Validation of a Dutch version of the Tinnitus Functional Index in a tertiary referral tinnitus clinic.

INTRODUCTION: Tinnitus is a condition with a subjective nature that requires self-report questionnaires for its assessment. Aspects such as quality of life, sleep or intrusiveness have been addressed by multiple tinnitus questionnaires, but the high responsiveness to treatment effects of the Tinnitus Functional Index (TFI) makes this questionnaire part of the standard practice in tinnitus screening. To date, the TFI has been translated to more than 20 languages and used in more than 22 countries. In this study, the TFI was translated to Dutch and validated through a clinical population in the Netherlands. METHODS: After a back-translation procedure, the Dutch TFI was filled-out by 377 patients in the tinnitus outpatient clinic at the Ear, Nose and Throat (ENT) department of the University Medical Center Groningen, in the Netherlands. Reliability and construct validity of the questionnaire were assessed by correlations with one other tinnitus questionnaire (Tinnitus Handicap Inventory, THI) and with three psychological functioning questionnaires (Rand-36, Cantril's ladder and the Hospital Anxiety and Depression Scale (HADS)). The eight-factor structure of the Dutch TFI was tested by means of exploratory factor analysis using three different models (ICM-CFA, ESEM and ESEM-CFA). RESULTS: The Dutch TFI showed a high internal consistency (α = 0.95), and construct validity was proven by moderate-to high-convergent correlations with the THI (r = 0.47-0.79) and by moderate convergent (r = 0.55-0.67) and good-to moderate-divergent (r = 0.12-0.47) correlations with the psychological functioning questionnaires. The eight-factor structure of the TFI was confirmed for the Dutch version by the three models. CONCLUSION: The Dutch version of the TFI is a reliable instrument for screening tinnitus impact in a clinical population, and its psychometric properties are comparable to the original TFI and other validated tinnitus questionnaires.

A Prospective Study of the Effect of Cochlear Implantation on Tinnitus.

Previous studies have shown diverse and sometimes even contrary results concerning the effect of cochlear implantation on tinnitus and the factors that can influence this effect. The aim of this prospective questionnaire study was to determine the effects of cochlear implantation on tinnitus and explore which factors can influence the effect of cochlear implantation on tinnitus. Forty-four of the patients implanted in our hospital returned 2 questionnaire packages, i.e., one before the cochlear implantation and one 6 months after implantation. Before implantation, 66% of the patients experienced tinnitus. This study shows that cochlear implantation could help to reduce tinnitus and the tinnitus handicap in at least 28% of the patients with preoperative tinnitus. In 72% of the patients the tinnitus remained after implantation. None of the patients developed tinnitus after implantation. A shorter duration of tinnitus prior to implantation, a more fluctuating type of tinnitus, a higher tinnitus handicap prior to implantation, and a round-window surgical approach might have a positive influence on the effect of cochlear implantation on tinnitus, but further research is necessary to confirm these findings.

Cluster Analysis to Identify Possible Subgroups in Tinnitus Patients.

INTRODUCTION: In tinnitus treatment, there is a tendency to shift from a "one size fits all" to a more individual, patient-tailored approach. Insight in the heterogeneity of the tinnitus spectrum might improve the management of tinnitus patients in terms of choice of treatment and identification of patients with severe mental distress. The goal of this study was to identify subgroups in a large group of tinnitus patients. METHODS: Data were collected from patients with severe tinnitus complaints visiting our tertiary referral tinnitus care group at the University Medical Center Groningen. Patient-reported and physician-reported variables were collected during their visit to our clinic. Cluster analyses were used to characterize subgroups. For the selection of the right variables to enter in the cluster analysis, two approaches were used: (1) variable reduction with principle component analysis and (2) variable selection based on expert opinion. RESULTS: Various variables of 1,783 tinnitus patients were included in the analyses. Cluster analysis (1) included 976 patients and resulted in a four-cluster solution. The effect of external influences was the most discriminative between the groups, or clusters, of patients. The "silhouette measure" of the cluster outcome was low (0.2), indicating a "no substantial" cluster structure. Cluster analysis (2) included 761 patients and resulted in a three-cluster solution, comparable to the first analysis. Again, a "no substantial" cluster structure was found (0.2). CONCLUSION: Two cluster analyses on a large database of tinnitus patients revealed that clusters of patients are mostly formed by a different response of external influences on their disease. However, both cluster outcomes based on this dataset showed a poor stability, suggesting that our tinnitus population comprises a continuum rather than a number of clearly defined subgroups.

Changes in tinnitus after cochlear implantation and its relation with psychological functioning.

This study retrospectively assessed the prevalence of tinnitus in cochlear implant patients and the changes after implantation in 212 patients implanted between 2000 and 2009. Patients were included at least 6 months after implantation and received 2 sets of questionnaires, one about the situation before implantation and one about the situation after implantation. Mostly standardized questionnaires assessed tinnitus handicap (Tinnitus Handicap Inventory, THI, and Tinnitus Handicap Questionnaire, THQ), tinnitus characteristics, hearing loss (Abbreviated Profile of Hearing Aid Benefit) and anxiety/depression (Hospital Anxiety and Depression Scale). Of the approached patients, 117 completed the full sets of questionnaires and 35 completed a short version. Preoperative tinnitus was reported by 51.3% of these patients, of which 55.6% reported a reduction or cessation of their tinnitus after implantation. However, 8.2% of the patients with tinnitus reported a postoperative deterioration of their tinnitus. In addition, among the patients without preoperative tinnitus, 19.6% reported the start of tinnitus after implantation. The self-reported change of tinnitus correlated with the pre- and postoperative scores on the THI and THQ. The THQ showed slightly more changes in scores after cochlear implantation compared to the THI. Overall hearing handicap and feelings of anxiety and depression decreased after implantation. In conclusion, tinnitus is reduced after cochlear implantation in an important part of the patients, but in a small part implantation has a negative effect on tinnitus. When tinnitus starts after implantation, the tinnitus handicap is mild.

