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Performance of the Tinnitus Functional Index as a diagnostic instrument in a UK clinical population.
Hear Res. 2018 Feb; 358:74-85.HR

Abstract

OBJECTIVES

The Tinnitus Functional Index (TFI) has been optimised as a diagnostic tool for quantifying the functional impact of tinnitus in US veteran and civilian groups. However, the TFI has not been fully evaluated for use in other English-speaking clinical populations despite its increasingly popular uptake. Here, a prospective multi-site longitudinal validation study was conducted to evaluate psychometric properties relevant to the UK clinical population. Guided by quality criteria for the measurement properties of health-related questionnaires, we specifically evaluated three diagnostic properties relating to the degree to which the TFI (i) covers the eight dimensions proposed to be important for diagnosis, (ii) reliably distinguishes individual differences in severity of tinnitus, and (iii) reliably measures the functional impact of tinnitus. We also examine whether clinically meaningful interpretations of the scores can be produced for the UK population.

METHODS

Twelve National Health Service audiology clinics across the UK recruited 255 tinnitus patients to complete questionnaires at four time-intervals, from initial clinical assessment and then over a nine-month period. Patients completed the TFI, the Tinnitus Handicap Inventory (THI), tinnitus case history questions, a Global rating of Perceived Problem with tinnitus and a Clinical Global Impression of perceived change in tinnitus. Baseline TFI data were used to examine the factor structure, construct validity and interpretability of the TFI. Follow-up TFI data were used to examine reliability.

RESULTS

Confirmatory factor analysis suggested that of the eight subscales (factors) initially established for the TFI, the 'Auditory' subscale did not contribute to the overall construct 'functional impact of tinnitus', and a modified seven-factor model (TFI-22) better fit the variance in the patient scores. Both the global 25-item TFI and the global TFI-22 scores showed exceptionally high internal consistency (α ≥ 0.95), high construct validity with the THI (r = 0.80) and high test-retest reliability (ICC = 0.87). Test-retest agreement however was only deemed to be borderline acceptable (89%). Receiver Operator Characteristic analysis indicated the 25-item TFI and TFI-22 has excellent ability to distinguish between different levels of impact (Area under the curve > 0.7).

CONCLUSION

The TFI was confirmed to cover multiple symptom domains, measuring a multi-domain construct of tinnitus, and satisfies a range of psychometric requirements for a good clinical measure, including having excellent reliability, stability over time and sensitivity to individual differences in tinnitus severity. However, a modified seven-factor structure without the Auditory subscale (TFI-22) is recommended for calculating a global composite score for UK patients. Using patients' experience and Receiver Operator Characteristic analysis, a grading system was presented which identifies the distinct grades of tinnitus impact in the UK clinical population that is broadly comparable to the US-based system.

Authors+Show Affiliations

NIHR Nottingham Biomedical Research Centre, Nottingham, UK; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, UK. Electronic address: kathryn.fackrell@nottingham.ac.uk.NIHR Nottingham Biomedical Research Centre, Nottingham, UK; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, UK.Medical Research Council Institute of Hearing Research, School of Medicine, The University of Nottingham, University Park, Nottingham, NG7 2RD, UK; Nottingham University Hospitals NHS Trust, Nottingham, UK.NIHR Nottingham Biomedical Research Centre, Nottingham, UK; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29129348

