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Vazirinejad R, Zakeri MA, Ahmadinia H, Hossini Rafsanjanipoor SM. A preliminary validation of the impact on participation and autonomy questionnaire in an Iranian sample of patients with type 2 diabetes. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:61. [PMID: 38559484 PMCID: PMC10979764 DOI: 10.4103/jehp.jehp_1655_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/09/2023] [Indexed: 04/04/2024]
Abstract
BACKGROUND This study aimed to determine the face, convergent validity, internal consistency, and stability reliability of the impact on participation and autonomy-Persian version (IPA-p) scale for using among Iranian patients with type 2 diabetes. MATERIALS AND METHODS Trained experts interviewed 227 type 2 diabetes patients who were registered in out-patient Diabetes Clinic of Ali-Ibn Abi-Talib Hospital, (Rafsanjan, Southeast Iran from May 2018 to February 2019) and their relatives to assess the face and convergent validity, internal consistency, and stability reliability of the IPA-p scale. A checklist was used to collect demographic information and also to record expert's̛̛̛̛̛̛ points of view about the scale to assess face validity. Internal consistency was measured using Cronbach's alpha, and stability was assessed using interclass correlation coefficients (ICCs). Test-retest method was used to detect the reliability of the questionnaire. Respondents completed the IPA-p scale on the two occasions with an interval of 30-45 days. RESULTS In relation to convergent validity, the confirmatory model showed an acceptable fit and the scale had a highly convergent validity. Exploratory factor analysis showed that the IPA-p scale has a ten-factor structure that explained 77.42% of the variance. Cronbach's alpha between the mean IPA-p scores achieved on the two occasions ranged from 0.65 to 0.92. Test-retest ICCs for the ten domains were between 0.64 and 0.81. CONCLUSIONS The IPA-p questionnaire can be a relatively valid and reliable instrument for assessing self-reported participation among Iranian type 2 diabetes patients. However, some improvement is needed to make it fully suitable for using among Persian-language diabetic patients.
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Affiliation(s)
- Reza Vazirinejad
- Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Department of Community Medicine, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Mohammad Ali Zakeri
- Pistachio Safety Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Hassan Ahmadinia
- Department of Epidemiology and Biostatistics, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Smith LJ, Pyke W, Fowler R, Matthes B, de Goederen E, Surenthiran S. Impact and experiences of vestibular disorders and psychological distress: Qualitative findings from patients, family members and healthcare professionals. Health Expect 2024; 27:e13906. [PMID: 37915279 PMCID: PMC10757133 DOI: 10.1111/hex.13906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/04/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION People with vestibular disorders frequently experience reduced quality of life and challenges with activities of daily living. Anxiety, depression and cognitive problems often co-present with vestibular disorders and can aggravate symptoms and prolong clinical recovery. We aimed to gain in-depth insights into the impact of vestibular disorders and the contribution of psychological factors by exploring multistakeholder perspectives. METHODS Semistructured interviews were conducted between October 2021 and March 2022 with 47 participants in the United Kingdom including: 20 patients (age M = 50.45 ± 13.75; 15 females), nine family members (age M = 61.0 ± 14.10; four females), and 18 healthcare professionals. Data were analysed using framework analysis. RESULTS Vestibular disorders impact diverse aspects of patients' lives including work, household chores, socialising, and relationships with family and friends. Being unable to engage in valued activities or fulfil social roles contributes to feelings of grief and frustration, affecting identity, confidence, and autonomy. Anxiety and low mood contribute to negative thought processes, avoidance, and social withdrawal, which can impede clinical recovery through reduced activity levels, and end engagement with treatment. Coping strategies were thought to help empower patients to self-manage their symptoms and regain a sense of control, but these require oversight from healthcare providers. CONCLUSIONS Daily activity limitations, social participation restrictions, and psychological distress can interact to impact quality of life, sense of self, and clinical recovery amongst people with vestibular disorders. Information and resources could aid societal awareness of the impact of vestibular disorders and help patients and families feel understood. An individualised and comprehensive approach that concurrently addresses mental, physical, social, and occupational needs is likely to be beneficial. PATIENT OR PUBLIC CONTRIBUTION Two group meetings were held at the beginning and end of the study with a patient and public involvement network formed of people with vestibular disorders and family members. These individuals commented on the study aims, interview schedule, participant recruitment practices, and interpretation of the themes identified. Two core patient members were involved at all stages of the research. These individuals contributed to the formulation of the interview schedule, development and application of the coding scheme, development and interpretation of themes, and preparation of the final manuscript.
