Expanding the Functional Profile of Hearing Loss: Evidence for Including Balance and Mobility Categories in the ICF Core Sets for Hearing Loss

Background and Objectives: Balance and mobility difficulties are common in adults with hearing loss (HL), but are often overlooked in clinical practice because of fragmented care models; the siloed structure of clinical services; and limitations in the current International Classification of Functioning, Disability and Health (ICF)-based assessment frameworks. This study aimed to quantify these difficulties and examine their associations with functional domains. Subjects and Methods: A cross-sectional study included 72 adults (mean age, 59±8.3 years), comprising participants with normal hearing (25%) and HL (75%), including both unaided and aided users. Participants were purposively recruited from the Speech and Hearing Clinic at Auburn University and had previously completed the HEAR-COMMAND Tool, a self-assessment questionnaire derived from the ICF-Core Sets for HL (ICF-CSHL). In addition, all participants completed the Balance and Mobility Scale (BMS), a 13-item instrument modeled after the HEAR-COMMAND Tool, to benchmark balance-mobility difficulties. Results: The BMS results demonstrated excellent internal consistency (α=0.90) and two distinct but correlated factors, Physical Mobility and Perceptual Experience, supporting its structural validity. Balance-mobility challenges were highly prevalent, including walking fatigue (73.6%), difficulty performing complex movements (72.2%), difficulty transitioning between positions (70.8%), leg stiffness (68.1%), standing instability (61.1%), and difficulty walking long distances (50%). BMS scores were strongly associated with HEAR-COMMAND scores, explaining significant variance in both the hearing domain (β=0.50, p<0.001, R2=0.40) and non-hearing domain (β=0.63, p<0.001, R2=0.48). Analysis of variance (ANOVA) showed that only the hearing-domain scores differed significantly among groups, with participants with normal hearing outperforming both unaided and aided participants with HL. Conclusions: The high prevalence and strong functional associations of balance-mobility challenges indicate that they are core components of disability in individuals with HL. Incorporating these domains into the ICF-CSHL frameworks and their derived assessment tools, including the HEAR-COMMAND Tool, may support a more person-centered and function-oriented approach to hearing healthcare.