Transcript Slide 1
A multi-disciplined approach to tinnitus research Nottingham Hearing Biomedical Research Unit Kathryn Fackrell 17/07/2015 A multi-disciplined approach to tinnitus research Measuring tinnitus Functional connectivity in the tinnitus brain Validation of measures of tinnitus Exploring therapeutic target Effect of tinnitus on working memory and attention Validation of a new cognitive model of tinnitus Evaluating interventions Benefit of self-help programmes Effectiveness of audiologist-delivered counselling Efficacy of (combination) hearing aids devices Efficacy of sound devices Efficacy of novel compounds Addressing questions that are important to patients and clinicians Effectiveness of audiologist-delivered counselling “‘Talking therapies’ will have an increased role to play in NHS care generally” Cognitive Behaviour Therapy • Offers a practical solution to dealing with current problems Counselling • Aims to empower patients to reach decisions and take actions for themselves Tinnitus Priority Setting Partnership: One of the top 10 unanswered questions Manualisation and feasibility of audiologistdelivered counselling for tinnitus Deb Hall Mary McMurran Dawn Marie-Walker Amanda Casey David Stockdale Manualisation and feasibility of audiologistdelivered counselling for tinnitus Develop a manual for audiologist-delivered talking therapy and test its feasibility Several interacting components Target a wide range of possible outcomes Have a permitted degree of flexibility or tailoring, ? What are the essential components of talking therapy for tinnitus that can be delivered by audiologists? Identifying components Step one: Scoping review Course materials articles, practical guidelines, protocols from relevant clinical trials, commentaries and professional magazine articles Step two: Consultation - Delphi review Develop a consensus on.. ? the essential components ? associated aims of tinnitus counselling From the shared perspective of the patient and the clinician. Identifying components Step two: Consultation - Delphi review Who do we need? → 20 patients → experienced some form of counselling or CBT for tinnitus complaint → From an audiologist, hearing therapist, or clinical psychologist → 20 audiologists/hearing therapists → received training in counselling or CBT and consult tinnitus patients Derek Hoare: [email protected] Evaluating self-help programmes: update Study one: Usability of program ? Gaining opinion of both the website and program ? New users who will • Complete the 6 week program • Complete survey each week ? People who have previously used the program Sandra Smith: • Complete one off survey [email protected] A Randomised Placebo Controlled Doubleblind trial of AUT00063 drug Investigate the efficacy and safety of AUT00063 drug versus placebo • Reduced activity at certain sites in the brain has been linked to hearing problems, such as tinnitus • voltage-gated potassium channels may be a drug target for hearingrelated problems. • an experimental new medicine – improve the action of these specific channels – treat the brain component of these hearing problems – early-onset subjective tinnitus Please follow the link for more information: http://www.autifony.com/autifony-tinnitus-quiet-study.asp An update on my PhD VALIDATION OF THE TFI The importance of questionnaires How? Diagnostic tool Why? Assess tinnitus severity Triaging patients Grade tinnitus severity Selection criteria Guiding decisions To determine treatment candidacy Identify minimal important change Inform treatment approaches Counsel patient To facilitate clinical audit To compare new management Evaluate treatment approaches & interventions Outcome measure Hoare & Hall (2011) Validating a new tinnitus questionnaire: Tinnitus Functional Index (TFI) Does the questionnaire reflect what it is measuring? Does the questionnaire compare to others tinnitus questionnaires? Does the questionnaire reliably show changes that occur over time? Is there a grading system? Diagnostic tool & measure of change of tinnitus distress UK clinical population 250 new tinnitus patients Final participants complete this April! ●Nottingham TFI score distribution Clinical population Mean score: 52.6849 Research population Mean score: 39.3175 Clinic overall scores N: 252 Aintree 2 QP1 60.78 55.2 QP2 43.83 48.77 3 61.74 56.64 4 50.81 46.07 5 48.16 47.14 6 49.62 46.35 7 42.22 29.64 8 55.28 42.88 9 48.41 43.62 10 57.14 48.80 11 47.68 35.97 12 53.02 46.01 Aintree TFI shows changes over time Aintree: 60.78 43.83 N: 15 Responsiveness: research population Floor and ceiling effects: limited detection of individual improvements and worsening Responsiveness: clinics population Floor and ceiling effects: limited detection of individual improvements and worsening UK clinical population 250 new tinnitus patients Factorial structure •Any identified domains/subscales •Is the structure reliable? Reproducibility •Can it reliably distinguish between people? Responsiveness •Does it reliably show small changes that occur over time? •Is there a minimal important change score? ●Nottingham Interpretability •What do the scores mean? Thank you for listening Nottingham Hearing Biomedical Research Unit: www.hearing.nihr.ac.uk Sandra Smith: [email protected] Derek Hoare: [email protected] Kathryn Fackrell: [email protected] http://www.autifony.com/autifony-tinnitus-quiet-study.asp