Hearing Rehabilitation With a Chat-Based Mobile Auditory Training Program in Experienced Hearing Aid Users: Prospective Randomized Controlled Study.

BACKGROUND: Hearing rehabilitation with auditory training (AT) is necessary to improve speech perception ability in patients with hearing loss. However, face-to-face AT has not been widely implemented due to its high cost and personnel requirements. Therefore, there is a need for the development of a patient-friendly, mobile-based AT program. OBJECTIVE: In this study, we evaluated the effectiveness of hearing rehabilitation with our chat-based mobile AT (CMAT) program for speech perception performance among experienced hearing aid (HA) users. METHODS: A total of 42 adult patients with hearing loss who had worn bilateral HAs for more than 3 months were enrolled and randomly allocated to the AT or control group. In the AT group, CMAT was performed for 30 minutes a day for 2 months, while no intervention was provided in the control group. During the study, 2 patients from the AT group and 1 patient from the control group dropped out. At 0-, 1- and 2-month visits, results of hearing tests and speech perception tests, compliance, and questionnaires were prospectively collected and compared in the 2 groups. RESULTS: The AT group (n=19) showed better improvement in word and sentence perception tests compared to the control group (n=20; P=.04 and P=.03, respectively), while no significant difference was observed in phoneme and consonant perception tests (both P>.05). All participants were able to use CMAT without any difficulties, and 85% (17/20) of the AT group completed required training sessions. There were no changes in time or completion rate between the first and the second month of AT. No significant difference was observed between the 2 groups in questionnaire surveys. CONCLUSIONS: After using the CMAT program, word and sentence perception performance was significantly improved in experienced HA users. In addition, CMAT showed high compliance and adherence over the 2-month study period. Further investigations are needed to validate long-term efficacy in a larger population. TRIAL REGISTRATION: Clinical Research Information Service (CRiS) KCT0006509; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=22110&search_page=L.

Defining interdisciplinary competencies for audiological rehabilitation: findings from a modified Delphi study.

OBJECTIVES: The aim of this study is to derive a consensus on an interdisciplinary competency framework regarding a holistic approach for audiological rehabilitation (AR), which includes disciplines from medicine, engineering, social sciences and humanities. DESIGN: We employed a modified Delphi method. In the first round survey, experts were asked to rate an initial list of 28 generic interdisciplinary competencies and to propose specific knowledge areas for AR. In the second round, experts were asked to reconsider their answers in light of the group answers of the first round. STUDY SAMPLE: An international panel of 27 experts from different disciplines in AR completed the first round. Twenty-two of them completed the second round. RESULTS: We developed a competency framework consisting of 21 generic interdisciplinary competencies grouped in five domains and nine specific competencies (knowledge areas) in three clusters. Suggestions for the implementation of the generic competencies in interdisciplinary programmes were identified. CONCLUSIONS: This study reveals insights into the interdisciplinary competencies that are unique for AR. The framework will be useful for educators in developing interdisciplinary programmes as well as for professionals in considering their lifelong training needs in AR.

Hearing preservation cochlear implantation in children: The HEARRING Group consensus and practice guide.

OBJECTIVES: To provide multidisciplinary cochlear implant teams with a current consensus statement to support hearing preservation cochlear implantation (HPCI) in children, including those children with symptomatic partial deafness (PD) where the intention is to use electric-acoustic stimulation (EAS). The main objectives are to provide guidelines on who is a candidate, how to assess these children and when to implant if Med-El Flex electrode arrays are chosen for implantation. METHODS: The HEARRING group reviewed the current evidence and practice regarding the management of children to be considered for HPCI surgery emphasizing the assessment needed prior to implantation in order to demonstrate the benefits in these children over time. The consensus statement addresses following three key questions: (1) Should these children be treated? (2) How to identify these children? (3) How to manage these children? SUMMARY: The HEARRING group concludes that irrespective of the degree of residual hearing present, the concepts of hearing and structure preservation should be applied in every child undergoing cochlear implantation and that HPCI is a safe and reliable treatment option. Early detection and multidisciplinary assessment are key to the identification of children with symptomatic PD, these children should undergo HPCI as early as possible.

Evaluating the short-term and long-term effects of an internet-based aural rehabilitation programme for hearing aid users in general clinical practice: a randomised controlled trial.