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Affiliation(s)
- Laura J. Smith
- Centre for Preventative Neurology, Wolfson Institute of Population HealthQueen Mary University of LondonLondonUK
- School of Psychology, Keynes CollegeUniversity of KentKentUK
| | - Wesley Pyke
- School of Psychology, Keynes CollegeUniversity of KentKentUK
| | - Rosanna Fowler
- School of Psychology, Keynes CollegeUniversity of KentKentUK
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Horstmannshoff C, Skudlik S, Petermann J, Kiesel T, Döringer T, Crispin A, Hermsdörfer J, Köberlein-Neu J, Jahn K, Schädler S, Bauer P, Voigt K, Müller M. Effectiveness of an evidence-based care pathway to improve mobility and participation in older patients with vertigo and balance disorders in primary care (MobilE-PHY2): study protocol for a multicentre cluster-randomised controlled trial. Trials 2023; 24:91. [PMID: 36747256 PMCID: PMC9902065 DOI: 10.1186/s13063-022-07017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/15/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Vertigo, dizziness or balance disorders (VDB) are common leading symptoms in older people, which can have a negative impact on their mobility and participation in daily live, yet, diagnosis is challenging and specific treatment is often insufficient. An evidence-based, multidisciplinary care pathway (CPW) in primary care was developed and pilot tested in a previous study. The aim of the present study is to evaluate the effectiveness and safety of the CPW in terms of improving mobility and participation in community-dwelling older people with VDB in primary care. METHODS For this multicentre cluster randomised controlled clinic trial, general practitioners (GP) will be recruited in two regions of Germany. A total of 120 patients over 60 years old with VDB will be included. The intervention is an algorithmized CPW. GPs receive a checklist for standardise clinical decision making regarding diagnostic screening and treatment of VDB. Physiotherapists (PT) receive a decision tree for evidence-based physiotherapeutic clinical reasoning and treatment of VDB. Implementation strategies comprises educational trainings as well as a workshop to give a platform for exchange for the GPs and PTs, an information meeting and a pocket card for home care nurses and informal caregivers and telephone peer counselling to give all participants the capability, opportunity and the motivation to apply the intervention. In order to ensure an optimised usual care in the control group, GPs get an information meeting addressing the national guideline. The primary outcome is the impact of VDB on participation and mobility of patients after 6 month follow-up, assessed using the Dizziness Handicap Inventory (DHI) questionnaire. Secondary outcomes are physical activity, static and dynamic balance, falls and fear of falling as well as quality of life. We will also evaluate safety and health economic aspects of the intervention. Behavioural changes of the participants as well as barriers, facilitating factors and mechanisms of impact of the implementation will be investigated with a comprehensive process evaluation in a mixed-methods design. DISCUSSION With our results, we aim to improve evidence-based health care of community-dwelling older people with VDB in primary care. TRIAL REGISTRATION DRKS, DRKS00028524 retrospectively registered on March 24, 2022.
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Affiliation(s)
- Caren Horstmannshoff
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024, Rosenheim, Germany. .,Department of Sport and Health Sciences, Chair of Human Movement Science, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany.
| | - Stefanie Skudlik
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024, Rosenheim, Germany
| | - Jenny Petermann
- Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 1307, Dresden, Germany
| | - Theresia Kiesel
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024, Rosenheim, Germany
| | - Tobias Döringer
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024, Rosenheim, Germany
| | - Alexander Crispin
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilian University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Joachim Hermsdörfer
- Department of Sport and Health Sciences, Chair of Human Movement Science, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, University of Wuppertal, Rainer-Gruenter-Str. 21, 42119, Wuppertal, Germany
| | - Klaus Jahn
- German Centre for Vertigo and Balance Disorders, Ludwig-Maximilian University of Munich, Marchioninistraße 15, 81377, Munich, Germany.,Schoen Clinic Bad Aibling, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany
| | - Stefan Schädler
- Physiotherapie im Schloss, Schloss 88, 3454, Sumiswald, Switzerland
| | - Petra Bauer
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024, Rosenheim, Germany
| | - Karen Voigt
- Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 1307, Dresden, Germany
| | - Martin Müller
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024, Rosenheim, Germany.,Department of Primary Care and Health Services Research, Medical Faculty, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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Kellerer S, Amberger T, Schlick C, Dlugaiczyk J, Wuehr M, Jahn K. Specific and individualized instructions improve the efficacy of booklet-based vestibular rehabilitation at home - a randomized controlled trial (RCT). J Vestib Res 2023; 33:349-361. [PMID: 37182850 DOI: 10.3233/ves-220122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Vestibular rehabilitation therapy (VRT) is effective for most patients with dizziness and imbalance. Home exercise programs are widely used. It is unknown, however, how specific the instructions for exercises have to be. OBJECTIVE To evaluate the effects of expert assessment and instructions in a booklet-based home VRT program for patients with chronic dizziness. METHODS Randomized controlled study on 74 participants with disabling dizziness for >3 months. All study participants received a booklet-based VRT for training at home. Participants were prescribed 20 minutes of exercise, twice a day. The intervention group (n = 37) received specific instructions (expert physiotherapist). The control group (n = 37) practiced without specific instructions. Primary outcome was the total score of the Dizziness Handicap Inventory (DHI-G). All outcomes were assessed at baseline, after 4 weeks, and at follow up 4 weeks later. RESULTS Both groups improved (DHI-G 43.94±18.89 at inclusion to 33.06±19.67 at follow-up in controls and 42.82±16.60 to 22.65±19.12 in the intervention group). The intervention group, however, improved more (p = 0.014). CONCLUSIONS We show a significant effect of expert physiotherapy guidance in home-based VRT. This strengthens the role of the physiotherapist in VRT: Tailored, personalized instructions are needed to get the best effect of VRT.
