The tinnitus functional index: Development of a new clinical measure for chronic, intrusive tinnitus

Mary B. Meikle, James Henry, Susan Griest, Barbara J. Stewart, Harvey B. Abrams, Rachel McArdle, Paula J. Myers, Craig W. Newman, Sharon Sandridge, Dennis C. Turk, Robert L. Folmer, Eric J. Frederick, John W. House, Gary P. Jacobson, Sam E. Kinney, William Martin, Stephen M. Nagler, Gloria E. Reich, Grant Searchfield, Robert SweetowJack A. Vernon

Research output: Contribution to journalArticle

265 Citations (Scopus)

Abstract

Objectives: Chronic subjective tinnitus is a prevalent condition that causes significant distress to millions of Americans. Effective tinnitus treatments are urgently needed, but evaluating them is hampered by the lack of standardized measures that are validated for both intake assessment and evaluation of treatment outcomes. This work was designed to develop a new self-report questionnaire, the Tinnitus Functional Index (TFI), that would have documented validity both for scaling the severity and negative impact of tinnitus for use in intake assessment and for measuring treatment-related changes in tinnitus (responsiveness) and that would provide comprehensive coverage of multiple tinnitus severity domains. Design: To use preexisting knowledge concerning tinnitus-related problems, an Item Selection Panel (17 expert judges) surveyed the content (175 items) of nine widely used tinnitus questionnaires. From those items, the Panel identified 13 separate domains of tinnitus distress and selected 70 items most likely to be responsive to treatment effects. Eliminating redundant items while retaining good content validity and adding new items to achieve the recommended minimum of 3 to 4 items per domain yielded 43 items, which were then used for constructing TFI Prototype 1. Prototype 1 was tested at five clinics. The 326 participants included consecutive patients receiving tinnitus treatment who provided informed consent-constituting a convenience sample. Construct validity of Prototype 1 as an outcome measure was evaluated by measuring responsiveness of the overall scale and its individual items at 3 and 6 mo follow-up with 65 and 42 participants, respectively. Using a predetermined list of criteria, the 30 best-functioning items were selected for constructing TFI Prototype 2. Prototype 2 was tested at four clinics with 347 participants, including 155 and 86 who provided 3 and 6 mo follow-up data, respectively. Analyses were the same as for Prototype 1. Results were used to select the 25 best-functioning items for the final TFI. Results: Both prototypes and the final TFI displayed strong measurement properties, with few missing data, high validity for scaling of tinnitus severity, and good reliability. All TFI versions exhibited the same eight factors characterizing tinnitus severity and negative impact. Responsiveness, evaluated by computing effect sizes for responses at follow-up, was satisfactory in all TFI versions. In the final TFI, Cronbach's alpha was 0.97 and test-retest reliability 0.78. Convergent validity (r = 0.86 with Tinnitus Handicap Inventory [THI]; r = 0.75 with Visual Analog Scale [VAS]) and discriminant validity (r = 0.56 with Beck Depression Inventory-Primary Care [BDI-PC]) were good. The final TFI was successful at detecting improvement from the initial clinic visit to 3 mo with moderate to large effect sizes and from initial to 6 mo with large effect sizes. Effect sizes for the TFI were generally larger than those obtained for the VAS and THI. After careful evaluation, a 13-point reduction was considered a preliminary criterion for meaningful reduction in TFI outcome scores. Conclusions: The TFI should be useful in both clinical and research settings because of its responsiveness to treatment-related change, validity for scaling the overall severity of tinnitus, and comprehensive coverage of multiple domains of tinnitus severity.

Original languageEnglish (US)
Pages (from-to)153-176
Number of pages24
JournalEar and Hearing
Volume33
Issue number2
DOIs
StatePublished - Mar 2012

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Tinnitus
Visual Analog Scale
Equipment and Supplies

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Speech and Hearing

Cite this

Meikle, M. B., Henry, J., Griest, S., Stewart, B. J., Abrams, H. B., McArdle, R., ... Vernon, J. A. (2012). The tinnitus functional index: Development of a new clinical measure for chronic, intrusive tinnitus. Ear and Hearing, 33(2), 153-176. https://doi.org/10.1097/AUD.0b013e31822f67c0

The tinnitus functional index : Development of a new clinical measure for chronic, intrusive tinnitus. / Meikle, Mary B.; Henry, James; Griest, Susan; Stewart, Barbara J.; Abrams, Harvey B.; McArdle, Rachel; Myers, Paula J.; Newman, Craig W.; Sandridge, Sharon; Turk, Dennis C.; Folmer, Robert L.; Frederick, Eric J.; House, John W.; Jacobson, Gary P.; Kinney, Sam E.; Martin, William; Nagler, Stephen M.; Reich, Gloria E.; Searchfield, Grant; Sweetow, Robert; Vernon, Jack A.