OBJECTIVE: Guided internet-based intervention beyond hearing aid (HA) fitting has been shown to be efficacious in randomised controlled trials (RCTs). However, internet interventions have rarely been applied clinically as a part of regular aural rehabilitation (AR). Our aim was to evaluate the effectiveness of internet-based AR for HA users from a clinical population. OUTCOME MEASURES: The Hearing Handicap Inventory for the Elderly (HHIE) was used as the primary outcome measure, and the Communication Strategies Scale (CSS) and the Hospital Anxiety and Depression Scale were used as secondary outcome measures. All questionnaires were administered before and directly after the intervention and at 6 months postintervention. METHODS: We used a parallel group design (RCT). The data were collected in 2013-2014 at three different clinics. Seventy-four HA users were randomly assigned to receive either full internet-based AR (intervention group, n=37) or one element of the internet-based AR (control group, n=37). RESULTS: Data were analysed following the intention-to-treat principle. Each group showed improved HHIE scores over time and did not differ significantly from each other. The intervention group showed significantly greater improvement compared with the control group for the CSS total and the non-verbal subscale scores. The intervention group and control group were also subdivided into two age groups: 20-59 years and 60-80 years. Significantly better improvement on the CSS total and non-verbal subscale scores was found in the older group compared with the younger participants. CONCLUSIONS: This study indicates that participants in an internet-based intervention applied in general clinical practice showed improved self-reported communication skills compared with a control group. Receiving a full intervention was not more effective in improving self-reported hearing problems than receiving just one element of the internet-based intervention. TRIAL REGISTRATION NUMBER: This trial is registered at ClinicalTrals.gov, NCT01837550; results.

Pediatric Minimum Speech Test Battery.

BACKGROUND: Assessment of patient outcomes and documentation of treatment efficacy serves as an essential component of (re)habilitative audiology; however, no standardized protocol exists for the assessment of speech perception abilities for children with hearing loss. This presents a significant challenge in tracking performance of children who utilize various hearing technologies for within-subjects assessment, between-subjects assessment, and even across different facilities. PURPOSE: The adoption and adherence to a standardized assessment protocol could help facilitate continuity of care, assist in clinical decision making, allow clinicians and researchers to define benchmarks for an aggregate clinical population, and in time, aid with patient counseling regarding expectations and predictions regarding longitudinal outcomes. DESIGN: The Pediatric Minimum Speech Test Battery (PMSTB) working group-comprised of clinicians, scientists, and industry representatives-commenced in 2012 and has worked collaboratively to construct the first PMSTB, which is described here. CONCLUSIONS: Implementation of the PMSTB in clinical practice and dissemination of associated data are both critical for achieving the next level of success for children with hearing loss and for elevating pediatric hearing health care ensuring evidence-based practice for (re)habilitative audiology.

[Speech audiometry for indication of conventional and implantable hearing aids]. / Sprachaudiometrie bei der Indikation von Hörhilfen und Hörimplantaten.

The social function of the human hearing apparatus is comprehension of speech. Auditory rehabilitation aims to enhance speech perception in everyday life. Consequently, audiological evaluation contains speech perception measurement. Many speech audiometric methods have been developed in German-speaking countries, which are suitable for quantification of speech perception abilities in quiet and in noise to address specific diagnostic questions. For establishment of the indication for technical hearing systems such as hearing aids and cochlear implants, the Freiburg monosyllabic test has been employed successfully for many years. Particularly sentence tests have been suggested as a complementary measure for hearing aid indication and assessment. This paper describes the characteristics and range of application of various speech audiometric methods, and highlights the methodological limitations of the individual tests.

Questionnaire validation - PEACH on Brazilian Portuguese. / Validação do questionário Parent's Evaluation of Aural/Oral Performance of Children - PEACH em língua portuguesa brasileira.

