What are Clinical Measures and why are they important?
There are several clinical measures used when you enrol for the CBT for Tinnitus E-Programme. All the measures used are validated questionnaires, which means they have been through a rigorous research process that demonstrates they have both “reliability” and “validity” i.e. their use has been formally tested with patients and results show high reliability and validity. If a measure has been proven to be unreliable, it is not considered to be valid.
Clinical measures used in the CBT for Tinnitus E-Programme:
- Tinnitus Functional Index (TFI) – everyone sends in a TFI - before starting the process, repeated at Stage 6, repeated at Stage 8 or 9, and where Core belief work has been undertaken during Stage 11, repeated at Stage 12. They can also be repeated one year after completing the process. The TFI is particularly useful as a measure that indicates change because of 8 subscales embedded within. This means that when the TFI is repeated part way through the process at Stage 6, not only does it show what progress has been made overall and within each of the embedded subscales, it also shows what remains to be done
- Tinnitus Handicap Inventory (THI) – everyone sends in a THI at the same intervals as the TFI. It is used as a secondary measure of tinnitus distress alongside the TFI
- GAD-7 is a measure that indicates general anxiety level – everyone sends in a GAD-7 at the same intervals as the TFI
- Perceived Stress Scale (PSS) measures your perceived stress. One person may perceive a certain thing stressful where another doesn't. Also, stress can be high when anxiety is low or moderate because stress and anxiety are not exactly the same. Everyone sends in a PSS at the same intervals as the TFI
- Anxiety Symptoms Questionnaire (ASQ) gives a measure of intensity and frequency for 17 anxiety symptoms. Although stress and anxiety are different, stress causes many physical symptoms that are the same as those caused by anxiety. An ASQ is completed when a GAD-7 is greater than mild anxiety, and also when a PSS is greater than mild stress. The ASQ is repeated at the same intervals as the TFI
- HSQ Khalfa – this hearing sensitivity questionnaire (available at Stage 1) is completed ONLY by those with hearing sensitivity symptoms alongside tinnitus – it is repeated at the same intervals as the TFI
When a search is carried out about the importance of using clinical outcomes measures, the overwhelming reason for using them is said to be they are used by clinicians and health services to demonstrate the usefulness of their treatments. In other words, the perspective is rarely – as far as I have ever seen – about the use of measures and outcomes being for the benefit of the “service user”, “client” or “patient”, albeit patient-benefit is implied as patients are intended to be the beneficiaries of health services.
Why clinical measures are important
Historically, I have always used clinical measures to measure Outcomes; but my reason for using them goes way beyond simply demonstrating how effective the treatments might be. After all, why would I be using any treatment (CBT or other) if I didn’t know they were effective?The main reason I use them, and the main reason I ask you to use them when enrolling on this CBT for Tinnitus process, is repeating the measures gives you evidence that what you are doing is benefiting you.
This is particularly helpful when you repeat them the first time on reaching Module 6 of 12. By this stage in the process, you haven’t reached where you need or want to be in terms of how you are and how you feel about tinnitus. It is easy to fall in to a trap of thinking “I think I might be a bit better than I was, but I’m still not there yet” which psychologically – and emotionally – can result in “All or nothing” thinking and undermine how you feel about the progress you have in fact made to date.
When we have been struggling with something – as people have invariably been doing with tinnitus when they enrol on the course, it is all too common to have thoughts that undermine your confidence. Thoughts like “It might work for others, but it probably won’t for me”, or “I must admit I have been feeling better than I was this past week, but it probably won’t last”.
It is NORMAL to be thinking like this when you are going through this process of – not inconsiderable - change.
What helps most is that even though you are still having undermining and self-sabotaging thoughts such as these, you repeat the TFI (and others), and see for yourself that your answers are actually different to those you gave just a few weeks before. Your new answers show you – in black and white – that the changes you are making are REAL and not imagined or “hoped for”.
Finally…
To finish off this item about using clinical measures, I would like to share with you an article written and published by me back in 2009. It was published in the British Academy of Audiology magazine that year, so its audience was Audiologists. It includes a case study about “Jack” – a pseudonym for an NHS patient I was working with at the time. You can download it here: The Therapy of Outcome Measures May 2009.pdf (61.76 KB)
To finish off this item about using clinical measures, I would like to share with you an article written and published by me back in 2009. It was published in the British Academy of Audiology magazine that year, so its audience was Audiologists. It includes a case study about “Jack” – a pseudonym for an NHS patient I was working with at the time. You can download it here: The Therapy of Outcome Measures May 2009.pdf (61.76 KB)