In: Ear and Hearing, Vol. 33, No. 2, 03.2012, p. 153-176.

Research output: Contribution to journalArticle

Meikle, MB, Henry, J, Griest, S, Stewart, BJ, Abrams, HB, McArdle, R, Myers, PJ, Newman, CW, Sandridge, S, Turk, DC, Folmer, RL, Frederick, EJ, House, JW, Jacobson, GP, Kinney, SE, Martin, W, Nagler, SM, Reich, GE, Searchfield, G, Sweetow, R & Vernon, JA 2012, 'The tinnitus functional index: Development of a new clinical measure for chronic, intrusive tinnitus', Ear and Hearing, vol. 33, no. 2, pp. 153-176. https://doi.org/10.1097/AUD.0b013e31822f67c0
Meikle, Mary B. ; Henry, James ; Griest, Susan ; Stewart, Barbara J. ; Abrams, Harvey B. ; McArdle, Rachel ; Myers, Paula J. ; Newman, Craig W. ; Sandridge, Sharon ; Turk, Dennis C. ; Folmer, Robert L. ; Frederick, Eric J. ; House, John W. ; Jacobson, Gary P. ; Kinney, Sam E. ; Martin, William ; Nagler, Stephen M. ; Reich, Gloria E. ; Searchfield, Grant ; Sweetow, Robert ; Vernon, Jack A. / The tinnitus functional index : Development of a new clinical measure for chronic, intrusive tinnitus. In: Ear and Hearing. 2012 ; Vol. 33, No. 2. pp. 153-176.
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author = "Meikle, {Mary B.} and James Henry and Susan Griest and Stewart, {Barbara J.} and Abrams, {Harvey B.} and Rachel McArdle and Myers, {Paula J.} and Newman, {Craig W.} and Sharon Sandridge and Turk, {Dennis C.} and Folmer, {Robert L.} and Frederick, {Eric J.} and House, {John W.} and Jacobson, {Gary P.} and Kinney, {Sam E.} and William Martin and Nagler, {Stephen M.} and Reich, {Gloria E.} and Grant Searchfield and Robert Sweetow and Vernon, {Jack A.}",
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TY - JOUR

T1 - The tinnitus functional index

T2 - Development of a new clinical measure for chronic, intrusive tinnitus

AU - Meikle, Mary B.

AU - Henry, James

AU - Griest, Susan

AU - Stewart, Barbara J.

AU - Abrams, Harvey B.

AU - McArdle, Rachel

AU - Myers, Paula J.

AU - Newman, Craig W.

AU - Sandridge, Sharon

AU - Turk, Dennis C.

AU - Folmer, Robert L.

AU - Frederick, Eric J.

AU - House, John W.

AU - Jacobson, Gary P.

AU - Kinney, Sam E.

AU - Martin, William

AU - Nagler, Stephen M.

AU - Reich, Gloria E.

AU - Searchfield, Grant

AU - Sweetow, Robert

AU - Vernon, Jack A.

