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Tinnitus Management in the Canadian Armed Forces: A Potential Role for Occupational Therapists
Poster · November 2016 DOI: 10.13140/RG.2.2.12193.40808
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Chelsea Jones Leiden University Medical Centre
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Jones, C., MScOT(C) Occupational Therapist, Physical Rehabilitation Department, 1 Field Ambulance
identifying barriers to participation in daily occupations and BACKGROUND PURPOSE formulate a tinnitus management intervention plan6,12. These DISCUSSION measures may also have potential to assist with measuring the Tinnitus is defined as auditory perceptions of sound in the The purpose of this presentation is to: 1) Present how an OT effectiveness of the intervention6. The goal of the tinnitus management intervention by the OT 1 absence of external acoustic stimulation . Consistent with has addressed this at Canadian Forces Base (CFB) was to reduce the disability caused by tinnitus and increase findings of military members in other developed countries, Edmonton, and 2) Discuss the utilization of outcome measures Between January 2014 and September 2016, 16 members functioning in daily occupations. Much of the disability caused 2,5,6,8,13 Canadian Armed Forces (CAF) service members (SMs) assessing the disability caused by tinnitus in CAF members had completed the outcome measures and fit the inclusion by tinnitus is due to the psychological distress it causes . experience tinnitus at an elevated prevalence when compared referred to OT. criteria for the tinnitus management intervention (Figure 2). The person with tinnitus may worry about whether this 2. to the general population Tinnitus may be caused, or Functional impairments due to tinnitus included sleep difficulty, symptom is a precursor or adjunct to a disease, a predictor of 5,6 exacerbated, by stress, noise-related trauma, mental health METHODS cognitive challenges (e.g. difficulty concentrating), future hearing loss, or evidence of a mental illness . SMs also conditions, (i.e. depression and anxiety), and other conditions communication challenges, social isolation, stress, anxiety, reported subjective fears of the tinnitus getting louder and
or circumstances many of which SMs already experience at a etc5,6. Although, in some of the cases, a concussion initiated worsening over their lifetime. Providing education on tinnitus 2,3 Utilizing an occupational perspective, OTs analyze barriers and higher rate than their civilian counterparts . A study of CAF the onset of tinnitus, a previous concussion or TBI was not a and self-management reduced this stress in SMs as per their facilitators of the CAF member’s natural and built environment, Army, Navy, and Air Force was completed in 2004 (Abel, S. prerequisite to receive the tinnitus management intervention. subjective report. As well as the education on tinnitus, stress 2004). Of the 1,057 members surveyed, 52% reported military work activities (e.g., occupation), and physical and management, mindfulness techniques, and cognitive 3 4 mental health factors . The frameworks and models utilized by experiencing some tinnitus . 11% reported moderate to much Figure 2: Inclusion criteria for participation in Tinnitus rehabilitation strategies to assist with communication, 4 OTs allow them to holistically address soldiers as part of the interference in their ability to hear . Tinnitus can have a Management Intervention attention, and concentration were also provided. Some SMs multidisciplinary team3,7. The Canadian Model of Occupational profound effect on a person’s functioning; disruption in sleep, benefited from social skills training to explain their tinnitus to Performance and Engagement (CMOP-E, Figure 1) is one cognition, socialization, affect, etc. and can reduce a soldier’s others and utilize language skills to ask for repetitions or ability to participate in activities of daily living (ADLs) including such model acknowledging the intertwining of biopsychosocial explanations of statements during verbal communication. 7 4,5,6 factors that may contribute to barriers in occupation These military tasks . . Some welcomed referrals to other stress management models were guides for the development of the tinnitus intervention tools such as Health Promotion programming and management intervention. The combination of the Psychosocial Services (PSS). Some found mindfulness psychoeducational, cognitive behavioural, and cognitive effective at providing some relief from the tinnitus as well as rehabilitative interventions are consistent with the evidence managing stress and continued to practice this on their own. based recommendations for the management of tinnitus within Although reducing the severity of the tinnitus itself was not the 1,5,6,8 military and civilian healthcare systems . primary goal of the OT, some SMs reported their tinnitus RESULTS severity and volume was reduced after the intervention. Figure 1: The Canadian Model of Occupational An intervention for tinnitus has many similarities to that for 7 Performance and Engagement (CMOP-E) The results of the outcome measures were collected and are chronic pain; addressing chronic pain management is a skill
summarized in Table 1. Those assessed scored in the mild to that OTs already practice. Due to the location of OT in the
catastrophic handicap/disability range on initial assessments. Physical Rehabilitation Department, there may be reduced
Out of the 16 patients, only one had been referred to an perceived stigma associated with participation in therapy
Managing tinnitus involves minimizing the resulting Otolaryngologist or other specialist due to tinnitus. Some SMs versus engaging with Mental Health or PSS. The tinnitus
psychological stress it can cause and maintaining or reported hearing loss as well as tinnitus. The majority of the management intervention acted as a bridge to reduce
increasing day-to-day functioning despite its presence1,4,5,6. patients had a medical history which included concussion(s), perceived stigma and increasing the SM’s willingness to
Management may include cognitive behavioral therapy, however the onset of tinnitus may have been prior to this engage in other beneficial therapies. Best practice for tinnitus
mindfulness, sound therapy, reassurance, education, etc.1,4,5,6 injury. None of the members had received any type of management includes a multi-disciplinary team interventions8.
Research regarding tinnitus management, therapy, prevention, intervention to address the dysfunction caused by tinnitus in The resource investment of the OT to produce and execute the
and rehabilitation with the CAF is limited. Currently within the past. tinnitus management intervention was minimal. There is also The outcome measures utilized included the Tinnitus Handicap Canadian Forces Health Services a formal protocol or research to demonstrate promise with online methods of Inventory and Tinnitus Reaction Questionnaire. These were intervention pathway to address the management of tinnitus Table 1: Results of Tinnitus Handicap Inventory (THQ), Tinnitus tinnitus management interventions13. utilized to assess the member’s perceived disability due to does not exist. Reaction Questionnaire (TRQ), and Tinnitus History Questionnaire. tinnitus6,9,10. These standardized outcome measures are
recommended in the literature for measuring the self-report Occupational therapists (OTs) have the responsibility to CONCLUSION functional challenges due to tinnitus6. The outcome measures assess, treat, and educate ill and injured SMs to facilitate their A standardized intervention process for tinnitus management are easy to utilize by clinicians, are validated in French and participation in everyday military work as well as self-care and for SMs could be addressed by OTs. Reducing the distress English, and allow the clinician to quantify the patient’s unique leisure occupations; thus enabling them to be fit, employable, and disability caused by tinnitus could increase SM’s overall and personal experience with tinnitus6,9,10,11. The psychometric and deployable while enhancing overall well-being3,7. functioning in activities of daily living as well as overall quality properties of both measures have been well Occupational therapists (OTs) may be a good fit to address of life. Future research on the effectiveness of tinnitus documented6,9,10,11,12. The Tinnitus History Questionnaire was tinnitus management within CFHS. OTs possess a unique and management interventions in the CAF population may be also utilized to gather subjective information regarding the pragmatic skill set that allows them to effectively unite physical, beneficial. member’s medical, operational, and rehabilitative history as it mental, and cognitive health with evidence-based assessment pertains to tinnitus. Outcome measures that measure the and intervention3,7. disability caused by tinnitus can assist the clinician with REFERENCES – ANNEX A
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