Chapter 3 76 of the four components mentioned above. Although it is increasingly acknowledged that it is important to address patient’s work needs in aural rehabilitation (Granberg & Gustafsson, 2021; Zuriekat et al., 2021), due to the lack of literature, it is unclear to what extent these kinds of services are currently provided and what the effects are of current services. To the best of our knowledge, a prospective evaluation of the NFR after the provision of any kind of aural rehabilitation has only been conducted in two recent studies (Gussenhoven et al., 2017; Van Leeuwen et al., 2021). Gussenhoven et al. (2017) performed a randomized controlled trial comparing a multidisciplinary programof aural rehabilitation including vocational and audiological components with audiological care as usual. They included employees experiencing hearing difficulties and restrictions at work due to their hearing loss. No significant decrease in the NFR was found in both groups at 3, 6, 9, or 12 months follow up, and the effect of the intervention on the NFR did not differ between the two groups. Van Leeuwen et al. (2021) performed a cohort study and evaluated the effect of using hearing aids and/or hearing assistive listening devices on the NFR. They included employees aged 18 to 67 with normal hearing or with hearing loss. A total of 147 employees with hearing loss were included who did not use hearing aids nor hearing assistive listening devices at baseline, but would be eligible for hearing aids based on their result on an online digit-triplet speech in noise test. After five years, 29 of them reported to use hearing aids and/or hearing assistive listening devices and 118 were not. Van Leeuwen et al. (2021) concluded that the uptake of hearing aids and/or hearing assistive devices did not have a significant effect on NFR. It can thus be concluded that a positive effect of aural rehabilitation on the NFR has not yet been demonstrated. Also, there are no studies available investigating factors associated with change in the NFR of employees with hearing loss who receive aural rehabilitation. Such research would be useful for evaluating and optimizing the aural rehabilitation strategies that are currently used. Therefore, the study objectives are: • To determine whether the model of Van der Hoek-Snieders et al. (2020) can be confirmed in a different population regarding the factors influencing the NFR and LE in employees with hearing loss; • To assess the NFR of employees with hearing loss before and after aural rehabilitation
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