Expanding the Functional Profile of Hearing Loss: Evidence for Including Balance and Mobility Categories in the ICF Core Sets for Hearing Loss.
- 1Department of Speech-Language and Hearing Sciences, ABILITY Research Lab, Auburn University, Auburn, AL, USA
Abstract
Background and objectives
Balance and mobility difficulties are common in adults with hearing loss (HL), but are often overlooked in clinical practice because of fragmented care models; the siloed structure of clinical services; and limitations in the current International Classification of Functioning, Disability and Health (ICF)-based assessment frameworks. This study aimed to quantify these difficulties and examine their associations with functional domains.Subjects and methods
A cross-sectional study included 72 adults (mean age, 59±8.3 years), comprising participants with normal hearing (25%) and HL (75%), including both unaided and aided users. Participants were purposively recruited from the Speech and Hearing Clinic at Auburn University and had previously completed the HEAR-COMMAND Tool, a self-assessment questionnaire derived from the ICF-Core Sets for HL (ICF-CSHL). In addition, all participants completed the Balance and Mobility Scale (BMS), a 13-item instrument modeled after the HEAR-COMMAND Tool, to benchmark balance-mobility difficulties.Results
The BMS results demonstrated excellent internal consistency (α=0.90) and two distinct but correlated factors, Physical Mobility and Perceptual Experience, supporting its structural validity. Balance-mobility challenges were highly prevalent, including walking fatigue (73.6%), difficulty performing complex movements (72.2%), difficulty transitioning between positions (70.8%), leg stiffness (68.1%), standing instability (61.1%), and difficulty walking long distances (50%). BMS scores were strongly associated with HEAR-COMMAND scores, explaining significant variance in both the hearing domain (β=0.50, p<0.001, R2=0.40) and non-hearing domain (β=0.63, p<0.001, R2=0.48). Analysis of variance (ANOVA) showed that only the hearing-domain scores differed significantly among groups, with participants with normal hearing outperforming both unaided and aided participants with HL.Conclusions
The high prevalence and strong functional associations of balance-mobility challenges indicate that they are core components of disability in individuals with HL. Incorporating these domains into the ICF-CSHL frameworks and their derived assessment tools, including the HEAR-COMMAND Tool, may support a more person-centered and function-oriented approach to hearing healthcare.
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BibTeX
@article{alfakir2026expanding,
title = {{Expanding the Functional Profile of Hearing Loss: Evidence for Including Balance and Mobility Categories in the ICF Core Sets for Hearing Loss.}},
author = {Razan Alfakir},
journal = {Journal of audiology \& otology},
year = {2026},
month = oct,
doi = {10.7874/jao.2025.00654},
url = {https://europepmc.org/article/MED/42958772},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Expanding the Functional Profile of Hearing Loss: Evidence for Including Balance and Mobility Categories in the ICF Core Sets for Hearing Loss.
AU - Razan Alfakir
PY - 2026
DA - 2026/10/20
JO - Journal of audiology & otology
DO - 10.7874/jao.2025.00654
UR - https://europepmc.org/article/MED/42958772
AB - Background and objectives Balance and mobility difficulties are common in adults with hearing loss (HL), but are often overlooked in clinical practice because of fragmented care models; the siloed structure of clinical services; and limitations in the current International Classification of Functioning, Disability and Health (ICF)-based assessment frameworks. This study aimed to quantify these difficulties and examine their associations with functional domains.Subjects and methods A cross-sectional study included 72 adults (mean age, 59±8.3 years), comprising participants with normal hearing (25%) and HL (75%), including both unaided and aided users. Participants were purposively recruited from the Speech and Hearing Clinic at Auburn University and had previously completed the HEAR-COMMAND Tool, a self-assessment questionnaire derived from the ICF-Core Sets for HL (ICF-CSHL). In addition, all participants completed the Balance and Mobility Scale (BMS), a 13-item instrument modeled after the HEAR-COMMAND Tool, to benchmark balance-mobility difficulties.Results The BMS results demonstrated excellent internal consistency (α=0.90) and two distinct but correlated factors, Physical Mobility and Perceptual Experience, supporting its structural validity. Balance-mobility challenges were highly prevalent, including walking fatigue (73.6%), difficulty performing complex movements (72.2%), difficulty transitioning between positions (70.8%), leg stiffness (68.1%), standing instability (61.1%), and difficulty walking long distances (50%). BMS scores were strongly associated with HEAR-COMMAND scores, explaining significant variance in both the hearing domain (β=0.50, p<0.001, R2=0.40) and non-hearing domain (β=0.63, p<0.001, R2=0.48). Analysis of variance (ANOVA) showed that only the hearing-domain scores differed significantly among groups, with participants with normal hearing outperforming both unaided and aided participants with HL.Conclusions The high prevalence and strong functional associations of balance-mobility challenges indicate that they are core components of disability in individuals with HL. Incorporating these domains into the ICF-CSHL frameworks and their derived assessment tools, including the HEAR-COMMAND Tool, may support a more person-centered and function-oriented approach to hearing healthcare.
SN - 2384-1621
SN - 2384-1710
ER -