Appropriate Uses of Self-Assessment Instruments

Self-assessment scales have been used widely in research and in clinical settings. Scales focusing on disability and handicap have been used successfully to evaluate the need for audiological rehabilitation and to measure the outcomes of treatment interventions, such as hearing aids, cochlear implants, and specific rehabilitation programs. Such uses are appropriate when there is psychometric evidence of the tests’ validity for these purposes. However, despite the considerable progress that has been made in the conceptualization and assessment of hearing disability and handicap (as defined by the World Health Organization), these measurements have little to offer in disability determination as defined by SSA. When a client seeks treatment for a hearing loss, it is usually assumed that symptoms are reported conscientiously. In contrast, when assessment is conducted for purposes of determining compensation, there is an inherent conflict of interest, and self-reports cannot be used with confidence (Dobie, 1996).

What, then, is the role of self-assessed disability or handicap in a compensation context? Dobie and Sakai (2001) argue that direct measurement of disability and handicap through self-report constitutes a gold standard, but that surrogate measures must be used in contexts in which compensation is involved. Despite the fact that audiometric measures of pure-tone threshold and speech recognition are imperfectly correlated with disability/handicap, they argue that these (more objective) measures can serve as surrogates in a compensation context. Moreover, based on the available data, they find insufficient evidence to support a change from the 1979 AAO-HNS/AMA (American Medical Association, 2001) method of estimating hearing handicap. Research is needed to more fully understand the relations and interactions among objective measures of hearing abilities, demographic and psychological factors, and self-reported communication outcomes and to evaluate the unique contribution of hearing loss among these other influences.

RECOMMENDATIONS

Disability Determination

The committee examined the use of self-reports and concludes that self-reports should not be used as criteria for disability determination. In clinical settings, there is little motivation for exaggeration of problems, but in the context of disability determination, conflict of interest poses a serious threat to the validity of self-reports.

The committee examined the potential usefulness of quality of life as



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