Some Considerations for the Use of the Abbreviated Profile of Hearing Aid Benefit (APHAB) as a Hearing-Aid Outcome Measure

The Abbreviated Profile of Hearing Aid Benefit (APHAB) has been one of the most frequently used patient-reported outcome measures (PROMs) since its inception 30 years ago. For the APHAB, single-valued 95% critical differences have been presented for the identification and interpretation of meaningful benefits in research and in the clinic. A narrative literature review of studies that used the global APHAB score as a hearing-aid outcome measure showed that the average benefit varied directly with the average unaided baseline score for each measure. Next, data from 584 older adults enrolled in our recently completed randomized controlled hearing-aid trial were examined. The same dependence of benefit scores on unaided baseline scores was observed in these data. Regression to the mean made relatively minor contributions to the observed dependence of APHAB scores on baseline unaided scores. These results indicate that the application of a single value for the 95% critical difference is not valid for the interpretation of APHAB scores. Rather, baseline-specific benefit criteria are needed. Based on these results, baseline-specific Minimal Detectable Differences (MDDs; or 95% critical differences) and Minimal Clinically Important Differences (MCIDs) using both distribution-based and anchor-based approaches were generated for the APHAB-global score.