Psychometric Validation of the Chinese Versions of the Effort Assessment Scale and Vanderbilt Fatigue Scale for Adults-10 for Assessing Listening Effort and Fatigue.

OBJECTIVES: Listening effort and listening-related fatigue are clinically important yet rarely assessed in routine audiology. This study culturally adapted the Effort Assessment Scale (EAS) into Chinese and psychometrically evaluated the Chinese EAS (C-EAS) and the 10-item Vanderbilt Fatigue Scale for Adults-10 (C-VFS-A-10) in Chinese-speaking adults. Associations with better-ear pure-tone average (PTA), tinnitus, and key demographic factors were also examined.

DESIGN: A two-phase study was conducted. Phase 1 followed established guidelines to translate and culturally adapt the EAS. Phase 2 was a cross-sectional validation in 701 adults recruited from a tertiary hospital in China (normal hearing, n = 180; unilateral hearing loss, n = 22; bilateral hearing loss, n = 499). A subsample of 85 participants with hearing loss completed repeat testing over 7 to 21 days to assess test-retest reliability. All participants completed the C-EAS, C-VFS-A-10, the Hearing Handicap Inventory for the Elderly/Adults-Screening version (HHIE/A-S), and pure-tone audiometry. Psychometric evaluation included internal consistency, test-retest reliability, factor analyses, convergent validity with PTA and HHIE/A-S, and item response theory (IRT) modeling, alongside ANCOVA and multivariable regression.

RESULTS: Both scales showed excellent internal consistency and high short-interval stability. Scale-specific confirmatory factor analyses supported essential unidimensionality adequate for total-score use. Convergent validity was supported by moderate associations with better-ear PTA and HHIE/A-S ( ρ = 0.47 to 0.63). Item-level diagnostics indicated localized local dependence for both instruments. For the C-EAS, item-level IRT parameter estimates were unstable under local dependence, supporting the use of summed total scores. For the C-VFS-A-10, a graded-response testlet model produced stable item parameters and high measurement precision across the range where most respondents fell. Scores on both measures increased with hearing-loss severity. In multivariable models, higher better-ear PTA and tinnitus independently predicted higher effort and fatigue scores, while age showed a small additional association with effort only.

CONCLUSIONS: The C-EAS and C-VFS-A-10 are reliable, culturally adapted measures of listening effort and listening-related fatigue for Chinese-speaking adults. Associations with better-ear PTA and tinnitus support clinical relevance.