What to look for when comparing Tinnitus Functional Index (TFI) results over time
From a clinician's perspective, it's good practice to measure change as a person (patient/client) progresses through a process, what ever the process is: from assessing the benefit experienced from using a hearing aid in respect of how they cope with tinnitus, to a comprehensive, in-depth CBT (Cognitive Behaviour Therapy) process like the CBT4T programme.
It is of value to the client/patient too, to see the qualitative experiences they are having in the real world reflected quantitatively. I have written about this extensively over the years.
A total TFI score provides the TFI category, so comparisons indicate a change from one category to another over time. In the case of the CBT4T process, it is always welcome to see a change from category 5 (initial TFI) > to category 4 (at the end of Stage 4) > to category 3 (at the end of Stage 6) etc; however, total scores offer only limited value.
The real value of the TFI is in the eight subscales. These reflect change over time in eight specific domains:
- Intrusiveness (unpleasantness, intrusiveness, persistence)
- Sense of control (reduced sense of control)
- Cognitive (cognitive interference, such as reduced ability to concentrate)
- Sleep (sleep disturbance)
- Auditory (auditory difficulties due to tinnitus)
- Relaxation (interference with relaxation)
- Quality of life (quality of life reduced)
- Emotional (emotional distress)
Two people - let's name them Peter and Jane - complete an initial TFI as they begin CBT4T. Both of them have an initial TFI score of 87.0% so both of them start with a category 5 TFI (73-100% very big problem)
By the end of Stage 4, Jane's TFI score is 64.0% and Peter's TFI score is also 64.0%. Both have reduced their TFI from a category 5 (73-100% very big problem) to category 4 (54-72% big problem).
Q: Does this mean that the experiences of both Peter and Jane are the same? Are both of them impacted in the same way by tinnitus?
A: There is no way of knowing without the subscales.
By the end of Stage 6, the significance of the subscales becomes starker. Peter's TFI at Stage 6 is 38.0% - category 3 (32-53% moderate problem); Jane's TFI is also 38.0% (32-53% moderate problem) but look at the differences in the subscales:
IMAGE: TFI COMPARISON OF STAGE 6 TFI RESULTS FOR PETER & JANE
The main differences are highlighted. These two sets of subscales tell a very different tale to "Both of them have a category 3 TFI".
On an individual basis, comparing an individual's Stage 6 TFI subscales with those they completed earlier (initial and at Stage 4), offer clear indicators of where there has been progress, and where there hasn't. It is these comparisons - comparing a person's initial subscales with those at Stage 4, at Stage 6 and beyond where the subscales have their value.
For example, Jane's Sleep disturbance subscale seems high (19/30) for Stage 6, yet compare it to her initial (30/30) and Stage 4 (26/30) Sleep disturbance subscale, it's clear that Jane is making good progress. Jane has always sent in Relaxation Logs - if not daily, most days. She sends her weekly report (SITREP), took full advantage of the Stage 4 tools (Two Arrows, Costs & Benefits Transaction and Cognitive Distortions Practical) and throughout Stages 5 and 6, uses the Meaning Adjuster at least once, three or four times a week.
Note: In the CBT4T process, the Meaning Adjuster starts at Stage 5; it's the main reframing tool in CBT4T and is used until it's not needed anymore because it has done its job as a training tool. How long it's needed for does vary from person to person, but a rule of thumb is to use it 3-5 times a week over 2-4 weeks. Some continue to use it a few weeks longer.
Let's now take an example from Peter's TFI. The Intrusiveness subscale (8/30) is good; comparing it to his earlier Intrusiveness subscale initially (26/30) and at Stage 4, when it was 10/30, Peter made excellent progress up to Stage 4, less so between Stages 4 and 6. In addition, the Auditory subscale has barely moved: initial 15/30, Stage 4 14/30, Stage 6 13/30. 13/30 is higher than would be anticipated generally at Stage 6. Peter used the Stage 4 tools only the once (Two Arrows, Costs & Benefits Transaction and Cognitive Distortions Practical), and the Meaning Adjuster a couple of times. He sends a weekly report (SITREP) most weeks - his work involves a lot of travel, so consistency can be challenging for him.
Two different people, both with a Tinnitus Functional Index (TFI) of 38.0% at Stage 6 - not the same at all.