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Affiliation(s)
- Silvy Kellerer
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich (LMU), Munich, Germany
| | - Tamara Amberger
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich (LMU), Munich, Germany
| | - Cornelia Schlick
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich (LMU), Munich, Germany
| | - Julia Dlugaiczyk
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich (LMU), Munich, Germany
- Department of Ear, Nose, Throat and Facial Surgery, Interdisciplinary Center for Vertigo and Neurological Visual Disorders, University Hospital Zurich, Zurich, Switzerland
| | - Max Wuehr
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich (LMU), Munich, Germany
| | - Klaus Jahn
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich (LMU), Munich, Germany
- Department of Neurology, Schön Klinik Bad Aibling, Bad Aibling, Germany
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The Adaptation of Participation Scale Short Simplified Questionnaire into Indonesian Language and the Psychometric Properties in Individuals with Type 2 Diabetes Mellitus with Vestibular Dysfunction. Rehabil Res Pract 2022; 2022:2565833. [PMID: 35756573 PMCID: PMC9217528 DOI: 10.1155/2022/2565833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/15/2022] [Accepted: 05/28/2022] [Indexed: 11/19/2022] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) has been reported to affect the vestibular system resulting in dizziness and vertigo complaints. This complication is known to disable the social participation. The Participation Scale Short Simplified (PSSS) has been developed to quantify the severity of social participation restrictions. The aim of this study was to translate and cross-culturally adapt the PSSS into Indonesian Bahasa (PSSS-Ina). The measurement properties of the translated version and the factors contributing to the severe participation restriction were determined. Methods The participants comprised 55 T2DM with vestibular dysfunction (VD) in the community center for diabetes mellitus in Central Java, Indonesia. The signs of VD were confirmed by head impulse test, Dix Hallpike Test, and supine roll test. The PSSS-Ina was administered twice with a four-week interval. The physical examination was also performed to identify the contributing factors. Results The test–retest reliability of the PSSS Indonesian Bahasa version (PSSS-Ina) between two measurement sessions was excellent (ICC of 0.93, p < 0.001, and 95% CI: 0.88–0.95). The correlation coefficient between two administrations was high (r = 0.88). Based on the demonstrated content validity, the values of the corrected item and total correlation were greater than 0.3. No floor and ceiling effects were observed. The good internal consistency was confirmed with Cronbach's alpha of 0.84. The factor analysis produced three factors of activity participation, social engagement, and work-related participation. The multiple logistic regression revealed that the balance performance of mCTSIB was the main factor contributing to the severe participation restriction reflected by the PSSS-Ina score. Conclusion The Indonesian version of the PSSS-Ina demonstrated excellent comprehensibility and reliability in individuals suffering T2DM with VD. This tool is therefore helpful in identifying the participation limitation in individuals with VD.
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Katzenberger B, Schwettmann L, Weigl M, Paulus A, Pedron S, Fuchs S, Koller D, Grill E. Behavioural and patient-individual determinants of quality of life, functioning and physical activity in older adults (MobilE-TRA 2): study protocol of an observational cohort study in a tertiary care setting. BMJ Open 2021; 11:e051915. [PMID: 34887277 PMCID: PMC8663098 DOI: 10.1136/bmjopen-2021-051915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Vertigo, dizziness and balance problems (VDB) as well as osteoarthritis (OA) are among the health conditions with the greatest impact on mobility and social participation in older adults. Patients with VDB and OA were shown to benefit from specialised care such as vestibular rehabilitation therapy or joint replacement. However, these effects are not permanent and seem to disappear over time. One important reason might be a decreasing adherence to therapy recommendations. Findings from behavioural economics (BE) can help to shed light on individual effects on adherence behaviour and long-term outcomes of VDB and OA. OBJECTIVE Based on insights from BE concepts (ie, self-efficacy, intention, and time and risk preferences), MobilE-TRA 2 investigates the determinants of functioning and health-related quality of life (HRQoL) 3 and 12 months after discharge from total hip replacement (THR)/total knee replacement (TKR) in patients with OA and after interdisciplinary evaluation for VDB. METHODS AND ANALYSIS MobilE-TRA 2 is a longitudinal observational study with data collection in two specialised tertiary care centres at the university hospital in Munich, Germany between 2020 and 2023. Patients aged 60 and older presenting for their first THR/TKR or interdisciplinary evaluation of VDB at Ludwig Maximilians University (LMU) hospital will be recruited for study participation. Three and twelve months after baseline assessment, all patients will receive a follow-up questionnaire. Mixed-effect regression models will be used to examine BE concepts as determinants of adherence, HRQoL and functioning. ETHICS AND DISSEMINATION The study was approved by the ethics committee at the medical faculty of the LMU Munich under the number 20-727. Results will be published in scientific, peer-reviewed journals and at national and international conferences. Findings will also be disseminated via newsletters, the project website and a regional conference for representatives of local and national authorities.
