General discussion 167 Conclusions The studies in this thesis provide insight into several aspects of work functioning in employees with hearing loss. Although hearing loss can be an important underlying cause of difficulties with work functioning, such as higher need for recovery (NFR), these difficulties cannot be quantified nor qualified by solely measuring the degree of hearing loss using the conventional pure-tone audiogram. For the ICF diagnosis of employees with hearing loss, it has been shown that it is important to consider how employees perceive their hearing, their job, and their functioning, as well as how they cope with associated difficulties. This broad approach should also guide aural rehabilitation practices. It has been shown that the NFR of employees with hearing loss can be improved by aural rehabilitation, although the NFR improved in only part of the employees. Interventions that focus on optimizing coping behaviour may be promising to improve the effects of the rehabilitation. Also, the involvement of employers and colleagues in the aural rehabilitation deserves further attention. More advanced tests should be used to assess the performance of auditory, hearingcritical job tasks. These tests are available to assess speech communication, but not to assess the detection of auditory warning signals. Therefore, an advanced signal detection test is proposed to assess this ability in locomotive engineers. Hopefully, this thesis will inspire clinicians and researchers to provide and validate rehabilitation services for employees with hearing loss to support their functioning and participation at work.
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