PP121 - Using the Personal Assessment of Communication Abilities (PACA) to Determine Self-Perceived Benefit in Adult Hearing Aid Users

Abstract:
The Personal Assessment of Communication Abilities (PACA) is a self-assessment tool that requires patients to rate their perceived difficulties across 12 listening scenarios.  Normative data for adults with hearing loss or its use to measure hearing aid benefit is not well studied.   All participants in this retrospective study were adult, first-time hearing aid patients who completed PACA assessments pre and post-hearing aid fitting, probe-mic verification, including the Speech Intelligibility Index (SII), and unaided and aided speech recognition testing. Pre- and post-PACA findings and their relationship to SII and speech recognition will be evaluated.

Summary:
Rationale/Purpose
The study was approved by The University of Texas at Dallas Institutional Review Board (IRB).  The Personal Assessment of Communication Abilities (PACA) is a self-assessment tool that evaluates perceived communication abilities.   It contains 12 common communication scenarios, and patients are asked to rate ability from “no difficulty” to “very  much difficulty” or “not relevant.” To date, there is minimal research on the PACA’s use for adults with hearing loss or its effectiveness as a measure of hearing aid benefit. The research aims to assess PACA's use in identifying changes in communication difficulties by comparing pre and post hearing aid fitting ratings as well as its relationship to the Speech Intelligibility Index (SII) and unaided and aided speech perception scores.

Methods
The retrospective, pre-post,  study gleaned data from approximately 50 adult patients seen at the Callier Center for Communication Disorders between January 2022 and December 2023.  Data was collected through eClinicalWorks, the Callier Center’s patient record system. All participants were over 18 years of age  and were first-time hearing aid users.  All profiles included pre and post fitting PACAs, probe-mic measures including unaided and aided SIIs, and unaided and aided speech intelligibility scores.

For each of the PACA’s 12 communication scenarios, there are six categories of perceived ability  from "no difficulty" to "very much difficulty," displayed on the form from left to right, respectively. Listening conditions include conversations, outdoor settings, and phone calls. Ratings shifted to the left post hearing aid fitting reflect improved listening ability  following amplification.

In addition to the PACA , SII, and speech perception findings, patient age, PTA,  and….. were also recorded.  The PACA findings were converted from category of difficulty to a scale where "no difficulty" = 0 and "very much difficulty" = 4.  Total PACA point values ranged from 0 to 48 points.  Items deemed “not relevant” were not included in the tally, and recorded point values for analysis reflected  percent of maximum difficulty for all relevant scenarios.  Analysis of data includes a summary of the listening conditions of greatest impact for adults with hearing loss, hearing aid benefit as measured by changes in PACA scores, SII, and speech perception scores.   The degree to which unaided and aided SII indices and speech recognition scores account for PACA findings  also will be assessed.

Anticipated Results & Conclusions
We anticipate that several scenarios have low relevance for first-time hearing aid users (e.g., land-line telephone) and that PACA findings post-fitting will largely reflect at least one category shift to the left (improvement).  Benefit as measured by the PACA will mirror, though imperfectly, SII benefit.  Limitations of this study include the retrospective strategy and lack of existing criterion for PACA improvement. Additionally, the  pre-fitting PACA  may underestimate the true difficulty, masking the validity of the post-assessment to measure true change. Additionally, the study may overlook communication difficulties not listed in the questionnaire.  This study will aid in confirming whether the PACA is a useful outcome measure.