Eur Arch Otorhinolaryngol DOI 10.1007/s00405-014-2983-9

Otology

Reliability and validity of the Nijmegen Cochlear Implant Questionnaire in Spanish Isabel Sanchez‑Cuadrado · Javier Gavilan · Rosa Perez‑Mora · Elena Muñoz · Luis Lassaletta 

Received: 29 December 2013 / Accepted: 22 February 2014 © Springer-Verlag Berlin Heidelberg 2014

Abstract The Nijmegen Cochlear Implant Questionnaire (NCIQ) is a specific and quantifiable self-assessment health-related quality of life (QoL) questionnaire. It was developed to determine the subjective benefits of a cochlear implant (CI). The present study aimed to determine the validity and reliability of the NCIQ in Spanish. Seventy-six adult, Spanish speaking, CI users and 28 control subjects answered the NCIQ. Reliability of the questionnaire was determined using Cronbach’s α coefficient and the validity established using Pearson’s correlation coefficient. All questionnaire respondents performed significantly better in all sub-domains with a cochlear implant than before cochlear implantation. The Cronbach’s α score exceeded 0.70 in most sub-domains and the total score. The objective measures: bisyllables tested without lip-reading and with masking; and bisyllables, tested without lip-reading and without masking were correlated with the sub-domain ‘advanced sound perception’. To determine health-related QoL the NCIQ in Spanish is a reliable self-assessment questionnaire and a valuable instrument in determining the subjective benefit of a CI. Keywords  Quality-of-life · Health-related · Spanish · NCIQ · Validation · Cochlear implant

Electronic supplementary material The online version of this article (doi:10.1007/s00405-014-2983-9) contains supplementary material, which is available to authorized users. I. Sanchez‑Cuadrado (*) · J. Gavilan · R. Perez‑Mora · E. Muñoz · L. Lassaletta  Department of Otolaryngology Head and Neck Surgery, Idipaz Hospital La Paz Institute for Health Research, Pº Castellana, 261, 28046 Madrid, Spain e-mail: [email protected]

Introduction For over two decades quality of life (QoL) studies have increased significantly. The most common definition describes QoL as the “patient’s emotional, social and physical well-being, including their ability to function in the ordinary tasks of living” [1, 2]. The values of the cochlear implants, irrespective of their effect on hearing, are subjective benefits in the social life, activities and self-esteem of the cochlear implant user [3]. The subjective benefits of a cochlear implant can be determined using health-related quality of life (QoL) questionnaires. Many health-related QoL questionnaires rely on selfreported measures to determine health status, but selfreported measures of health are usually perceived as a weak measure of objective health status. Thus, it is important to verify the reliability (“ability of an instrument to measure consistently”) and validity (“the extent to which an instrument measures what it is intended to measure”) in the evaluation of measurement instruments [4]. Validity is the most important issue to consider when deciding whether to use a particular assessment tool because an assessment that does not provide useful information about how an individual benefits is of no value to the clinician [5]. To our knowledge, several questionnaires have been used to evaluate QoL in adults with CI, but only the Glasgow Benefit Inventory (GBI) has been validated in Spanish [6]. GBI was designed as a general questionnaire to determine health status produced by ORL intervention and according to Robinson et al. GBI is more a measure of patient benefit, “it measures the changes in health status resulting from ORL intervention, but does not provide a measure of the status of the patient either prior to or after the intervention” [7]. The Nijmegen Cochlear Implant Questionnaire (NCIQ) is a quantifiable self-assessment health-related QoL

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Eur Arch Otorhinolaryngol

instrument specific for cochlear implant users [8] that it provides a measure of benefit that can be used to compare the status of the individual prior to and after surgery. The NCIQ has six sub-domains: basic sound perception, advanced sound perception, speech production, selfesteem, activity and social interactions. The answers to the questionnaire are provided on a 5-point Likert scale, with scores ranging from 0 (very poor) to 100 (optimal). Since the NCIQ was first published in 2000 by Hinderink et al. [8], it has been validated and shown to be reliable and sensitive to clinical changes in several languages [2, 8– 14], such as Chinese. After English and Chinese, Spanish is the third spoken language in the world and one of the most used in internet [15]. Using an international validated questionnaire in this type of studies is recommended because it allows comparing different CI populations and creating the opportunity to monitor the effect of CIs in deaf patients. The present study aimed to determine the reliability and predictive validity of the NCIQ in quantifying the selfassessment of health-related QoL in Spanish adult CI users.