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Affiliation(s)
- Benedict Katzenberger
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilians University Munich, Munich, Germany
- Munich Center of Health Sciences, Ludwig Maximilians University Munich, Munich, Germany
- Pettenkofer School of Public Health, Ludwig Maximilians University Munich, Munich, Germany
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Center Munich German Research Center for Environmental Health, Neuherberg, Germany
- Department of Economics, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Martin Weigl
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital Munich, Munich, Germany
| | - Alexander Paulus
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital Munich, Munich, Germany
| | - Sara Pedron
- Institute of Health Economics and Health Care Management, Helmholtz Center Munich German Research Center for Environmental Health, Neuherberg, Germany
- Professorship of Public Health and Prevention, Faculty of Sport and Health Science, Technical University of Munich, Munich, Germany
| | - Sebastian Fuchs
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilians University Munich, Munich, Germany
- Pettenkofer School of Public Health, Ludwig Maximilians University Munich, Munich, Germany
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital Munich, Munich, Germany
| | - Daniela Koller
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilians University Munich, Munich, Germany
- Munich Center of Health Sciences, Ludwig Maximilians University Munich, Munich, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilians University Munich, Munich, Germany
- German Centre for Vertigo and Balance Disorders, University Hospital Munich, Munich, Germany
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Regauer V, Seckler E, Grill E, Ippisch R, Jahn K, Bauer P, Müller M. Development of a complex intervention to improve mobility and participation of older people with vertigo, dizziness and balance disorders in primary care: a mixed methods study. BMC FAMILY PRACTICE 2021; 22:89. [PMID: 33980155 PMCID: PMC8117292 DOI: 10.1186/s12875-021-01441-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/22/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vertigo, dizziness and balance disorders (VDB) are common in older people and cause restrictions in mobility and social participation. Due to a multifactorial aetiology, health care is often overutilised, but many patients are also treated insufficiently in primary care. The purpose of this study was to develop a care pathway as a complex intervention to improve mobility and participation in older people with VDB in primary care. METHODS The development process followed the UK Medical Research Council guidance using a mixed-methods design with individual and group interviews carried out with patients, physical therapists (PTs), general practitioners (GPs), nurses working in community care and a multi-professional expert panel to create a first draft of a care pathway (CPW) and implementation strategy using the Consolidated Framework of Implementation Research and the Expert recommendations for Implementing Change. Subsequently, small expert group modelling of specific components of the CPW was carried out, with GPs, medical specialists and PTs. The Behaviour Change Wheel was applied to design the intervention´s approach to behaviour change. To derive theoretical assumptions, we adopted Kellogg´s Logic Model to consolidate the hypothesized chain of causes leading to patient-relevant outcomes. RESULTS Individual interviews with patients showed that VDB symptoms need to be taken more seriously by GPs. Patients demanded age-specific treatment offers, group sessions or a continuous mentoring by a PT. GPs required a specific guideline for diagnostics and treatment options including psychosocial interventions. Specific assignment to and a standardized approach during physical therapy were desired by PTs. Nurses favoured a multi-professional documentation system. The structured three-day expert workshop resulted in a first draft of CPW and potential implementation strategies. Subsequent modelling resulted in a CPW with components and appropriate training materials for involved health professionals. A specific implementation strategy is now available. CONCLUSION A mixed-methods design was suggested to be a suitable approach to develop a complex intervention and its implementation strategy. We will subsequently test the intervention for its acceptability and feasibility in a feasibility study accompanied by a comprehensive process evaluation to inform a subsequent effectiveness trial. TRIAL REGISTRATION The research project is registered in "Projektdatenbank Versorgungsforschung Deutschland" (Project-ID: VfD_MobilE-PHY_17_003910; date of registration: 30.11.2017).
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Affiliation(s)
- Verena Regauer
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Marchioninistraße 17, 81377 Munich, Germany
| | - Eva Seckler
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Marchioninistraße 17, 81377 Munich, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Marchioninistraße 17, 81377 Munich, Germany
- German Centre for Vertigo and Balance Disorders, Ludwig-Maximilian University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Richard Ippisch
- Practice Centre Neurology, Psychiatry and Psychotherapy Germering, Josef-Kistler-Straße 10, 82110 Germering, Germany
| | - Klaus Jahn
- German Centre for Vertigo and Balance Disorders, Ludwig-Maximilian University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
- Schoen Clinic Bad Aibling, Kolbermoorer Strasse 72, 83043 Bad Aibling, Germany
| | - Petra Bauer
- Faculty for Applied Health and Social Sciences, Development and Technology Transfer, Cen-Tre for Research, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
| | - Martin Müller
- Faculty for Applied Health and Social Sciences, Development and Technology Transfer, Cen-Tre for Research, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
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Ruthberg JS, Rasendran C, Kocharyan A, Mowry SE, Otteson TD. The economic burden of vertigo and dizziness in the United States. J Vestib Res 2021; 31:81-90. [PMID: 33285661 DOI: 10.3233/ves-201531] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Vertigo and dizziness are extremely common conditions in the adult population and therefore place a significant social and economic burden on both patients and the healthcare system. However, limited information is available for the economic burden of vertigo and dizziness across various health care settings. OBJECTIVE Estimate the economic burden of vertigo and dizziness, controlling for demographic, socioeconomic, and clinical comorbidities. METHODS A retrospective analysis of data from the Medical Expenditures Panel Survey (2007-2015) was performed to analyze individuals with vertigo or dizziness from a nationally representative sample of the United States. Participants were included via self-reported data and International Classification of Diseases, 9th Revision Clinical Modification codes. A cross-validated 2-component generalized linear model was utilized to assess vertigo and dizziness expenditures across demographic, socioeconomic and clinical characteristics while controlling for covariates. Costs and utilization across various health care service sectors, including inpatient, outpatient, emergency department, home health, and prescription medications were evaluated. RESULTS Of 221,273 patients over 18 years, 5,275 (66% female, 34% male) reported either vertigo or dizziness during 2007-2015. More patients with vertigo or dizziness were female, older, non-Hispanic Caucasian, publicly insured, and had significant clinical comorbidities compared to patients without either condition. Furthermore, each of these demographic, socioeconomic, and clinical characteristics lead to significantly elevated costs due to having these conditions for patients. Significantly higher medical expenditures and utilization across various healthcare sectors were associated with vertigo or dizziness (p < 0.001). The mean incremental annual healthcare expenditure directly associated with vertigo or dizziness was $2,658.73 (95% CI: 1868.79, 3385.66) after controlling for socioeconomic and demographic characteristics. Total annual medical expenditures for patients with dizziness or vertigo was $48.1 billion. CONCLUSION Vertigo and dizziness lead to substantial expenses for patients across various healthcare settings. Determining how to limit costs and improve the delivery of care for these patients is of the utmost importance given the severe morbidity, disruption to daily living, and major socioeconomic burden associated with these conditions.
