Measurement properties of the Dizziness Handicap Inventory by cross-sectional and longitudinal designs

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Different outcome measures and domains of functioning: 18 months follow-up of persons with dizziness

Aims: To explore changes in different outcome measures in a follow-up of persons with dizziness, and to investigate if these changes indicate different domains of functioning. Methodology: Sixty-eight persons with dizziness, mean age of 47 years, were included in an 18-month follow-up. Outcome measures used: the Vertigo Symptom Scale, Patient Specific Functional Scale, Disability Scale, Dizziness Handicap Inventory, and tests of Dynamic Visual Acuity, Single Leg Stance, and Walking Speeds. Major findings: We found significant improvements in impairments indicated by outcome measures of dizziness and visual acuity, and in activity and participation indicated by outcome measures of standing balance, patient-specific activities, disability and quality of life. Similar patterns of change were also found in subgroup analyses, except in gender. Correlations between change-scores were in the range r = 0–0.6. Significant correlations were found between change scores indicating body function and activity/participation (0.3 ≤ r ≥ 5). We found no correlations between self-report measures and tests. Conclusion: Comprehensive use of outcome measures addressing body function, activity and participation appear to provide information of changes in different domains of functioning. To enable broad and meaningful follow-up of patients with long-lasting dizziness, generic and condition-specific measures, self-reports and tests in different domains of functioning should be further explored

Different outcome measures and domains of functioning: 18 months follow-up of persons with dizziness

Aims: To explore changes in different outcome measures in a follow-up of persons with dizziness, and to investigate if these changes indicate different domains of functioning. Methodology: Sixty-eight persons with dizziness, mean age of 47 years, were included in an 18-month follow-up. Outcome measures used: the Vertigo Symptom Scale, Patient Specific Functional Scale, Disability Scale, Dizziness Handicap Inventory, and tests of Dynamic Visual Acuity, Single Leg Stance, and Walking Speeds. Major findings: We found significant improvements in impairments indicated by outcome measures of dizziness and visual acuity, and in activity and participation indicated by outcome measures of standing balance, patient-specific activities, disability and quality of life. Similar patterns of change were also found in subgroup analyses, except in gender. Correlations between change-scores were in the range r = 0–0.6. Significant correlations were found between change scores indicating body function and activity/participation (0.3 ≤ r ≥ 5). We found no correlations between self-report measures and tests. Conclusion: Comprehensive use of outcome measures addressing body function, activity and participation appear to provide information of changes in different domains of functioning. To enable broad and meaningful follow-up of patients with long-lasting dizziness, generic and condition-specific measures, self-reports and tests in different domains of functioning should be further explored

Vestibular Rehabilitation After Traumatic Brain Injury: Case series

Background and Purpose There has been an increasing focus on vestibular rehabilitation (VR) after traumatic brain injury (TBI) in recent years. However, detailed descriptions of the content of and patient responses to VR after TBI are limited. The purposes of this case series are (1) to describe a modified, group-based VR intervention and (2) to examine changes in self-reported and performance-based outcome measures. Case Description Two women and 2 men (aged 24–45 years) with mild TBI, dizziness, and balance problems participated in an 8-week intervention consisting of group sessions with guidance, individually modified VR exercises, a home exercise program, and an exercise diary. Self-reported and performance-based outcome measures were applied to assess the impact of dizziness and balance problems on functions related to activity and participation. Outcomes The intervention caused no adverse effects. Three of the 4 patients reported reduced self-perceived disability because of dizziness, diminished frequency and severity of dizziness, improved health-related quality of life, reduced psychological distress, and improved performance-based balance. The change scores exceeded the minimal detectable change, indicating a clinically significant change or improvement in the direction of age-related norms. The fourth patient did not change or improve in most outcome measures. Discussion A modified, group-based VR intervention was safe and appeared to be viable and beneficial when addressing dizziness and balance problems after TBI. However, concurrent physical and psychological symptoms, other neurological deficits, and musculoskeletal problems might influence the course of central nervous system compensation and recovery. The present case series may be useful for tailoring VR interventions to patients with TBI. Future randomized controlled trials are warranted to evaluate the short- and long-term effects of VR after TBI

Effect of vestibular rehabilitation on change in health-related quality of life in patients with dizziness and balance problems after traumatic brain injury: A randomized controlled trial

Objective: Secondary analysis, testing the effect on change in health-related quality of life of group-based vestibular rehabilitation in patients with mild-moderate traumatic brain injury, dizziness and -balance problems. Design: A single-blind randomized controlled trial. Subjects: A total of 65 patients aged 16–60 years with a Rivermead Post-concussion Symptoms Questionnaire dizziness score ≥2, and Dizziness Handicap Inventory score >15 points. Data collection was performed at baseline 3.5 (standard deviation (SD) 2.1) months post-injury, end of intervention, and 4.4 (SD 1.0) months after baseline. Methods: Quality of Life after Brain Injury was the main outcome. Independent variables were demographic and injury variables, Hospital Anxiety and Depression Scale, changes on the Rivermead Post-concussion Symptoms Questionnaire (RPQ3 physical and RPQ13 psychological/cognitive), and Vertigo Symptom Scale-Short Form. Results: Mean age of participants was 39.4 years (SD 13.0); 70.3% women. Predictors of change in the Quality of Life after Brain Injury were receiving the vestibular rehabilitation (p=0.049), baseline psychological distress (p=0.020), and change in RPQ3 physical (p=0.047) and RPQ13 psychological/cognitive (p=0.047). Adjusted R2 was 0.399, F=6.13, p<0.001. Conclusion: There was an effect in favour of the intervention group in improvement in health-related quality of life. Changes on the Rivermead Post-concussion Symptoms Questionnaire were also associated with change on the Quality of Life after Brain Injury

Effect of vestibular rehabilitation on change in health-related quality of life in patients with dizziness and balance problems after traumatic brain injury: A randomized controlled trial

This paper is the first to present results of a vestibular rehabilitation intervention study on changes in healthrelated quality of life in patients with dizziness and balance problems after mild-to-moderate traumatic brain injury. The intervention group received exercises and guidance aimed at self-efficacy and how to cope with their dizziness and balance problems. In addition, both the intervention and control groups received treatment as usual, comprising multidisciplinary rehabilitation at a university hospital. The main result was measured as change on the Quality of Life after Brain Injury questionnaire. Post-concussion symptoms, vertigo and psychological distress were also measured. The study showed that the group receiving the vestibular rehabilitation intervention underwent more improvement in health-related quality of life than the group receiving usual treatment alone. Other factors that influenced the improvement in quality of life were psychological distress at the start of the study and fewer post-concussion symptoms