Evaluation of the Global Score From the Abbreviated Profile of Hearing-Aid Performance and the Development of an Improved Shorter Version: The APHAP9

The 24-item Abbreviated Profile of Hearing Aid Performance (APHAP) includes 18 items evaluating the frequency of occurrence of everyday speech-communication difficulties. Originally, these 18 items comprised three separate subscales designed to tap different everyday listening conditions. More recently, a single global speech-communication score averaging all 18 items has been used. The psychometrics of this 18-item global APHAP score have not been evaluated previously. Such an evaluation was the primary focus of this research.

Unaided and aided APHAP item responses were available from 582 and 532 older adults, respectively. Participants, between 50 and 81 years old, had mild-to-moderate hearing loss and were enrolled in a clinical trial to compare fitting methods. Unaided and aided APHAP measurements were conducted before fitting and after 6 weeks of first-time hearing aid use, respectively. The unidimensionality and reliability of the APHAP global scores were evaluated for unaided and aided conditions using a wide variety of statistics. In addition, Item Response Theory (IRT) was used to analyze each of the 18 items comprising the unaided and aided APHAP-global scores.

Limited support for the unidimensionality of the global APHAP scores was observed, especially for the unaided scores. Unidimensionality was enhanced considerably by selecting the most informative nine items of the 18 based on the results of IRT analyses. The nine-item APHAP-global score, the APHAP9, was found to be unidimensional and reliable. The APHAP9 was well fit by a graded-response IRT model and demonstrated good item and test information as well as the desired local independence of test items, in both the unaided and aided test conditions. Responsiveness or sensitivity to change following hearing-aid intervention was also demonstrated for the APHAP9.

The APHAP9 is a psychometrically sound measure of the perceived frequency of difficulties in everyday speech communication and represents an improvement over the global 18-item APHAP score. At half the length, the APHAP9 is also much more efficient than its 18-item predecessor.