Evidence-based treatment and quality of life in heart failure.

OBJECTIVES: To explore whether prescription of evidence-based drug therapy is associated with better quality of life (QoL) in patients with heart failure (HF). METHODS: Patients (n = 62) were recruited in the outpatient clinic of Groningen University Hospital. Inclusion criteria were previous diagnosis of HF, age 40-80 years; ejection fraction of less than 45%, free from other serious disease (such as cancer) and psychiatric problems in the last year. QoL was assessed with the RAND 36-item health survey questionnaire, on five scales: physical functioning, mental health, social functioning, vitality and general health perception. Medication prescribed for 1 to 6 months before the QoL assessment was classified as either evidence-based treatment or under-treatment, according to the 2001 European guidelines on optimal HF treatment. The study had a cross-sectional design. RESULTS: QoL did not differ significantly between evidence-based and under-treated patients, unadjusted or after adjustment for significant patient imbalances. CONCLUSIONS: Conventional step-up medication approach in HF may have a positive impact on survival or morbidity, but it seems not beneficial in relation to QoL. Other interventions should be designed to improve QoL of patients with HF.

Changes in personal control as a predictor of quality of life after pulmonary rehabilitation.

OBJECTIVE: Perceptions of mastery and self-efficacy may be related to better outcomes in pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD). This study examined (1) whether patients with COPD improved during a rehabilitation programme with respect to quality of life (QoL) and perceptions of self-efficacy and mastery, and (2) whether increased perceptions of mastery and self-efficacy contributed to a higher QoL after rehabilitation. METHODS: Thirty-nine consecutive COPD patients (aged 60.5 +/- 9.0) were included from a rehabilitation centre and completed self-report questionnaires assessing symptoms, QoL, and perceptions of personal control. RESULTS: COPD patients improved during rehabilitation in overall QoL and self-efficacy, although no significant changes were found in QoL domains and mastery. Changes in self-efficacy during rehabilitation contributed to the explanation of the social and psychological functioning QoL domains. CONCLUSION: Even in seriously impaired COPD patients in advanced stages of illness, positive changes in self-efficacy and overall well-being can be established during rehabilitation. Changes in self-efficacy were related to a better QoL, suggesting the importance of personal control in the adjustment to COPD. PRACTICE IMPLICATIONS: Focussing more explicitly on the enhancement of perceptions of personal control in COPD patients may be an important aim of pulmonary rehabilitation.

The relationship between self-efficacy and self-reported physical functioning in chronic obstructive pulmonary disease and chronic heart failure.

In this study, the authors investigated whether self-reported physical functioning of patients with chronic obstructive pulmonary disease (COPD) and chronic systolic heart failure (CHF) was primarily explained by illness-specific differences related to diagnosis or whether more generic factors also contributed to their physical functioning. Consecutive patients with COPD (n = 56; mean age = 67.8, SD = 8.5) and CHF (n = 65; mean age = 60.0, SD = 10.2)from the outpatient clinics of a university hospital and a general hospital completed a self-report questionnaire, including the Rand-36 Health Survey, Cantril's ladder, the Mastery scale, the Perceived Health Competence Scale, and the Self-efficacy scale. COPD patients scored significantly worse in self-reported physical and psychological functioning and perceived health competence than did patients with CHF Regression analysis revealed that both the diagnosis and the illness severity contributed to self-reported physical functioning, although self-efficacy explained the main part of physical functioning. Therefore, important aims in the treatment of patients with COPD and CHF should be not only improving physical functioning but also enhancing self-efficacy.

Consequences of chronic obstructive pulmonary disease and chronic heart failure: the relationship between objective and subjective health.

This study investigates whether the relationship between objective health parameters and general health perceptions was mediated by symptoms of dyspnoea and physical functioning in patients with chronic obstructive pulmonary disease (COPD) and patients with chronic heart failure (CHF). The different health parameters were organised according to Wilson and Cleary's conceptual model of patient outcomes (Wilson & Cleary (1995). Journal of the American Medical Association, 273, 59-65). Second, we investigated whether perceptions of personal control were related to the health parameters in the model. Consecutive patients with COPD and CHF were included from the outpatient clinics of a university hospital and a general hospital, and from a rehabilitation centre, all in the Netherlands. Ninety-five COPD patients (aged 65.0+/-9.3; forced expiratory volume in 1s (FEV1)<70%) were included and compared with 90 CHF patients (aged 59.6+/-10.0; left ventricular ejection fraction (LVEF)<45%). The relationship between objective health parameters (FEV1 or LVEF) and subjective health (self-reported physical functioning) was not mediated by symptoms of dyspnoea. FEV1 or LVEF and symptoms of dyspnoea were independently related to self-reported physical functioning, which was directly related to general health perceptions. Perceived health competence was related to symptoms of dyspnoea and general health perceptions in patients with either COPD or CHF. Although patients with COPD reported lower levels in all self-reported health parameters in the model than the patients with CHF, this study showed that the relations between the health parameters in the model were comparable for COPD and CHF patients.