An integrated knowledge translation experience: Use of the Network of Pediatric Audiologists of Canada to facilitate the development of The University of Western Ontario Pediatric Audiological Monitoring Protocol (UWO PedAMP v1.0).

The goals of this project were: (1) to determine the important factors that influence implementation of evidence-based practice by Canadian audiologists; and (2) to utilize the knowledge-to-action process (Graham et al., 2006) during the development of a guideline for outcome measures to evaluate the auditory development and performance of young children who wear hearing aids, to facilitate clinical uptake and identify barriers to implementation (Bagatto, Moodie & Scollie, 2010; Bagatto et al., 2011; Bagatto, Moodie, Seewald, Bartlett, & Scollie, 2011; Moodie, Bagatto et al., 2011; Moodie, Kothari et al., 2011). Two projects (Chapters 3 and 4) included the participation of The Network of Pediatric Audiologists of Canada. The outcome measures guideline to evaluate the auditory development and performance of young children who wear hearing aids is called The University of Western Ontario Pediatric Audiological Monitoring Protocol (UWO PedAMP). This body of work includes a chapter on knowledge translation and how it can be used to promote the clinical implementation of evidence in audiology (Chapter 3). It also includes three studies: (1) an examination of factors influencing the use of evidence by Canadian audiologists [Chapter 2]; (2) an initial evaluation by the Network of Pediatric Audiologists of Canada of the individual components considered for inclusion in the UWO PedAMP [Chapter 4]; and (3) a final evaluation by the Network audiologists of the released version of the UWO PedAMP and associated training materials [Chapter 5]. Results of the first study indicated that Canadian audiologists rate themselves as competent in finding, evaluating and using research evidence to change practice. Their greatest barriers to evidence-based practice are related to time. By partnering with Canadian audiologists and using the knowledge-to-action framework to guide us (Chapter 4), we were successful in developing the UWO PedAMP guideline into what they rated as being a high-quality, systematic, hearing aid outcome evaluation tool that improves the quality and effectiveness of audiological care received by young children with hearing loss. The results presented in Chapter 5 indicated that the UWO PedAMP is appropriate for clinical implementation, and is recommended by these Canadian audiologists as preferred audiology practice

A critical review of audiological outcome measures for infants and children

Outcome evaluation is an important stage in the pediatric hearing aid fitting process, however a systematic way of evaluating outcome in the pediatric audiology population is lacking. This is in part due to the need for an evidence-based outcome evaluation guideline for infants and children with hearing loss who wear hearing aids. As part of the development of a guideline, a critical review of the existing pediatric audiology outcome evaluation tools was conducted. Subjective outcome evaluation tools that measure auditory-related behaviors in children from birth to 6 years of age were critically appraised using a published grading system (Andresen, 2000). Of the tools that exist, 12 were appraised because they met initial criteria outlined by the Network of Pediatric Audiologists of Canada as being appropriate for children birth to 6 years of age who wear hearing aids. Tools that were considered for the guideline scored high in both statistical and feasibility criteria. The subjective outcome evaluation tools that were ultimately chosen to be included in the guideline were the LittlEARS Auditory Questionnaire (Tsiakpini et al., 2004) and the Parents\u27 Evaluation of Aural/Oral Performance of Children (PEACH) Rating Scale (Ching & Hill, 2005b) due to the high grades they received in the critical review and their target age ranges. Following this critical review of pediatric outcome evaluation tools, the next step was for the Network Clinicians to evaluate the guideline (Moodie et al., 2011b)

Protocol for the Provision of Amplification

This Protocol addresses the provision of amplification (hereafter: \u27Amplification\u27) to infants and pre-school children who are receiving services from the Ontario Infant Hearing Program (IHP). Providing amplification includes the process of prescribing a hearing aid based on appropriate assessment information, verification that the specified acoustical performance targets have been achieved, fitting the device on the child, and evaluation of device effectiveness in daily life

Protocol for the Provision of Amplification v 2023.01

This Protocol addresses the provision of amplification (hereafter: \u27Amplification\u27) to infants and children who are receiving services from the Ontario Infant Hearing Program (IHP). For the purposes of this protocol, providing amplification includes the processes of prescribing a hearing aid (air or bone conduction) and/or other hearing assistance technologies based on appropriate assessment information, verification that the specified acoustical performance targets have been achieved, fitting the device on the child, and ongoing evaluation of device effectiveness in daily life. Amplification within the IHP does not include the provision of cochlear implants

