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      Core Outcome Domains for early phase clinical trials of sound-, psychology-, and pharmacology-based interventions to manage chronic subjective tinnitus in adults: the COMIT’ID study protocol for using a Delphi process and face-to-face meetings to establish consensus

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          Abstract

          Background

          The reporting of outcomes in clinical trials of subjective tinnitus indicates that many different tinnitus-related complaints are of interest to investigators, from perceptual attributes of the sound (e.g. loudness) to psychosocial impacts (e.g. quality of life). Even when considering one type of intervention strategy for subjective tinnitus, there is no agreement about what is critically important for deciding whether a treatment is effective. The main purpose of this observational study is, therefore to, develop Core Outcome Domain Sets for the three different intervention strategies (sound, psychological, and pharmacological) for adults with chronic subjective tinnitus that should be measured and reported in every clinical trial of these interventions. Secondary objectives are to identify the strengths and limitations of our study design for recruiting and reducing attrition of participants, and to explore uptake of the core outcomes.

          Methods

          The ‘Core Outcome Measures in Tinnitus: International Delphi’ (COMIT’ID) study will use a mixed-methods approach that incorporates input from health care users at the pre-Delphi stage, a modified three-round Delphi survey and final consensus meetings (one for each intervention). The meetings will generate recommendations by stakeholder representatives on agreed Core Outcome Domain Sets specific to each intervention. A subsequent step will establish a common cross-cutting Core Outcome Domain Set by identifying the common outcome domains included in all three intervention-specific Core Outcome Domain Sets. To address the secondary objectives, we will gather feedback from participants about their experience of taking part in the Delphi process. We aspire to conduct an observational cohort study to evaluate uptake of the core outcomes in published studies at 7 years following Core Outcome Set publication.

          Discussion

          The COMIT’ID study aims to develop a Core Outcome Domain Set that is agreed as critically important for deciding whether a treatment for subjective tinnitus is effective. Such a recommendation would help to standardise future clinical trials worldwide and so we will determine if participation increases use of the Core Outcome Set in the long term.

          Trial registration

          This project has been registered (November 2014) in the database of the Core Outcome Measures in Effectiveness Trials (COMET) initiative.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s13063-017-2123-0) contains supplementary material, which is available to authorized users.

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          Most cited references17

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          Consensus for tinnitus patient assessment and treatment outcome measurement: Tinnitus Research Initiative meeting, Regensburg, July 2006.

          There is widespread recognition that consistency between research centres in the ways that patients with tinnitus are assessed and outcomes following interventions are measured would facilitate more effective co-operation and more meaningful evaluations and comparisons of outcomes. At the first Tinnitus Research Initiative meeting held in Regensburg in July 2006 an attempt was made through workshops to gain a consensus both for patient assessments and for outcome measurements. It is hoped that this will contribute towards better cooperation between research centres in finding and evaluating treatments for tinnitus by allowing better comparability between studies.
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            Difficulties experienced by tinnitus sufferers.

            Ninety-seven members of a tinnitus self-help group were asked to list the difficulties that they had as a result of their tinnitus. Seventy-two replies were returned from 22 men and 48 women (sex not reported in two cases) whose average age was 61 years. Tinnitus was associated with hearing difficulties in 53%, effects on lifestyle in 93%, effects on general health in 56%, and emotional difficulties in 70% of the sample. Getting to sleep was the most frequently mentioned difficulty, and many respondents indicated that they experienced depression, annoyance, and insecurity. The clinical application of this open-ended questionnaire are discussed.
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              Characterization of tinnitus by tinnitus patients.

              A questionnaire was administered to 528 tinnitus patients to obtain data on their reactions to tinnitus. Results include a discussion of: (a) population characteristics, (b) perceptual characteristics, (c) the impact of tinnitus on daily life, and (d) etiology. Significant gender differences are also discussed. Tinnitus was not an occasional phenomenon, but was present for more than 26 days per month in 74% of the patients. Other important findings about tinnitus include: (a) Hearing levels at 1000 and 4000 Hz were less than or equal to 25 dB HL for 18% of the tinnitus patients, which suggests that some patients had normal hearing or mild hearing losses; (b) the prevalence of tinnitus in patients with noise-induced hearing loss (NIHL) was 30% for males and only 3% for females; (c) about 25% of the patients reported tinnitus severity had increased since tinnitus onset; (d) the effects of tinnitus were more severe in patients who reported tinnitus as their primary complaint and in patients diagnosed as having Ménière's syndrome tinnitus; and (e) some patients reported that noise exacerbated their tinnitus, whereas others reported that a quiet background exacerbated their tinnitus.
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                Author and article information

                Contributors
                kathryn.fackrell@nottingham.ac.uk
                harriet.smith@nottingham.ac.uk
                v_colley@hotmail.co.uk
                charlie.48@virginmedia.com
                adele.horobin@nottingham.ac.uk
                hfhaider@gmail.com
                londeroa@club-internet.fr
                Birgit.Mazurek@charite.de
                deborah.hall@nottingham.ac.uk
                Journal
                Trials
                Trials
                Trials
                BioMed Central (London )
                1745-6215
                23 August 2017
                23 August 2017
                2017
                : 18
                : 388
                Affiliations
                [1 ]NIHR Nottingham Hearing Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU UK
                [2 ]ISNI 0000 0004 1936 8868, GRID grid.4563.4, Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, , University of Nottingham, ; Nottingham, NG7 2UH UK
                [3 ]ISNI 0000 0004 0641 4263, GRID grid.415598.4, , Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, ; Derby Road, Nottingham, NG7 2UH UK
                [4 ]ISNI 0000000121511713, GRID grid.10772.33, ENT Department of Hospital Cuf Infante Santo, , Nova Medical School, ; Travessa do Castro, 3, 1350-070 Lisbon, Portugal
                [5 ]Service ORL et CCF, Consultation Acouphène et Hyperacousie, Hôpital Européen G. Pompidou, 20, rue Leblanc, 75015 Paris, France
                [6 ]ISNI 0000 0001 2218 4662, GRID grid.6363.0, Tinnitus Center, , Charite University Hospital, ; Chariteplatz 1, 10117 Berlin, Germany
                Article
                2123
                10.1186/s13063-017-2123-0
                5569503
                28835261
                c47c5571-8af5-4c52-a348-78db04033b86
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 3 April 2017
                : 27 July 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000272, National Institute for Health Research;
                Award ID: Nottingham Hearing Biomedical Research Unit
                Award Recipient :
                Funded by: British Tinnitus Association
                Award ID: N/A
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100000703, Action on Hearing Loss;
                Award ID: F74_Hall
                Award Recipient :
                Categories
                Study Protocol
                Custom metadata
                © The Author(s) 2017

                Medicine
                consensus methods,core outcome set,delphi process,drugs
                Medicine
                consensus methods, core outcome set, delphi process, drugs

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