RP207 - SESSION CANCELED - Tinnitus Needs, Goals, and Outcomes: Applying the Client-Oriented Scale of Improvement in Tinnitus (COSIT)

Abstract:
The purpose of the Client Oriented Scale of Improvement in Tinnitus (COSIT) is to identify needs for tinnitus rehabilitation, set treatment goals and assess individual outcomes. We report on how we use the COSIT clinically to engage with clients and build therapeutic alliance. Research that shows that the Tinnitus Functional Index and COSIT measure similar constructs and both differentiate responders from non-responders to therapy. Our results are consistent with the COSIT being an ideal clinical tool because of its high responsiveness to individual goals with therapy. The TFI is better suited as a cross-population questionnaire because of its universal content.

Summary:
Background
The purpose of the Client Oriented Scale of Improvement in Tinnitus (COSIT) is to set treatment goals and assess individual outcomes. The Tinnitus Functional Index (TFI) was developed as a comprehensive questionnaire to measure individual and population responses to tinnitus therapies.

Objective
To investigate the convergent validity and responsiveness of the COSIT and TFI and report how we use these two tools clinically.

Methods
A secondary data analysis of COSIT and TFI measures from 99 participants who used sound-based therapy with hearing aids or earphones was undertaken. A thematic analysis of COSIT goals was applied. Non-parametric statistical methods were used to measure convergence of COSIT “change with treatment scores” and “final scores” to change in TFI scores pre and post treatment and the final TFI scores with treatment. The level of agreement between the measures were determined using receiver operating characteristic (ROC) curves. Treatment responsiveness was determined by comparing treatment-related change in total scores and subscales for responders vs. non-responders according to >13-point change in the TFI and COSIT score of ≥2.

Results
The five most common COSIT goals were reducing tinnitus by addressing: 1. Well-being. 2. Hearing. 3. Sleep. 4. Focus 5. Context. The change in TFI and COSIT change scores, and Final TFI and COSIT Final scores showed a moderate to strong agreement. The COSIT classified a higher percentage (78%) of participants as responders than the TFI did (43%). There was a fair agreement between the clinically meaningful change scores for TFI and COSIT (κ = 0.29).

Conclusion
The TFI and COSIT measured similar constructs, and both differentiated responders from non-responders. Our results are consistent with the COSIT being an ideal “one for one” tool because of its high responsiveness to individual goals. The TFI is better suited as a “one for all” questionnaire because of its universal content. Clinical trials should consider use of both the COSIT and TFI because of their different, but complimentary, strengths. The COSIT can be used to build therapeutic alliance and is an invaluable counselling tool for experienced and inexperienced clinicians.

Brief Summary of Clinical Takeaways:
The clinical takeaways for this session are that the COSIT and the TFI are both valuable tools for assessing tinnitus; the COSIT can be used to build therapeutic alliance and is an invaluable counselling tool and outcome measure for experienced and inexperienced clinicians that can be easily integrated into practice.