Part II: Evaluation of professional functioning 91 byGussenhoven et al. (2017) who had a follow-up time of 3, 6, 9, and 12months, and should be investigated by future research. Differences in the provided intervention between the studies might also explain that we found a significant reduction in NFR in contrast to earlier studies, such as differences in the aural rehabilitation decisions, the type of counselling, and the quality of the technology that was used. Although the aspects of aural rehabilitation that were provided differed between the patients in this study, most patients in our study received a broad intervention including several aspects of aural rehabilitation. For example, instruction or counselling on coping behavior was provided to 31 percent of our study population, to 14 percent of the intervention group of Gussenhoven et al. (2017), and Van Leeuwen et al. (2021) did not assess this aspect of aural rehabilitation. Presumably, instruction or counselling on coping behavior was provided more frequently in our study than in the two previous studies. Although themeanNFRdecreased after the aural rehabilitation, NFRonly decreased in approximately one third of the employees. This finding suggests that the current usual practice may not be sufficient to achieve a reduction in NFR in all employees with hearing loss. Therefore, improving current practices should be considered and investigated. Also, there is need for standards or guidelines of hearing health care for employees with hearing loss. For example, the use of questionnaires regarding NFR, LE, andhearing-relatedcopingbehavior at baseline seems tobeuseful andconvenient to describe patient’s work needs at baseline. However, these questionnaires need to be validated for the use of diagnosing and evaluating the hearing-related difficulties of employees with hearing loss. Also, in our study sample, hearing aid interventions received most attention, whereas the application of assistive listening devices and the use of instruction/counselling was not that often registered. Although this is in line with international practices (Hickson et al., 2013; Kochkin, 2009; Timmer et al., 2015), the great focus on hearing aid interventions might not have resulted in the optimal mix of aural rehabilitation components. We did not observe obvious differences in the improvement in NFR between patients receiving different hearing aid interventions. Although it would be plausible that the provision of a first hearing aid would have greater impact on NFR than fine tuning hearing aid settings, this appears not to be the case in our study population. This might imply that the effect of hearing aid interventions on NFR might be rather marginal, which is in line with results of Van Leeuwen et al. (2021). Since
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