PURPOSE: Translate, adapt and validate the Parent's Evaluation of Aural/Oral Performance of Children questionnaire to Brazilian Portuguese, as well as analyzing the interaction between parents/caregivers and children. METHODS: After translated, back translated and adapted this questionnaire was administered to 13 parents or guardians of children with moderate to severe hearing loss that were treated in the ambulatory of audiology of the Institution. Parents should fill out the diary, answering the questionnaire, giving as many examples of observed behaviors for each question and return for follow-up after a week for an interview with the evaluator or child's therapist. RESULTS: Data are presented in frequency and percentage. We used chi-square test with a 5% significance level (p). Two questions were culturally adapted to Brazilian Portuguese. The questionnaires were answered by mothers most of the time (69.2%). CONCLUSIONS: The questionnaire was translated and adapted respecting the cultural aspects of the Brazilian population. It was observed that, for some questions, it is necessary care when analyzing the answers that parents provide, taking into consideration the child's age and linguistic content that is required for the observed behavior, avoiding erroneous interpretations made on the quality of amplification and the use of hearing aids or CI due to this. The questionnaire is of great importance since it measures the performance of children in their daily life situations.

Validação do questionário parent's evaluation of aural/oral performance of children ­ peach em língua portuguesa brasileira / Questionnaire validation - peach on brazilian portuguese

RESUMO Objetivo Traduzir, adaptar e validar o questionário Parent’s Evaluation of Aural/Oral Performance of Children para a língua portuguesa brasileira, aplicar o questionário e analisar a interação entre pais/cuidadores e crianças. Métodos Após ser traduzido, retrotraduzido e adaptado, o PEACH foi aplicado a 13 pais ou responsáveis por crianças deficientes auditivas de grau moderado a profundo atendidas no Ambulatório de Audiologia Educacional da instituição. Pediu-se aos pais que preenchessem o diário, respondessem ao questionário fornecendo o maior número de exemplos de comportamentos observados em cada questão e comparecessem ao retorno, após uma semana, para entrevista com a avaliadora ou terapeuta da criança. Resultados Os dados são apresentados em frequência e porcentagem. Usou-se o teste de qui-quadrado, tendo-se adotado 5% como nível de significância (p). Duas questões sofreram adaptação cultural para a língua portuguesa brasileira; as mães foram as pessoas que mais responderam ao questionário (69,2%). Conclusão O questionário foi traduzido e adaptado respeitando os aspectos culturais da população brasileira. Em algumas questões deve-se tomar cuidado ao analisar as respostas dos pais, levando-se em conta a idade da criança e o conteúdo linguístico exigido para que se observe o comportamento, evitando interpretações errôneas quanto à qualidade da amplificação e do uso do AASI/IC. A aplicação do questionário é de grande importância, visto que mede o desempenho das crianças em situações de sua vida diária.

ABSTRACT Purpose Translate, adapt and validate the Parent's Evaluation of Aural/Oral Performance of Children questionnaire to Brazilian Portuguese, as well as analyzing the interaction between parents/caregivers and children. Methods After translated, back translated and adapted this questionnaire was administered to 13 parents or guardians of children with moderate to severe hearing loss that were treated in the ambulatory of audiology of the Institution. Parents should fill out the diary, answering the questionnaire, giving as many examples of observed behaviors for each question and return for follow-up after a week for an interview with the evaluator or child's therapist. Results Data are presented in frequency and percentage. We used chi-square test with a 5% significance level (p). Two questions were culturally adapted to Brazilian Portuguese. The questionnaires were answered by mothers most of the time (69.2%). Conclusions The questionnaire was translated and adapted respecting the cultural aspects of the Brazilian population. It was observed that, for some questions, it is necessary care when analyzing the answers that parents provide, taking into consideration the child's age and linguistic content that is required for the observed behavior, avoiding erroneous interpretations made on the quality of amplification and the use of hearing aids or CI due to this. The questionnaire is of great importance since it measures the performance of children in their daily life situations.

Functional performance in older adults with hearing loss: Application of the International Classification of Functioning brief core set for hearing loss: A pilot study.

OBJECTIVES: The beta version of the International Classification of Functioning, Disability, and Health (ICF) brief core set for hearing loss in adults was developed and recommended to be validated through the audiologic rehabilitation clinical practice. The aims of this pilot study were to validate the ICF brief core set by examining the dimensions of hearing performance measures used in a standard care university clinic specializing in amplification, and seeing if those dimensions support the structure provided by the core set. DESIGN: ICF linking, classification, and qualifier coding procedures were applied on a data set identified from clinical records and two paper-pencil questionnaires; and completed by consensus of two experienced audiologists. STUDY SAMPLE: Forty-nine participants were recruited from an out-patient population at an audiology clinic. RESULTS: Eighteen of 27 items from the brief core set were able to be linked and validated. Four factors were identified, and confirmed the structure of ICF concept: Auditory function, Other functions, Activities/contextual interaction, and Third-party disability. Further, three predictors significantly discriminated performance in 28 participants: the use of hearing assistive devices, speech-reading, and active social life. CONCLUSIONS: The ICF brief core set is a valuable tool for use in audiologic rehabilitation clinical practice and research design.