Citation

Fackrell, Kathryn, et al. "Performance of the Tinnitus Functional Index as a Diagnostic Instrument in a UK Clinical Population." Hearing Research, vol. 358, 2018, pp. 74-85.
Fackrell K, Hall DA, Barry JG, et al. Performance of the Tinnitus Functional Index as a diagnostic instrument in a UK clinical population. Hear Res. 2018;358:74-85.
Fackrell, K., Hall, D. A., Barry, J. G., & Hoare, D. J. (2018). Performance of the Tinnitus Functional Index as a diagnostic instrument in a UK clinical population. Hearing Research, 358, 74-85. https://doi.org/10.1016/j.heares.2017.10.016
Fackrell K, et al. Performance of the Tinnitus Functional Index as a Diagnostic Instrument in a UK Clinical Population. Hear Res. 2018;358:74-85. PubMed PMID: 29129348.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Performance of the Tinnitus Functional Index as a diagnostic instrument in a UK clinical population. AU - Fackrell,Kathryn, AU - Hall,Deborah A, AU - Barry,Johanna G, AU - Hoare,Derek J, Y1 - 2017/11/10/ PY - 2017/05/04/received PY - 2017/10/19/revised PY - 2017/10/30/accepted PY - 2017/11/14/pubmed PY - 2017/11/14/medline PY - 2017/11/14/entrez KW - Confirmatory factor analysis KW - Convergent validity KW - Diagnostic tool KW - Interpretability KW - Outcome instruments KW - Reliability KW - Tinnitus severity SP - 74 EP - 85 JF - Hearing research JO - Hear. Res. VL - 358 N2 - OBJECTIVES: The Tinnitus Functional Index (TFI) has been optimised as a diagnostic tool for quantifying the functional impact of tinnitus in US veteran and civilian groups. However, the TFI has not been fully evaluated for use in other English-speaking clinical populations despite its increasingly popular uptake. Here, a prospective multi-site longitudinal validation study was conducted to evaluate psychometric properties relevant to the UK clinical population. Guided by quality criteria for the measurement properties of health-related questionnaires, we specifically evaluated three diagnostic properties relating to the degree to which the TFI (i) covers the eight dimensions proposed to be important for diagnosis, (ii) reliably distinguishes individual differences in severity of tinnitus, and (iii) reliably measures the functional impact of tinnitus. We also examine whether clinically meaningful interpretations of the scores can be produced for the UK population. METHODS: Twelve National Health Service audiology clinics across the UK recruited 255 tinnitus patients to complete questionnaires at four time-intervals, from initial clinical assessment and then over a nine-month period. Patients completed the TFI, the Tinnitus Handicap Inventory (THI), tinnitus case history questions, a Global rating of Perceived Problem with tinnitus and a Clinical Global Impression of perceived change in tinnitus. Baseline TFI data were used to examine the factor structure, construct validity and interpretability of the TFI. Follow-up TFI data were used to examine reliability. RESULTS: Confirmatory factor analysis suggested that of the eight subscales (factors) initially established for the TFI, the 'Auditory' subscale did not contribute to the overall construct 'functional impact of tinnitus', and a modified seven-factor model (TFI-22) better fit the variance in the patient scores. Both the global 25-item TFI and the global TFI-22 scores showed exceptionally high internal consistency (α ≥ 0.95), high construct validity with the THI (r = 0.80) and high test-retest reliability (ICC = 0.87). Test-retest agreement however was only deemed to be borderline acceptable (89%). Receiver Operator Characteristic analysis indicated the 25-item TFI and TFI-22 has excellent ability to distinguish between different levels of impact (Area under the curve > 0.7). CONCLUSION: The TFI was confirmed to cover multiple symptom domains, measuring a multi-domain construct of tinnitus, and satisfies a range of psychometric requirements for a good clinical measure, including having excellent reliability, stability over time and sensitivity to individual differences in tinnitus severity. However, a modified seven-factor structure without the Auditory subscale (TFI-22) is recommended for calculating a global composite score for UK patients. Using patients' experience and Receiver Operator Characteristic analysis, a grading system was presented which identifies the distinct grades of tinnitus impact in the UK clinical population that is broadly comparable to the US-based system. SN - 1878-5891 UR - https://www.unboundmedicine.com/medline/citation/29129348/Performance_of_the_Tinnitus_Functional_Index_as_a_diagnostic_instrument_in_a_UK_clinical_population_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0378-5955(17)30212-5 DB - PRIME DP - Unbound Medicine ER -
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