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Affiliation(s)
- Jeremy S Ruthberg
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Armine Kocharyan
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sarah E Mowry
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Todd D Otteson
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Ahmed RAMA, Fahmy EM, Awad AM, Hamdy MM, Shaker HAAR. Efficacy of transmastoidal galvanic stimulation on recovery outcomes in patients with unilateral peripheral vestibular disorders: a randomized controlled trial. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00207-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Peripheral vestibular disorders are common disorders among population with increased prevalence with age advancement, manifested by balance disorders and postural instability that negatively affect daily activities and social participation.
Objectives
To investigate the effect of transmastoidal galvanic stimulation added to a designed vestibular rehabilitation program on recovery outcomes in Egyptian patients with unilateral peripheral vestibular disorders.
Subjects and methods
Forty patients (from both sexes) diagnosed with unilateral peripheral vestibular weakness were evenly and randomly designated into two groups: study and control groups. The study group received transmastoidal galvanic stimulation, in addition to a vestibular rehabilitation program, whereas control group undergone vestibular rehabilitation program only. Treatment sessions were conducted three times weekly for four successive weeks. Assessment of vestibular canal weakness was carried out using videonystagmography, postural stability using computerized posturography, while participation in daily activities was carried out using Vestibular Disorders Activities of Daily Living Scale (VADL). All assessment measures were carried out pre- and post-treatment.
Results
Study group showed improvement of post-treatment scores of canal weakness, postural stability parameters, and VADL scale in reverse to control group that showed improvement of scores of preference and VADL only. A statistically significant difference was found between both groups in post-treatment scores of canal weakness, total equilibrium composite, and vestibular component with more improvement in the study group.
Conclusion
Adding transmastoidal galvanic stimulation to vestibular rehabilitation exercises for unilateral peripheral vestibular disorders improves the recovery outcomes of vestibular canal weakness, equilibrium, and vestibular components of postural stability.
Trial registration
Clinical trials identification number (NCT04010435). Registered 7 March 2019—retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/LoginUser?ts=1&cx=-jg9qo4
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Regauer V, Seckler E, Müller M, Bauer P. Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review. BMC Geriatr 2020; 20:494. [PMID: 33228601 PMCID: PMC7684969 DOI: 10.1186/s12877-020-01899-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 11/12/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Vertigo, dizziness and balance disorders (VDB) are among the most relevant contributors to the burden of disability among older adults living in the community and associated with immobility, limitations of activities of daily living and decreased participation. The aim of this study was to identify the quality of evidence of physical therapy interventions that address mobility and participation in older patients with VDB and to characterize the used primary and secondary outcomes. METHODS A systematic search via MEDLINE (PubMed), Cochrane Library, CINAHL, PEDro, forward citation tracing and hand search was conducted initially in 11/2017 and updated in 7/2019. We included individual and cluster-randomized controlled trials and trials with quasi-experimental design, published between 2007 and 2017/2019 and including individuals ≥65 years with VDB. Physical therapy and related interventions were reviewed with no restrictions to outcome measurement. Screening of titles, abstracts and full texts, data extraction and critical appraisal was conducted by two independent researchers. The included studies were heterogeneous in terms of interventions and outcome measures. Therefore, a narrative synthesis was conducted. RESULTS A total of 20 randomized and 2 non-randomized controlled trials with 1876 patients met the inclusion criteria. The included studies were heterogeneous in terms of complexity of interventions, outcome measures and methodological quality. Vestibular rehabilitation (VR) was examined in twelve studies, computer-assisted VR (CAVR) in five, Tai Chi as VR (TCVR) in three, canal repositioning manoeuvres (CRM) in one and manual therapy (MT) in one study. Mixed effects were found regarding body structure/function and activities/participation. Quality of life and/or falls were assessed, with no differences between groups. VR is with moderate quality of evidence superior to usual care to improve balance, mobility and symptoms. CONCLUSION To treat older individuals with VDB, VR in any variation and in addition to CRMs seems to be effective. High-quality randomized trials need to be conducted to inform clinical decision making. TRIAL REGISTRATION PROSPERO 2017 CRD42017080291 .
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Affiliation(s)
- Verena Regauer
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany.
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Marchioninistraße 17, 81377, Munich, Germany.
| | - Eva Seckler
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Marchioninistraße 17, 81377, Munich, Germany
| | - Martin Müller
- Faculty for Applied Health and Social Sciences and Centre for Research, Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany
| | - Petra Bauer
- Faculty for Applied Health and Social Sciences and Centre for Research, Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany
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Stam H, van Vugt VA, Twisk JWR, Finne-Soveri H, Garms-Homolová V, Declercq A, Jónsson PV, Onder G, van der Roest HG, van Hout H, Maarsingh OR. The Prevalence and Persistence of Dizziness in Older European Home Care Recipients: A Prospective Cohort Study. J Am Med Dir Assoc 2019; 21:338-343.e1. [PMID: 31672569 DOI: 10.1016/j.jamda.2019.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/25/2019] [Accepted: 09/08/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The prevalence of different geriatric syndromes in older home care (HC) recipients is yet to be determined. Dizziness is often regarded as a geriatric syndrome. The natural course of dizziness in older people is still unknown, because of a lack of longitudinal studies. The objective of this study was to investigate the prevalence and persistence of dizziness in HC recipients. DESIGN Prospective cohort study. SETTING Home care organizations in 6 European countries participating in the EU-funded Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project. PARTICIPANTS 2616 community-dwelling long-term HC recipients aged 65 years or older. METHODS Data were collected at baseline and 6 and 12 months by using the interRAI Home Care instrument (interRAI-HC). Dizziness status was assessed by the number of days people experienced dizziness in the last 3 days (0-3) and later dichotomized for analyses (present or not in the last 3 days). Dizziness persistence was defined as the odds for dizzy people at baseline to also report dizziness at subsequent follow-up moments, compared with people who were not dizzy at baseline. The pattern of dizziness was descriptively analyzed in recipients who completed all measurements. Generalized estimating equations analysis was used to determine the persistence of dizziness symptoms. RESULTS The prevalence of dizziness of 2616 eligible HC recipients at baseline was 25.1%, ranging from 16.2% (Belgium) to 39.7% (Italy). The majority of dizzy recipients at baseline also experienced dizziness after 6 and 12 months (79.1%). Dizziness persistence was high at 6 months [odds ratio (OR) 57.8, 95% confidence interval (CI) 43.1-77.5] and at 12 months (OR 30.2, 95% CI 22.3-41.1). CONCLUSIONS AND IMPLICATIONS Dizziness in older HC recipients in Europe is common, and dizziness persistence is high. This warrants a more active approach in treating dizziness in older HC recipients.