[The experience of the work of a regional cochlear implantation center].

The objective of the present study was to determine the main lines of the development of a regional cochlear implantation centre and to estimate the effectiveness of rehabilitation of the children treated with the use of cochlear implantation. Analysis of the results of the work of the branch of the Russian Research and Practical Centre of Audiology and Hearing Rehabilitation based at Voronezh Regional Children's Clinical Hospital No 1 provided materials for the establishment of the principle directions of activities of the regional cochlear implantation centre where a total of 161 children have been kept under observation during the last years. Fifty six of the 138 children at the age varying from 1 to 12 years were given the surgical treatment. The patients were followed up within two and more years after connection of the speech processor. The study group was comprised only of the pre-lingually deaf children. It is concluded that the performance of most cochlear implantation procedures based at local centres allows to reduce the cost of rehabilitation and makes the high-tech medical aid more readily available to the patients; moreover, the practical introduction of remote speech processor programming software into the work of regional cochlear implantation centres enhances the effectiveness of the rehabilitative measures based at local medical facilities.

Patient-centred audiological rehabilitation: perspectives of older adults who own hearing aids.

OBJECTIVE: Patient-centred care is a term frequently associated with quality health care. Despite extensive literature from a range of health-care professions that provide description and measurement of patient-centred care, a definition of patient-centredness in audiological rehabilitation is lacking. The current study aimed to define patient-centred care specific to audiological rehabilitation from the perspective of older adults who have owned hearing aids for at least one year. DESIGN: Research interviews were conducted with a purposive sample of older adults concerning their perceptions of patient-centredness in audiological rehabilitation, and qualitative content analysis was undertaken. STUDY SAMPLE: The participant sample included ten adults over the age of 60 years who had owned hearing aids for at least one year. RESULTS: Data analysis revealed three dimensions to patient-centred audiological rehabilitation: the therapeutic relationship, the players (audiologist and patient), and clinical processes. Individualised care was seen as an overarching theme linking each of these dimensions. CONCLUSIONS: This study reported two models: the first model describes what older adults with hearing aids believe constitutes patient-centred audiological rehabilitation. The second provides a guide to operationalised patient-centred care. Further research is required to address questions pertaining to the presence, nature, and impact of patient-centred audiological rehabilitation.

Proposed norms for the Glasgow hearing-aid benefit profile (Ghabp) questionnaire.

OBJECTIVE: To form a normative set of responses to the GHABP questionnaire from a large regional dataset. DESIGN: Participants were asked to rate their hearing disability, handicap, hearing-aid (HA) use, HA benefit, HA satisfaction, and residual (aided) disability on a five-point scale for four situations: quiet conversation, television (TV) listening, noisy conversation, and group conversation. A subset of participants also estimated the time spent in these situations. STUDY SAMPLE: A group of 1574 adults with normal to profound hearing thresholds participated. RESULTS: There was a significant relationship between increasing perceived disability and increasing hearing loss as given by the better-ear audiometric average (BEA). Responses for HA measures did not vary greatly with hearing loss: HA use was reported as high, whereas residual disability, HA benefit, and satisfaction were all reported on average as moderate. CONCLUSIONS: The results can be used as a normative dataset with which to evaluate individual responses in the clinic, where the GHABP provides a useful short-form questionnaire to engage the patient. The lack of systematic changes in hearing-aid related responses shows room for improvement in the benefit afforded by amplification.

An Australian survey of audiologists' preferences for patient-centredness.

