拓展听力损失的功能特征：将平衡与移动能力类别纳入听力损失ICF核心集的证据

文献信息

中文摘要

背景与目的： 平衡与移动困难在听力损失（HL）成人中很常见，但由于碎片化的照护模式、临床服务的孤岛式结构以及当前基于国际功能、残疾和健康分类（ICF）的评估框架的局限性，这些困难在临床实践中常被忽视。本研究旨在量化这些困难并检验其与功能领域的关联。
受试者与方法： 一项横断面研究纳入72名成人（平均年龄59±8.3岁），包括听力正常者（25%）和HL者（75%），涵盖未助听和助听使用者。参与者从奥本大学言语与听力诊所目的性招募，且此前已完成HEAR-COMMAND工具——一种源自听力损失ICF核心集（ICF-CSHL）的自评问卷。此外，所有参与者完成了平衡与移动量表（BMS），一种仿照HEAR-COMMAND工具编制的13条目工具，用以基准评估平衡-移动困难。
结果： BMS结果显示出极好的内部一致性（α=0.90）和两个不同但相关的因子——身体移动与感知体验，支持其结构效度。平衡-移动挑战高度普遍，包括行走疲劳（73.6%）、完成复杂动作困难（72.2%）、体位转换困难（70.8%）、腿部僵硬（68.1%）、站立不稳（61.1%）和长距离行走困难（50%）。BMS评分与HEAR-COMMAND评分强相关，可解释听力领域（β=0.50，p<0.001，R2=0.40）和非听力领域（β=0.63，p<0.001，R2=0.48）的显著方差。方差分析（ANOVA）显示仅听力领域评分在组间存在显著差异，听力正常参与者的表现优于未助听和助听的HL参与者。
结论： 平衡-移动挑战的高患病率和强功能关联表明它们是HL个体残疾的核心组成部分。将这些领域纳入ICF-CSHL框架及其衍生评估工具（包括HEAR-COMMAND工具），可能支持更加以人为本、以功能为导向的听力保健方法。

英文摘要

BACKGROUND AND OBJECTIVES: Balance and mobility difficulties are common in adults with hearing loss (HL), but are often overlooked in clinical practice because of fragmented care models; the siloed structure of clinical services; and limitations in the current International Classification of Functioning, Disability and Health (ICF)-based assessment frameworks. This study aimed to quantify these difficulties and examine their associations with functional domains.
SUBJECTS AND METHODS: A cross-sectional study included 72 adults (mean age, 59±8.3 years), comprising participants with normal hearing (25%) and HL (75%), including both unaided and aided users. Participants were purposively recruited from the Speech and Hearing Clinic at Auburn University and had previously completed the HEAR-COMMAND Tool, a self-assessment questionnaire derived from the ICF-Core Sets for HL (ICF-CSHL). In addition, all participants completed the Balance and Mobility Scale (BMS), a 13-item instrument modeled after the HEAR-COMMAND Tool, to benchmark balance-mobility difficulties.
RESULTS: The BMS results demonstrated excellent internal consistency (α=0.90) and two distinct but correlated factors, Physical Mobility and Perceptual Experience, supporting its structural validity. Balance-mobility challenges were highly prevalent, including walking fatigue (73.6%), difficulty performing complex movements (72.2%), difficulty transitioning between positions (70.8%), leg stiffness (68.1%), standing instability (61.1%), and difficulty walking long distances (50%). BMS scores were strongly associated with HEAR-COMMAND scores, explaining significant variance in both the hearing domain (β=0.50, p<0.001, R2=0.40) and non-hearing domain (β=0.63, p<0.001, R2=0.48). Analysis of variance (ANOVA) showed that only the hearing-domain scores differed significantly among groups, with participants with normal hearing outperforming both unaided and aided participants with HL.
CONCLUSIONS: The high prevalence and strong functional associations of balance-mobility challenges indicate that they are core components of disability in individuals with HL. Incorporating these domains into the ICF-CSHL frameworks and their derived assessment tools, including the HEAR-COMMAND Tool, may support a more person-centered and function-oriented approach to hearing healthcare.