Feasibility of personalised remote long-term follow-up of people with cochlear implants: a randomised controlled trial

Abstract

Introduction Substantial resources are required to provide lifelong postoperative care to people with cochlear implants. Most patients visit the clinic annually. We introduced a person-centred remote follow-up pathway, giving patients telemedicine tools to use at home so they would only visit the centre when intervention was required. Objectives To assess the feasibility of comparing a remote care pathway with the standard pathway in adults using cochlear implants. Design Two-arm randomised controlled trial. Randomisation used a minimisation approach, controlling for potential confounding factors. Participant blinding was not possible, but baseline measures occurred before allocation. Setting University of Southampton Auditory Implant Service: provider of National Health Service care. Participants 60 adults who had used cochlear implants for at least 6 months. Interventions Control group (n=30) followed usual care pathway. Remote care group (n=30) received care remotely for 6 months incorporating: home hearing in noise test, online support tool and self-adjustment of device (only 10 had compatible equipment). Main outcome measures Primary: change in patient activation; measured using the Patient Activation Measure. Secondary: change in hearing and quality of life; qualitative feedback from patients and clinicians. Results One participant in the remote care group dropped out. The remote care group showed a greater increase in patient activation than the control group. Changes in hearing differed between the groups. The remote care group improved on the Triple Digit Test hearing test; the control group perceived their hearing was worse on the Speech, Spatial and Qualities of Hearing Scale questionnaire. Quality of life remained unchanged in both groups. Patients and clinicians were generally positive about remote care tools and wanted to continue. Conclusions Adults with cochlear implants were willing to be randomised and complied with the protocol. Personalised remote care for long-term follow-up is feasible and acceptable, leading to more empowered patients. Trial registration number NCT14644286.

Health State Utility Values Associated with Cochlear Implants in Adults: A Systematic Review and Network Meta-Analysis

“…com/EANDH/B66, which displays health statue utility values reported in included studies). One study reported substantially lower mean HSUV for bilateral cochlear implant compared with other studies (0.41 and 0.04), although sample sizes for these estimates were low at n = 2 and n = 3 (Cullington et al 2018). Two studies reported vignette-based HSUV estimates whereby HSUV were obtained from responses from participants other than patients with the condition.…”

“…Zwolan et al (2014) compared those aged 65 years and older to those under age 65 years and did not detect a significant difference in HUI-3 derived HSUV pre-or postunilateral cochlear implantation, but did observe a greater mean improvement in HUI-3 hearing single attribute utility for the older cohort. In a randomized trial, Cullington et al (2018) found that standard in-person versus remote audiology care had no detectable effect on unilateral or bilateral cochlear implant HSUV.…”

“…Title and abstract screening identified 263 articles, and full-text eligibility assessment revealed 48 studies representing 36 unique cohorts that met criteria for this review. Of these, 34 studies representing 29 cohorts report HSUV for unilateral cochlear implant only (Harris et al 1995;Wyatt et al 1996;Palmer et al 1999;Krabbe et al 2000;Hogan et al 2001;Francis et al 2002;UK Cochlear Implant Study Group 2004a, 2004b, 2004cHawthorne et al 2004;Lee et al 2006;Klop et al 2007;Damen et al 2007;Klop et al 2008;Lenarz et al 2013;Arnoldner et al 2014;Straatman et al 2014;Zwolan et al 2014;Runge et al 2016;Manrique-Huarte et al 2016;Lenarz et al 2017;Sladen et al 2017;Kasemsiri et al 2018;Summerfield & Barton 2019;Theriou et al 2019) and 14 studies representing 7 cohorts report HSUV for bilateral cochlear implants (Summerfield et al 2002;Bichey et al 2002;Summerfield et al 2006;Bichey & Miyamoto 2008;Chen et al 2014;Härkönen et al 2015;Kuthubutheen et al 2015;Smulders et al 2016aSmulders et al , 2016bRamakers et al 2016;Kraaijenga et al 2017;Cullington et al 2018;Kraaijenga et al 2019).…”

Preventing Sudden Cessation of Implantable Pulse Generators in Deep Brain Stimulation: A Systematic Review and Protocol Proposal

“…Cochlear implants share similarities with DBS, requiring timely power source management. Cochlear implant clinicians and patients extensively utilize telehealth checkups, resulting in empowerment and improved hearing outcomes [26][27][28] similar to DBS.…”

Implantable Hearing Devices in Ontario: A Population-Based Study of Access to Care and Access to Devices

“…Another population-based study from Ontario identified geographical location as a factor for delayed pediatric cochlear implantation (amongst other factors including progressive HL, complex medical conditions, and family indecision)with tele-audiology, these pediatric patients could potentially receive improved access to the hearing care despite their geographic status, which may help alleviate burdens on both themselves and the medical system down the line [Nassiri et al, 2022]. A recent randomized controlled trial also demonstrated the feasibility of personalized remote long-term follow-up care for patients with CI [Cullington et al, 2018]. Follow-up care after IHD (particularly for CI) can be lengthy during the first year and often becomes a time-consuming task for patients when distance traveled is factored in.…”