individual appointment.

Most people who take this kind of program report that it is helpful. In one survey conducted at the Mayo Clinic Jacksonville, 307 patients were asked to rate the helpfulness of the program (from 1, "not helpful," to 6 "very helpful"); the average rating was 5.8 with 97% of the patients giving a score of 5 or 6. Another survey, conducted at a multi-center dispensing practice, found that hearing aid return rates were reduced from 9% to 3% for the people who had completed the program, compared to those who had not. While these surveys may not meet a strict definition of research, they clearly indicate that these AR programs have been helpful to lots of hearing aid users and their SOs. Certainly, this has been my experience when I conducted such programs myself.

What does count as research are the studies reviewed by Dr. David Hawkins in the Journal of the Academy of Audiology several years ago. After an intensive search of the literature, he found just twelve that met the criteria of a properly conducted research study. These were studies that employed both appropriate research conditions and recognized outcome measures. The typical program was conducted over a four week period and usually compared the performance of subjects who received a hearing aid but no AR to a group that received a hearing aid plus a short-term group AR program. It should be noted that these were counseling based studies, unlike those that focus directly on communication skills (such as speechreading and auditory training).

After carefully examining all of these studies, Hawkins concludes that there is "reasonably" good evidence that these programs will provide for, at the least, a short-term reduction in the self-perception of a hearing handicap as well as better use of communication strategies and hearing aids. As such, from a research perspective these programs are clearly worth doing. Even so, there is still some question whether these benefits persist over time, as well as whether or not the right kinds of "outcome" measures were employed. In my judgment people who take such a program can benefit from an occasional "booster" shot, whether in the form of another "review" short-term AR program, or perhaps by just being an active member of a Hearing Loss Association of America chapter. In short, in the same way we get booster shots to protect us against the flu each year, an occasional AR boost can also be beneficial.

The most recent research study (2009) on the effects of a short-term AR program, conducted by Drs. Jill Preminger and Suzanne Meeks, has an interesting twist. They provided an identical program to two groups, an experimental one in which their significant others were also provided with a separate AR program and a control group whose SOs received no such program (later rectified). Previous research had shown that the inclusion of SOs in the same classes as the persons with a hearing loss was beneficial to both parties. The researchers took this concept one step further, providing group classes designed specifically for SOs, in recognition of the fact that they also have a hearing "problem," just by living with someone with a hearing loss.

The basic question that the investigators asked was: Would the person with a hearing loss and the SO both judge the impact of the hearing loss on their quality of life (stress, affect, mood, marital communication, etc.) similarly after the SOs separate program compared to their previous pre-treatment ratings. It is surely a recipe for a tension filled marriage if the two parties see the impact of the hearing loss very differently. Pre-treatment, both groups of hearing-impaired subjects and their SOs were administered identical quality of life rating scales. Only about 50% of the couples, in both groups, rated the impact of the hearing loss similarly (termed "congruence"). For half the couples, then, there were significant differences in their perception of how the hearing loss affected their lives. Usually, it was the person with a hearing loss who felt the hearing loss had a greater effect than the SO. Obviously, it is not exactly a good omen for marital comity when couples have such disparate views of a condition that affects both their lives. After the study, however, the congruence score increased to 72% for the partners in the experimental group. Not perfect by any means, but clearly superior to the lack of congruence prior to the group program for SOs. No congruence change was noted for the control group, which remained at 50%.