Personalised long-term follow-up of cochlear implant patients using remote care, compared with those on the standard care pathway: study protocol for a feasibility randomised controlled trial

Introduction Many resources are required to provide postoperative care to patients who receive a cochlear implant. The implant service commits to lifetime follow-up. The patient commits to regular adjustment and rehabilitation appointments in the first year and annual follow-up appointments thereafter. Offering remote follow-up may result in more stable hearing, reduced patient travel expense, time and disruption, more empowered patients, greater equality in service delivery and more freedom to optimise the allocation of clinic resources. Methods and analysis This will be a two-arm feasibility randomised controlled trial (RCT) involving 60 adults using cochlear implants with at least 6 months device experience in a 6-month clinical trial of remote care. This project will design, implement and evaluate a person-centred long-term follow-up pathway for people using cochlear implants offering a triple approach of remote and self-monitoring, self-adjustment of device and a personalised online support tool for home speech recognition testing, information, self-rehabilitation, advice, equipment training and troubleshooting. The main outcome measure is patient activation. Secondary outcomes are stability and quality of hearing, stability of quality of life, clinic resources, patient and clinician experience, and any adverse events associated with remote care. We will examine the acceptability of remote care to service users and clinicians, the willingness of participants to be randomised, and attrition rates. We will estimate numbers required to plan a fully powered RCT. Ethics and dissemination Ethical approval was received from North West—Greater Manchester South Research Ethics Committee (15/NW/0860) and the University of Southampton Research Governance Office (ERGO 15329). Results Results will be disseminated in the clinical and scientific communities and also to the patient population via peer-reviewed research publications both online and in print, conference and meeting presentations, posters, newsletter articles, website reports and social media. Trial registration number ISRCTN14644286; Pre-results.

[1]  N Marangos,et al.  COCHLEAR IMPLANTS , 1976, The Lancet.

[2]  S. Pocock,et al.  Sequential treatment assignment with balancing for prognostic factors in the controlled clinical trial. , 1975, Biometrics.

[3]  J Bamford,et al.  The BKB (Bamford-Kowal-Bench) sentence lists for partially-hearing children. , 1979, British journal of audiology.

[4]  Alexandre Gault,et al.  Use of telemedicine in the remote programming of cochlear implants , 2009, Acta oto-laryngologica.

[5]  J. Festen,et al.  The digits-in-noise test: assessing auditory speech recognition abilities in noise. , 2013, The Journal of the Acoustical Society of America.

[6]  De Wet Swanepoel,et al.  Validation of remote mapping of cochlear implants , 2014, Journal of telemedicine and telecare.

[7]  J. Mcelveen,et al.  Remote Programming of Cochlear Implants: A Telecommunications Model , 2010, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[8]  Andrew Botros,et al.  The next generation of Nucleus® fitting: A multiplatform approach towards universal cochlear implant management , 2013, International journal of audiology.

[9]  Tammo Houtgast,et al.  Development and validation of an automatic speech-in-noise screening test by telephone , 2004, International journal of audiology.

[10]  Roland Laszig,et al.  Remote fitting in Nucleus cochlear implant recipients , 2010, Acta oto-laryngologica.

[11]  Julie Kosaner,et al.  Cochlear Implant Programming: A Global Survey on the State of the Art , 2014, TheScientificWorldJournal.

[12]  P. Bower,et al.  Self-management support interventions to reduce health care utilisation without compromising outcomes: a systematic review and meta-analysis , 2014, BMC Health Services Research.

[13]  Judith H Hibbard,et al.  Development and testing of a short form of the patient activation measure. , 2005, Health services research.

[14]  T. Houtgast,et al.  Results From the Dutch Speech-in-Noise Screening Test by Telephone , 2005, Ear and hearing.

[15]  G. Eskilsson,et al.  Remote programming of MED-EL cochlear implants: users' and professionals' evaluation of the remote programming experience , 2014, Acta oto-laryngologica.

[16]  J. Galvin,et al.  Effects of auditory training on adult cochlear implant patients: a preliminary report , 2004, Cochlear implants international.

[17]  J. Müller,et al.  Quality standards for adult cochlear implantation , 2013, Cochlear implants international.

[18]  A. Pettigrew Context and Action in the Transformation of the Firm , 1987 .

[19]  Ishan Ann Tsay,et al.  Using a patient-driven software tool for programming multiple cochlear implant patients simultaneously in a telemedicine setting , 2012 .

[20]  W. Noble,et al.  The Speech, Spatial and Qualities of Hearing Scale (SSQ) , 2004, International journal of audiology.

[21]  John C. Norcross,et al.  Ethical Principles of Psychologists and Code of Conduct , 2013 .

[22]  T. Houtgast,et al.  How we do it: The Dutch functional hearing–screening tests by telephone and internet , 2006, Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery.

[23]  Jim Bellows,et al.  Is Patient Activation Associated With Outcomes of Care for Adults With Chronic Conditions? , 2007, The Journal of ambulatory care management.

[24]  Blake S Wilson,et al.  Cochlear implants: current designs and future possibilities. , 2008, Journal of rehabilitation research and development.

[25]  Gary Wills,et al.  Introduction to the Lifeguide: Software Facilitating the Development of Interactive Behaviour Change Internet Interventions , 2022 .

[26]  S. T. Goverts,et al.  Assessing speech recognition abilities with digits in noise in cochlear implant and hearing aid users , 2015, International journal of audiology.

[27]  M. Hagen,et al.  Ethical principles of psychologists and code of conduct. , 2002, The American psychologist.

[28]  Damian McEntegart,et al.  Randomization by minimization for unbalanced treatment allocation , 2009, Statistics in medicine.

[29]  Mahmoud Saghaei,et al.  Implementation of an open-source customizable minimization program for allocation of patients to parallel groups in clinical trials , 2011 .

[30]  D R Taves,et al.  Minimization: A new method of assigning patients to treatment and control groups , 1974, Clinical pharmacology and therapeutics.

[31]  Maria Valéria Schmidt Goffi-Gomez,et al.  Remote programming of cochlear implants. , 2014, CoDAS.

[32]  P. Skarżyński,et al.  Remote Fitting of Cochlear Implant System , 2010, Cochlear implants international.

[33]  Daniel L. Valente,et al.  Use of telehealth for research and clinical measures in cochlear implant recipients: a validation study. , 2012, Journal of speech, language, and hearing research : JSLHR.

[34]  Daniel L. Valente,et al.  The effect of technology and testing environment on speech perception using telehealth with cochlear implant recipients. , 2012, Journal of speech, language, and hearing research : JSLHR.

[35]  P. Williamson,et al.  Design and analysis of pilot studies: recommendations for good practice. , 2004, Journal of evaluation in clinical practice.

[36]  J. Hibbard,et al.  Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. , 2004, Health services research.

[37]  D. Altman,et al.  Preparing raw clinical data for publication: guidance for journal editors, authors, and peer reviewers , 2010, BMJ : British Medical Journal.

[38]  G W Torrance,et al.  Multi-attribute health status classification systems. Health Utilities Index. , 1995, PharmacoEconomics.

[39]  H. Cullington What do our service users really want , 2013 .