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Affiliation(s)
- Hanneke Stam
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Vincent A van Vugt
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Vjenka Garms-Homolová
- Department of Economics and Law, HTW Berlin University of Applied Sciences, Berlin, Germany
| | - Anja Declercq
- LUCAS & Centre for Sociological Research, KU Leuven, Belgium
| | - Pálmi V Jónsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Henriëtte G van der Roest
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Hein van Hout
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Otto R Maarsingh
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Balance and mobility in geriatric patients : Assessment and treatment of neurological aspects. Z Gerontol Geriatr 2019; 52:316-323. [PMID: 31161336 DOI: 10.1007/s00391-019-01561-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/05/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Personal autonomy in advanced age critically depends on mobility in the environment. Geriatric patients are often not able to walk safely with sufficient velocity. In many cases, multiple factors contribute to the deficit. Diagnostic identification of single components enables a specific treatment. OBJECTIVE This article describes the most common neurological causes of imbalance and impaired gait that are relevant for a pragmatic approach for the assessment of deficits in clinical and natural environments taking into account the physiology of balance and gait control, typical morbidities in older people and the potential of innovative assessment technologies. MATERIAL AND METHODS Expert opinion based on a narrative review of the literature and with reference to selected research topics. RESULTS AND DISCUSSION Common neurological causes of impaired balance and mobility are sensory deficits (reduced vision, peripheral neuropathy, vestibulopathy), neurodegeneration in disorders with an impact on movement control and motoric functions (Parkinsonian syndromes, cerebellar ataxia, vascular encephalopathy) and functional (psychogenic) disorders, particularly a fear of falling. Clinical tests and scores in laboratory environments are complemented by the assessment in the natural environment. Wearable sensors, mobile smartphone-based assessment of symptoms and functions and adopted strategies for analysis are currently emerging. Use of these data enables a personalized treatment. Furthermore, sensor-based assessment ensures that effects are measured objectively.
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13
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Berenschot L, Grift Y. Validity and reliability of the (adjusted) Impact on Participation and Autonomy questionnaire for social-support populations. Health Qual Life Outcomes 2019; 17:41. [PMID: 30808341 PMCID: PMC6390377 DOI: 10.1186/s12955-019-1106-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 02/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background Decentralisation of social support and budget cuts spurred interest in outcome-oriented payment systems in the Netherlands. Hence, measurement of relevant outcomes, such as self-reliance and participation, is needed. The Impact on Participation and Autonomy (IPA) questionnaire for rehabilitation clients was adapted for social support, called IPA-MO, and its validity and reliability were tested among social support clients in eight municipalities in 2014 and 2016. Methods The total research sample comprised of 4120 persons. Homogeneous subgroups were distinguished based on 1) disability and 2) age. Exploratory factor analysis (PCF) was used to identify domains for IPA-MO. Model fit was assessed with Confirmatory Factor Analysis (CFA) using structural equation modelling. Results PCF revealed that the IPA-MO model consists of all five original IPA domains: Autonomy indoors, Family role, Autonomy outdoors, Social life and relations, and Work and education. As a result of new items added, a new, sixth domain was developed: Financial autonomy. Due to high non-response on Work & education, construct validity was first tested for a five-domain IPA-MO model. The composition of the IPA-MO domains showed slight differences: the item on ‘mobility indoor’ shifted from Autonomy indoors (IPA) to Family Role in IPA-MO. The item on reciprocity shifted from Social Life and relations (IPA) to Autonomy outdoors (IPA-MO). Internal reliability was confirmed for all domains (Cronbach’s alpha >.80). CFA showed acceptable construct validity of the five-domain IPA-MO model for the social support population (CFI .936, TLI .925, SRMR .051), all age groups and most disability-based groups. Construct validity including Work & education was tested for 234 participants. Then, PCF revealed six domains and the model fit was acceptable (CFI .915, TLI .903, SRMR .067). Conclusions IPA-MO is a valid and reliable instrument to assess outcomes of social support. Further research on the domain Financial autonomy is needed. Social-support clients are numerous and dispersed and, in spite of the best intentions, hard to involve widely in policy processes. A valid outcome measure offers municipalities possibilities to gain insight in social costs and benefits of new policies. Outcome measurement also allows to contract bundled-services of providers, thereby changing the incentives for providers from increasing production to much needed innovation. Taking the perceptions of autonomy and participation of social-support clients as the acid test for the effectiveness of social support policies, may prove a serious game-changer in politics.
