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A Randomized Control Trial: Supplementing Hearing Aid Use with Listening and Communication Enhancement (LACE) Auditory Training

Saunders, Gabrielle H.; Smith, Sherri L.; Chisolm, Theresa H.; Frederick, Melissa T.; McArdle, Rachel A.; Wilson, Richard H.

doi: 10.1097/AUD.0000000000000283
Research Articles

Objective: To examine the effectiveness of the Listening and Communication Enhancement (LACE) program as a supplement to standard-of-care hearing aid intervention in a Veteran population.

Design: A multisite randomized controlled trial was conducted to compare outcomes following standard-of-care hearing aid intervention supplemented with (1) LACE training using the 10-session DVD format, (2) LACE training using the 20-session computer-based format, (3) placebo auditory training (AT) consisting of actively listening to 10 hr of digitized books on a computer, and (4) educational counseling—the control group. The study involved 3 VA sites and enrolled 279 veterans. Both new and experienced hearing aid users participated to determine if outcomes differed as a function of hearing aid user status. Data for five behavioral and two self-report measures were collected during three research visits: baseline, immediately following the intervention period, and at 6 months postintervention. The five behavioral measures were selected to determine whether the perceptual and cognitive skills targeted in LACE training generalized to untrained tasks that required similar underlying skills. The two self-report measures were completed to determine whether the training resulted in a lessening of activity limitations and participation restrictions. Outcomes were obtained from 263 participants immediately following the intervention period and from 243 participants 6 months postintervention. Analyses of covariance comparing performance on each outcome measure separately were conducted using intervention and hearing aid user status as between-subject factors, visit as a within-subject factor, and baseline performance as a covariate.

Results: No statistically significant main effects or interactions were found for the use of LACE on any outcome measure.

Conclusions: Findings from this randomized controlled trial show that LACE training does not result in improved outcomes over standard-of-care hearing aid intervention alone. Potential benefits of AT may be different than those assessed by the performance and self-report measures utilized here. Individual differences not assessed in this study should be examined to evaluate whether AT with LACE has any benefits for particular individuals. Clinically, these findings suggest that audiologists may want to temper the expectations of their patients who embark on LACE training.

A multisite randomized controlled trial examining the effectiveness of the Listening and Communication Enhancement (LACE) was conducted. Standard-of-care hearing aid intervention was supplemented with DVD LACE training, computer-based LACE training, placebo training (listening to digitized books), and educational counseling. Participants were 279 Veterans. Data for five behavioral and two self-report measures were collected at baseline, immediately following the intervention period, and at 6-months post-intervention. There were no statistically significant main effects or interactions involving intervention on any outcome measure, leading to the conclusion that LACE training does not improve outcomes over provision of hearing aids alone.

1National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon, USA; 2Department of Otolaryngology, Oregon Health and Sciences University, Portland, Oregon, USA; 3Audiologic Rehabilitation Laboratory, Auditory and Vestibular Dysfunction Research Enhancement Award Program, VA Medical Center, Mountain Home, Tennessee, USA; 4Department of Audiology and Speech-Language Pathology, East Tennessee State University, Johnson City, Tennessee, USA; 5Department of Communication Sciences & Disorders, University of South Florida, Tampa, Florida, USA; and 6Bay Pines VA Healthcare System, Bay Pines, Florida, USA.

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The authors have no conflicts of interest to disclose.

Received January 6, 2015; accepted January 6, 2016.

Address correspondence to Gabrielle H. Saunders, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, 3710 SW US Veterans Hospital Road, Portland, OR 97239, USA. E-mail: gabrielle.saunders@va.gov

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