OBJECTIVE: Patient-centredness is becoming a core value of health services worldwide, however it remains largely unexplored in audiology. This study investigated audiologists' preferences for patient-centredness and identified factors that explain audiologists' preferences for patient-centredness. DESIGN: All members of the Audiological Society of Australia received two questionnaires: (1) a descriptive questionnaire (e.g. age, gender, place of residence, years in practice, employment characteristics), and (2) a modified patient-practitioner orientation scale (PPOS; Krupat et al, 2000) which measures preferences for two aspects of patient-centredness, sharing and caring. STUDY SAMPLE: In total 663 (46%) audiologists returned both questionnaires fully completed. RESULTS: Mean PPOS scores indicated that audiologists prefer patient-centredness. Linear regression modelling identified that older audiologists, that had practiced longer, and who worked in community education, industrial audiology, or teaching had a significantly greater preference for patient-centredness than their peers. In contrast, audiologists who practiced in a private environment and who worked in the area of assessment of adults had a significantly lesser preference for patient-centredness than their peers. CONCLUSIONS: Audiologists prefer client-centredness and age, years of experience, and employment characteristics can partly explain preferences for patient-centredness. Future research should explore the relationships between patient-centredness and intervention outcomes in audiology.

Patient-centred care: a review for rehabilitative audiologists.

OBJECTIVE: This discussion paper aims to synthesise the literature on patient-centred care from a range of health professions and to relate this to the field of rehabilitative audiology. Through review of the literature, this paper addresses five questions: What is patient-centred care? How is patient-centred care measured? What are the outcomes of patient-centred care? What are the factors contributing to patient-centred care? What are the implications for audiological rehabilitation? DESIGN: Literature review and synthesis. STUDY SAMPLE: Publications were identified by structured searches in PubMed, Cinahl, Web of Knowledge, and PsychInfo, and by inspecting the reference lists of relevant articles. RESULTS: Few publications from within the audiology profession address this topic and consequently a review and synthesis of literature from other areas of health were used to answer the proposed questions. CONCLUSION: This paper concludes that patient-centred care is in line with the aims and scope of practice for audiological rehabilitation. However, there is emerging evidence that we still need to inform the conceptualisation of patient-centred audiological rehabilitation. A definition of patient-centred audiological rehabilitation is needed to facilitate studies into the nature and outcomes of it in audiological rehabilitation practice.

On a reference-free speech quality estimator for hearing aids.

A reference-free speech quality measure is proposed and assessed for hearing aid applications. The proposed speech quality metric is validated with subjective ratings obtained from hearing impaired listeners under a number of noisy and reverberant conditions. In addition, a comparison is drawn between the proposed measure and a state-of-the-art electroacoustic measure that relies on a clean reference signal. The results showed that the reference-free measure had a lower correlation with the subjective ratings of hearing aid speech quality in comparison to the correlations achieved by the measure utilizing a reference signal. Nevertheless, advantages of the reference-free approach are discussed.

Speechreading development in deaf and hearing children: introducing the test of child speechreading.

PURPOSE: In this article, the authors describe the development of a new instrument, the Test of Child Speechreading (ToCS), which was specifically designed for use with deaf and hearing children. Speechreading is a skill that is required for deaf children to access the language of the hearing community. ToCS is a deaf-friendly, computer-based test that measures child speechreading (silent lipreading) at 3 psycholinguistic levels: (a) Words, (b) Sentences, and (c) Short Stories. The aims of the study were to standardize the ToCS with deaf and hearing children and to investigate the effects of hearing status, age, and linguistic complexity on speechreading ability. METHOD: Eighty-six severely and profoundly deaf children and 91 hearing children participated. All children were between the ages of 5 and 14 years. The deaf children were from a range of language and communication backgrounds, and their preferred mode of communication varied. RESULTS: Speechreading skills significantly improved with age for both groups of children. There was no effect of hearing status on speechreading ability, and children from both groups showed similar performance across all subtests of the ToCS. CONCLUSION: The ToCS is a valid and reliable assessment of speechreading ability in school-age children that can be used to measure individual differences in performance in speechreading ability.

Validation of the Parents' Evaluation of Aural/Oral Performance of Children (PEACH) Rating Scale.