All patients had a bilateral severe-to-profound hearing loss. Inclusion criteria for the control group were to be postlocutive deaf adult on a waiting list for a CI. Table  1 shows the demographic profile of all patients. In the study group all wearing conditions were included (e.g. unilateral CI, bilateral CI, bimodal: one CI and one hearing aid) with a minimum of 6 months of use of the CI. One patient had been bilaterally implanted with a CI. In both groups, the most frequent etiology of deafness was unknown followed by Meniérè’s disease and otosclerosis. The average duration of deafness until the questionnaire in the control group or prior to implantation was 6.5 years (min 1 year, max 52 years). The average age at CI surgery was 53 years (min 21 years, max 79 years) and the mean age at the time of administration of the NCIQ in the study group was 59 (min 24 years, max 81 years) and in the control group was 58 years (min 35 years, max 80 years). All subjects gave written informed consent for the inclusion of their data in this study. Ethics committee approval was obtained.

Methods

Administration of NCIQ

Subjects

The cross-cultural adaptation measures were used to translate the NCIQ into its Spanish version prior to the beginning of the study [16]. The 76 post-CI surgery patients completed the standard version and afterwards the retrospective version of the NCIQ [8] at least 1 hour later. The 28 control group patients completed the standard version. Administration of the NCIQ was performed at routine visits to the department of otolaryngology. Each sub-domain contains 10 items, formulated as statements with five answers on a Likert-type scale varying from “never” to “always” or from “no” to “good”. Subjects were required to answer which statement best fit their experiences related to the question. As in the original paper of Hinderink et al. [8] the answer categories for all items were transformed: 1 = 0, 2 = 25, 3 = 50, 4 = 75, and 5 = 100. Scores for the sub-domains were computed by adding together the 10-item scores of each subdomain and dividing by the number of completed items.

The present study included 76 adult CI users (42 female, 34 male) and 28 control subjects (17 female, 11 male). Table 1  Demographic and clinical characteristics of the CI users and the control group Demographics characteristics

CI group (n = 76)

Control group (n = 28)

Age (years mean ± SD) Age at onset deafness (years mean ± SD) Duration of deafness (years mean ± SD) CI age (years mean ± SD) Sex  Female (%)  Male (%) Education level  Lower (%)  Secondary (%)  University (%) Paid employment  Yes (%)  No (%) Living situation  Alone (%)

59 ± 14 47 ± 18

58 ± 13 54 ± 14

6 ± 9

6 ± 8

 With others (%)

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53 ± 14 55 45

61 49

55 27 18

57 30 13

34 66

25 75

24

7

76

93

Analyses Descriptive statistics were used to report demographic and baseline data. The scores of the sub-domains and total score were compared between the standard, retrospective and control groups of the NCIQ using t tests or Mann– Whitney U tests. Reliability of the NCIQ was determined using Cronbach’s α. An α coefficient of 0.70 or higher was considered reliable.

Eur Arch Otorhinolaryngol

Validity was confirmed using Pearson’s Correlation Coefficient to determine a correlation between the subdomains: basic sound perception, advanced sound perception, speech production, self-esteem, activity, social interactions; the total score and the objective measure: Bisyllable testing without lip-reading and without masking. A p value of

Reliability and validity of the Nijmegen Cochlear Implant Questionnaire in Spanish.

The Nijmegen Cochlear Implant Questionnaire (NCIQ) is a specific and quantifiable self-assessment health-related quality of life (QoL) questionnaire. ...
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