Relevance of the International Classification of Functioning, Health and Disability: Children & Youth Version in Early Hearing Detection and Intervention Programs

Early hearing detection and intervention (EHDI) programs have been guided by principles from the Joint Committee on Infant Hearing and an international consensus of best practice principles for family-centered early intervention. Both resources provide a solid foundation from which to design, implement, and sustain a high-quality, family-centered EHDI program. As a result, infants born with permanent hearing loss and their families will have the support they need to develop communication skills. These families also will benefit from programs that align with the framework offered by the World Health Organization\u27s International Classification of Functioning, Disability and Health: Children & Youth Version (ICF-CY). Within this framework, health and functioning is defined and measured by describing the consequences of the health condition (i.e., hearing loss) in terms of body function, structures, activity, and participation as well as social aspects of the child. This article describes the relevance of the ICF-CY for EHDI programs and offers a modified approach by including aspects of quality of life and human development across time

External validation of the LittlEARS® Auditory Questionnaire with English-speaking families of Canadian children with normal hearing

OBJECTIVE: To examine the external validity of the United Kingdom English version of the LittlEARS(®) Auditory Questionnaire with English-speaking families of Canadian children with normal hearing. METHODS: The United Kingdom English version of the LittlEARS was administered to English-speaking families of 130 children with normal hearing in Ontario, Canada. Total scores for these children were compared to German-derived normative values. RESULTS: There was no significant difference between Canadian and German norms when using the United Kingdom English version of the LittlEARS Auditory Questionnaire. CONCLUSIONS: The United Kingdom English version of the LittlEARS Auditory Questionnaire is appropriate for use with English-speaking families of normal hearing Canadian children

Knowledge translation in audiology: Promoting the clinical application of best evidence

The impetus for evidence-based practice (EBP) has grown out of widespread concern with the quality, effectiveness (including cost-effectiveness), and efficiency of medical care received by the public. Although initially focused on medicine, EBP principles have been adopted by many of the health care professions and are often represented in practice through the development and use of clinical practice guidelines (CPGs). Audiology has been working on incorporating EBP principles into its mandate for professional practice since the mid-1990s. Despite widespread efforts to implement EBP and guidelines into audiology practice, gaps still exist between the best evidence based on research and what is being done in clinical practice. A collaborative dynamic and iterative integrated knowledge translation (KT) framework rather than a researcher-driven hierarchical approach to EBP and the development of CPGs has been shown to reduce the knowledge-to-clinical action gaps. This article provides a brief overview of EBP and CPGs, including a discussion of the barriers to implementing CPGs into clinical practice. It then offers a discussion of how an integrated KT process combined with a community of practice (CoP) might facilitate the development and dissemination of evidence for clinical audiology practice. Finally, a project that uses the knowledge-to-action (KTA) framework for the development of outcome measures in pediatric audiology is introduced

Fit-to-targets for the desired sensation level version 5.0a hearing aid prescription method for children

Purpose: The purpose of this study was to measure the range of fit to Desired Sensation Level version 5.0 (DSL v5.0) targets in pediatric practice environments. Results will be used in the future to develop clinical-aided speech intelligibility index typical performance data. Method: Clinical partners collected data from 161 final hearing aid settings for children aged ≤ 10 years. Measured data were obtained by performing 2-cm coupler-simulated real-ear measurements using the DSL v5.0 implementation on the Audioscan VF-1 (Etymonic Design Inc., Dorchester, ON, Canada) for soft, average, and loud speech inputs and maximum hearing aid output levels. Results: Fittings were within ± 5-dB root-mean-square (RMS) error of target for 77%, 80%, and 82% of fittings for the soft, medium, and loud speech test levels, respectively. Aided maximum power output measures were within ± 5-dB RMS error in 72% of cases. Degree of hearing loss, test frequency, and frequency by test level were significant factors in deviation from target. The range of aided speech intelligibility index values exhibited a strong correlation with the hearing levels of the children tested. Conclusion: This study provides evidence that typical hearing aid fittings for children can be achieved within ± 5-dB RMS error of the DSL v5.0 target. Greater target deviations were observed at extreme frequencies and as the severity of hearing loss increased.