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Affiliation(s)
- Lucienne Berenschot
- Berenschot Onderzoek en Advies, Hogekampweg 50, Apeldoorn, 7316MT, the Netherlands
| | - Yolanda Grift
- Faculty of Law, Economics and Governance, University Utrecht School of Economics, PO Box 80125, Utrecht, 3508 TC, the Netherlands.
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Stam H, van der Wouden JC, Hugtenburg JG, Twisk JWR, van der Horst HE, Maarsingh OR. Effectiveness of a multifactorial intervention for dizziness in older people in primary care: A cluster randomised controlled trial. PLoS One 2018; 13:e0204876. [PMID: 30300371 PMCID: PMC6178383 DOI: 10.1371/journal.pone.0204876] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/12/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Dizziness is common in older people. Physicians are often unable to identify a specific cause for dizziness in older people, even after an extensive diagnostic work-up. A prognosis-oriented approach, i.e. treating modifiable risk factors for an unfavourable course of dizziness, may reduce dizziness-related impairment in older people in primary care. DESIGN Cluster randomized controlled trial. SETTING 45 primary care practices in The Netherlands. PARTICIPANTS 168 participants aged ≥65y who consulted their general practitioner for dizziness and experienced significant dizziness-related impairment (Dizziness Handicap Inventory (DHI) ≥30). Participants were part of to the intervention group (n = 83) or control group (n = 85), depending on whether they were enlisted in an intervention practice or in a control practice. INTERVENTIONS The multifactorial intervention consisted of: medication adjustment in case of ≥3 prescribed fall-risk-increasing drugs (FRIDs) and/or stepped mental health care in case of anxiety disorder and/or depression and/or exercise therapy in case of impaired functional mobility. The intervention was compared to usual care. OUTCOME MEASURES The primary outcome was dizziness-related impairment. Secondary outcomes were quality of life (QoL), dizziness frequency, fall frequency, anxiety and depression, use of FRIDs. RESULTS Intention-to-treat analysis showed no significant intervention effect on dizziness-related impairment (DHI score difference -0.69 [95% CI -5.66;4.28]; p = 0.79). The intervention proved effective in reducing the number of FRIDs (FRID difference -0.48 [95% CI -0.89;-0.06]; p = 0.02). No significant intervention effects were found on other secondary outcomes. The uptake of and adherence to the interventions was significantly lower in patients eligible for ≥2 interventions compared to patients eligible for one intervention (p<0.001). CONCLUSIONS The multifactorial intervention for dizziness in older patients showed no significant intervention effect on most outcomes and adherence to the multifactorial intervention was low. Although multifactorial treatment for older dizzy people seems promising in theory, we question its feasibility in daily practice. Future research could focus on a sequential treatment for dizziness, e.g. measuring effectiveness of various evidence-based therapies in a stepwise approach.
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Affiliation(s)
- Hanneke Stam
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- * E-mail:
| | - Johannes C. van der Wouden
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jacqueline G. Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jos W. R. Twisk
- Department of Clinical Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Henriëtte E. van der Horst
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Otto R. Maarsingh
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Stam H, Maarsingh OR, Heymans MW, van Weert HCPM, van der Wouden JC, van der Horst HE. Predicting an Unfavorable Course of Dizziness in Older Patients. Ann Fam Med 2018; 16:428-435. [PMID: 30201639 PMCID: PMC6131005 DOI: 10.1370/afm.2289] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 06/01/2018] [Accepted: 06/28/2018] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Because dizziness in older people is often chronic and can substantially affect daily functioning, it is important to identify those at risk for an unfavorable course of dizziness to optimize their care. We aimed to develop and externally validate a prediction model for an unfavorable course of dizziness in older patients in primary care, and to construct an easy-to-use risk prediction tool. METHODS We used data from 2 prospective cohorts: a development cohort with 203 patients aged 65 years or older who consulted their primary care physician for dizziness and had substantial dizziness-related impairment (Dizziness Handicap Inventory [DHI] ≥30), and a validation cohort with 415 patients aged 65 years or older who consulted their primary care physician for dizziness of any severity. An unfavorable course was defined as presence of substantial dizziness-related impairment (DHI ≥30) after 6 months. RESULTS Prevalence of an unfavorable course of dizziness was 73.9% in the development cohort and 43.6% in the validation cohort. Predictors in the final model were the score on the screening version of the DHI, age, history of arrhythmia, and looking up as a provoking factor. The model showed good calibration and fair discrimination (area under the curve = 0.77). On external validation, discriminative ability remained stable (area under the curve = 0.78). The constructed risk score was strongly correlated with the prediction model. Performance measures for risk score cut-off values are presented to determine the optimal cut-off point for clinical practice. CONCLUSIONS We developed an easy-to-use risk score for dizziness-related impairment in primary care. The risk score, consisting of only 4 predictors, will help primary care physicians identify patients at high risk for an unfavorable course of dizziness.