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N2 - Objectives: Chronic subjective tinnitus is a prevalent condition that causes significant distress to millions of Americans. Effective tinnitus treatments are urgently needed, but evaluating them is hampered by the lack of standardized measures that are validated for both intake assessment and evaluation of treatment outcomes. This work was designed to develop a new self-report questionnaire, the Tinnitus Functional Index (TFI), that would have documented validity both for scaling the severity and negative impact of tinnitus for use in intake assessment and for measuring treatment-related changes in tinnitus (responsiveness) and that would provide comprehensive coverage of multiple tinnitus severity domains. Design: To use preexisting knowledge concerning tinnitus-related problems, an Item Selection Panel (17 expert judges) surveyed the content (175 items) of nine widely used tinnitus questionnaires. From those items, the Panel identified 13 separate domains of tinnitus distress and selected 70 items most likely to be responsive to treatment effects. Eliminating redundant items while retaining good content validity and adding new items to achieve the recommended minimum of 3 to 4 items per domain yielded 43 items, which were then used for constructing TFI Prototype 1. Prototype 1 was tested at five clinics. The 326 participants included consecutive patients receiving tinnitus treatment who provided informed consent-constituting a convenience sample. Construct validity of Prototype 1 as an outcome measure was evaluated by measuring responsiveness of the overall scale and its individual items at 3 and 6 mo follow-up with 65 and 42 participants, respectively. Using a predetermined list of criteria, the 30 best-functioning items were selected for constructing TFI Prototype 2. Prototype 2 was tested at four clinics with 347 participants, including 155 and 86 who provided 3 and 6 mo follow-up data, respectively. Analyses were the same as for Prototype 1. Results were used to select the 25 best-functioning items for the final TFI. Results: Both prototypes and the final TFI displayed strong measurement properties, with few missing data, high validity for scaling of tinnitus severity, and good reliability. All TFI versions exhibited the same eight factors characterizing tinnitus severity and negative impact. Responsiveness, evaluated by computing effect sizes for responses at follow-up, was satisfactory in all TFI versions. In the final TFI, Cronbach's alpha was 0.97 and test-retest reliability 0.78. Convergent validity (r = 0.86 with Tinnitus Handicap Inventory [THI]; r = 0.75 with Visual Analog Scale [VAS]) and discriminant validity (r = 0.56 with Beck Depression Inventory-Primary Care [BDI-PC]) were good. The final TFI was successful at detecting improvement from the initial clinic visit to 3 mo with moderate to large effect sizes and from initial to 6 mo with large effect sizes. Effect sizes for the TFI were generally larger than those obtained for the VAS and THI. After careful evaluation, a 13-point reduction was considered a preliminary criterion for meaningful reduction in TFI outcome scores. Conclusions: The TFI should be useful in both clinical and research settings because of its responsiveness to treatment-related change, validity for scaling the overall severity of tinnitus, and comprehensive coverage of multiple domains of tinnitus severity.

AB - Objectives: Chronic subjective tinnitus is a prevalent condition that causes significant distress to millions of Americans. Effective tinnitus treatments are urgently needed, but evaluating them is hampered by the lack of standardized measures that are validated for both intake assessment and evaluation of treatment outcomes. This work was designed to develop a new self-report questionnaire, the Tinnitus Functional Index (TFI), that would have documented validity both for scaling the severity and negative impact of tinnitus for use in intake assessment and for measuring treatment-related changes in tinnitus (responsiveness) and that would provide comprehensive coverage of multiple tinnitus severity domains. Design: To use preexisting knowledge concerning tinnitus-related problems, an Item Selection Panel (17 expert judges) surveyed the content (175 items) of nine widely used tinnitus questionnaires. From those items, the Panel identified 13 separate domains of tinnitus distress and selected 70 items most likely to be responsive to treatment effects. Eliminating redundant items while retaining good content validity and adding new items to achieve the recommended minimum of 3 to 4 items per domain yielded 43 items, which were then used for constructing TFI Prototype 1. Prototype 1 was tested at five clinics. The 326 participants included consecutive patients receiving tinnitus treatment who provided informed consent-constituting a convenience sample. Construct validity of Prototype 1 as an outcome measure was evaluated by measuring responsiveness of the overall scale and its individual items at 3 and 6 mo follow-up with 65 and 42 participants, respectively. Using a predetermined list of criteria, the 30 best-functioning items were selected for constructing TFI Prototype 2. Prototype 2 was tested at four clinics with 347 participants, including 155 and 86 who provided 3 and 6 mo follow-up data, respectively. Analyses were the same as for Prototype 1. Results were used to select the 25 best-functioning items for the final TFI. Results: Both prototypes and the final TFI displayed strong measurement properties, with few missing data, high validity for scaling of tinnitus severity, and good reliability. All TFI versions exhibited the same eight factors characterizing tinnitus severity and negative impact. Responsiveness, evaluated by computing effect sizes for responses at follow-up, was satisfactory in all TFI versions. In the final TFI, Cronbach's alpha was 0.97 and test-retest reliability 0.78. Convergent validity (r = 0.86 with Tinnitus Handicap Inventory [THI]; r = 0.75 with Visual Analog Scale [VAS]) and discriminant validity (r = 0.56 with Beck Depression Inventory-Primary Care [BDI-PC]) were good. The final TFI was successful at detecting improvement from the initial clinic visit to 3 mo with moderate to large effect sizes and from initial to 6 mo with large effect sizes. Effect sizes for the TFI were generally larger than those obtained for the VAS and THI. After careful evaluation, a 13-point reduction was considered a preliminary criterion for meaningful reduction in TFI outcome scores. Conclusions: The TFI should be useful in both clinical and research settings because of its responsiveness to treatment-related change, validity for scaling the overall severity of tinnitus, and comprehensive coverage of multiple domains of tinnitus severity.

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