BACKGROUND: The Parents' Evaluation of Aural/Oral Performance of Children (PEACH) is a caregiver report questionnaire that is suitable for use with children who wear hearing aids. It is available in both a Diary format and a Rating Scale format. Following a critical review of subjective outcome evaluation tools for infants, toddlers, and preschool children (Bagatto, Moodie, Seewald et al, 2011), the Rating Scale version of the PEACH was included in a recently developed guideline for monitoring real-world auditory performance of children who have hearing loss (Bagatto, Moodie, Malandrino et al, 2011). Normative data exist only for the PEACH Diary, not the Rating Scale. PURPOSE: This article evaluates whether published normative data for the PEACH Diary (Ching and Hill, 2007) are replicated on a different sample of children using the PEACH Rating Scale. RESEARCH DESIGN: Fifty-nine children with normal hearing aged 2 mo to 83 mo and their primary caregivers participated in the study. Caregivers completed the PEACH Rating Scale for each child with normal hearing. RESULTS: Results indicated close agreement to existing normative data collected with the PEACH Diary, with no differences in scores between males and females and good internal consistency. Age-related trends published for the Diary version were replicated using the Rating Scale version, as significantly lower scores were observed for children 20 mo of age and younger compared to those older than 20 mo of age. CONCLUSIONS: The currently published norms for the PEACH Diary are valid for use with the PEACH Rating Scale with caregivers of normal hearing children. This validation work adds to the evidence base of the PEACH Rating Scale and supports its use in clinical practice.

Monitoring progress in vocal development in young cochlear implant recipients: relationships between speech samples and scores from the Conditioned Assessment of Speech Production (CASP).

PURPOSE: To determine the concurrent validity of the Conditioned Assessment of Speech Production (CASP; Ertmer & Stoel-Gammon, 2008) and data obtained from speech samples recorded at the same intervals. METHOD: Nineteen children who are deaf who received cochlear implants before their 3rd birthdays participated in the study. Speech samples and CASP scores were gathered at 6, 12, 18, and 24 months postactivation. Correlation analyses were conducted to assess the concurrent validity of CASP scores and data from samples. RESULTS: CASP scores showed strong concurrent validity with scores from speech samples gathered across all recording sessions (6-24 months). CONCLUSIONS: The CASP was found to be a valid, reliable, and time-efficient tool for assessing progress in vocal development during young cochlear implant recipients' first 2 years of device experience.

Facilitating the transition from the pediatric to adult cochlear implant setting: perspectives of CI professionals.

OBJECTIVES: Over the last 20 years, the availability of cochlear implantation has resulted in a pediatric population with different health needs than adults who receive cochlear implants (CIs). These pediatric patients are now transitioning to adult hospital settings in significant numbers. This issue of transition is not unique to cochlear implant services: research in other chronic health conditions has documented a variety of challenges for youth and health care providers. The objectives of this study were to identify factors important in the transition from pediatric to adult CI services from the perspective of service providers and to make recommendations to improve transition practices in the future. METHODS: Focus groups were conducted with professionals providing specialized CI services in pediatric and adult hospitals, and specialized educators in the school setting. Qualitative research methodology was used to identify key themes. Data extracted from patient files allowed comparison of pediatric and adult CI recipients. RESULTS: Youth who had received CIs in the pediatric setting differed from other adult patients in the incidence of prelingual hearing losses, and age at CI surgery. Key focus group themes were related to service delivery models, communication between settings, and skills needed by the patients to effectively meet their own health needs. DISCUSSION: Factors identified by CI professionals were very similar to those identified in research for other health conditions. From the focus groups, as well as other literature, a number of recommendations are proposed to facilitate a positive transition of young people to adult health care.

A critical review of audiological outcome measures for infants and children.

Outcome evaluation is an important stage in the pediatric hearing aid fitting process, however a systematic way of evaluating outcome in the pediatric audiology population is lacking. This is in part due to the need for an evidence-based outcome evaluation guideline for infants and children with hearing loss who wear hearing aids. As part of the development of a guideline, a critical review of the existing pediatric audiology outcome evaluation tools was conducted. Subjective outcome evaluation tools that measure auditory-related behaviors in children from birth to 6 years of age were critically appraised using a published grading system (Andresen, 2000). Of the tools that exist, 12 were appraised because they met initial criteria outlined by the Network of Pediatric Audiologists of Canada as being appropriate for children birth to 6 years of age who wear hearing aids. Tools that were considered for the guideline scored high in both statistical and feasibility criteria. The subjective outcome evaluation tools that were ultimately chosen to be included in the guideline were the LittlEARS Auditory Questionnaire (Tsiakpini et al., 2004) and the Parents' Evaluation of Aural/Oral Performance of Children (PEACH) Rating Scale (Ching & Hill, 2005b) due to the high grades they received in the critical review and their target age ranges. Following this critical review of pediatric outcome evaluation tools, the next step was for the Network Clinicians to evaluate the guideline (Moodie et al., 2011b).