Participants were encouraged to experiment with different processor settings and programs and redo the test whenever they wanted. However, participants could complete the test at any other time during the 6 months. The protocol required participants to complete the hearing test a minimum of two times: month 1 and month 6 of the trial. 9 Participants were advised that although a direct connection between the sound processor and the computer eliminates the effects of background noise, testing with the computer speakers allows assessment of the whole hearing pathway including the microphone-a part that commonly deteriorates due to dust, humidity or damage. Full methodological details of the test have been published elsewhere. An incorrect response caused a decrease in noise. If they entered all three digits correctly, the noise level increased. Participants listened to sets of three digits in background noise and typed in the numbers they heard. Each time a participant completed the test, the results were emailed to the research team and included a code to identify the participant. The customised site was provided by the charity Action on Hearing Loss. Participants in the remote care arm accessed a password-protected online hearing in noise test based on the Triple Digit Test (TDT) each participant had an individual log-in. 4 Clinics may be able to improve use of resources through reducing the need for follow-up appointments. Patients who are empowered and involved in their care tend to have better outcomes, 2 3 and those using self-management tools show a significant improvement in outcomes. Greater equality in service delivery as routine support can be accessed regardless of distance from clinic. Reduction of travel cost and time, time off work and disruption to family life More appropriate adjustments of the cochlear implant processor in real-life situations as they provide an ability to fine-tune when away from clinic Ĭonvenience of not travelling to routine appointments More stable hearing as problems could be identified and resolved quicker Increased confidence to manage one’s own hearing Potential benefits for the patient from the use of these remote care tools are: If effective, these tools could mean that people using cochlear implants could only attend the clinic when intervention is required, eliminating the need for routine clinic-led appointments. We designed, implemented and evaluated remote care tools that the patient could use at home to manage these tasks. The following tasks are usually completed in routine follow-up appointments: hearing and speech recognition testing, device adjustment, rehabilitation, equipment check and troubleshooting, and provision of replacement or upgraded equipment. Deterioration usually occurs gradually, and without tools to test at home, the patient may not notice a change and may spend several months listening with poorer hearing. However, routine appointments do provide opportunities for the clinician to detect deterioration in a patient’s hearing or speech recognition. This may result in resources being used to provide appointments that provide little if any benefit to the patient. Most clinics provide regular annual follow-up, whether or not further intervention is needed. Accessing services can involve considerable time commitment, travel expense, missed work and family disruption. 1 There are 18 cochlear implant centres in the UK, providing surgery, an acute phase of adjustment and rehabilitation, and then clinic-led long-term follow-up services. Around 14 000 people in the UK use cochlear implants, increasing by approximately 1200 new patients each year. Cochlear implants provide hearing to people mainly with severe to profound deafness.
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