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Affiliation(s)
- Hanneke Stam
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Iniversiteit Amsterdam, Amsterdam, The Netherlands
| | - Otto R Maarsingh
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Iniversiteit Amsterdam, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Clinical Epidemiology and Biostatistics, Amsterdam UMC, Vrije Iniversiteit Amsterdam, Amsterdam, The Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes C van der Wouden
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Iniversiteit Amsterdam, Amsterdam, The Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Iniversiteit Amsterdam, Amsterdam, The Netherlands
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16
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Kisch R, Bergmann A, Koller D, Leidl R, Mansmann U, Mueller M, Sanftenberg L, Schelling J, Sundmacher L, Voigt K, Grill E. Patient trajectories and their impact on mobility, social participation and quality of life in patients with vertigo/dizziness/balance disorders and osteoarthritis (MobilE-TRA): study protocol of an observational, practice-based cohort study. BMJ Open 2018; 8:e022970. [PMID: 29680815 PMCID: PMC5914901 DOI: 10.1136/bmjopen-2018-022970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Mobility limitations have a multitude of different negative consequences on elderly patients including decreasing opportunities for social participation, increasing the risk for morbidity and mortality. However, current healthcare has several shortcomings regarding mobility sustainment of older adults, namely a narrow focus on the underlying pathology, fragmentation of care across services and health professions and deficiencies in personalising care based on patients' needs and experiences. A tailored healthcare strategy targeted at mobility of older adults is still missing. OBJECTIVE The objective is to develop multiprofessional care pathways targeted at mobility sustainment and social participation in patients with vertigo/dizziness/balance disorders (VDB) and osteoarthritis (OA) . METHODS Data regarding quality of life, mobility limitation, pain, stiffness and physical function is collected in a longitudinal observational study between 2017 and 2019. General practitioners (GPs) recruit their patients with VDB or OA. Patients who visited their GP in the last quarter will be identified in the practice software based on VDB and OA-related International Classification of Diseases 10th Revision. Study material will be sent from the practice to patients by mail. Six months and 12 months after baseline, all patients will receive a mail directly from the study team containing the follow-up questionnaire. GPs fill out questionnaires regarding patient diagnostics, therapy and referrals. ETHICS AND DISSEMINATION The study was approved by the ethical committee of the Ludwig-Maximilians-Universität München and of the Technische Universität Dresden. Results will be published in scientific, peer-reviewed journals and at national and international conferences. Results will be disseminated via newsletters, the project website and a regional conference for representatives of local and national authorities.
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Affiliation(s)
- Rebecca Kisch
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians Universität München, Munich, Germany
| | - Antje Bergmann
- Department of General Practice/Medical Clinic III, University Hospital Carl Gustav Carus of the Technische Universität Dresden, Dresden, Germany
| | - Daniela Koller
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians Universität München, Munich, Germany
- Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Reiner Leidl
- Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Munich, Germany
| | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians Universität München, Munich, Germany
- Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martin Mueller
- Faculty of Applied Health and Social Sciences, Hochschule Rosenheim, Rosenheim, Germany
| | - Linda Sanftenberg
- Institute of General Practice and Family Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Joerg Schelling
- Institute of General Practice and Family Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Leonie Sundmacher
- Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Health Services Management, Munich School of Management, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Karen Voigt
- Department of General Practice/Medical Clinic III, University Hospital Carl Gustav Carus of the Technische Universität Dresden, Dresden, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians Universität München, Munich, Germany
- German Centre for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
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Agrawal Y, Pineault KG, Semenov YR. Health-related quality of life and economic burden of vestibular loss in older adults. Laryngoscope Investig Otolaryngol 2017; 3:8-15. [PMID: 29492463 PMCID: PMC5824117 DOI: 10.1002/lio2.129] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/12/2017] [Accepted: 11/10/2017] [Indexed: 01/05/2023] Open
Abstract
Objectives Vestibular loss is a debilitating condition, and despite its high prevalence in older adults, the quality of life (QoL) burden of vestibular loss in older individuals has not been well-studied. This report quantifies the impact on overall QoL and identifies domains of health most affected. We hypothesize vestibular loss will be associated with impairment in diverse domains of health-related QoL. Study Design Prospective, case-control study. Methods A convenience sample of 27 patients age ≥60 years with vestibular physiologic loss was recruited from an academic neurotology clinic. The patients did not have any identifiable cause of their vestibular loss other than aging. The convenience sample was compared to an age-matched cross-sectional sample of the general US population (n = 1266). The main outcome was QoL measured by the Ontario Health Utilities Index Mark III (HUI3). Results Compared to the general population, patients with vestibular loss had significantly lower overall unadjusted HUI3 scores (-0.32, p < 0.001). Multivariate regression analysis showed vestibular loss was significantly associated with poorer performance in vision (-0.11 p < 0.0001), speech (-0.15, p < 0.0001), dexterity (-0.13, p < 0.0001), and emotion (-0.07, p = 0.0065). Adjusted aggregate HUI3 was also significantly lower for vestibular loss (-0.15, p = 0.0105). These QoL decrements resulted in an average loss of 1.30 Quality-Adjusted Life Years (QALYs). When using a $50,000/QALY willingness-to-pay threshold, vestibular loss was associated with a $64,929 lifetime economic burden per affected older adult, resulting in a total lifetime societal burden of $227 billion for the US population ≥60 years of age. Conclusions Loss of vestibular function with aging significantly decreases quality of life across multiple domains of well-being. These QoL reductions are responsible for heavy societal economic burdens of vestibular loss, which reveal potential benefits of prompt diagnosis and treatment of this condition. Level of Evidence 3.
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Affiliation(s)
- Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD U.S.A
| | - Kevin G Pineault
- Department of Otolaryngology-Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD U.S.A
| | - Yevgeniy R Semenov
- Division of Dermatology Washington University School of Medicine Saint Louis MO U.S.A
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Lorbeer R, Hetterich H, Strobl R, Schafnitzel A, Patscheider H, Schindler A, Müller-Peltzer K, Sommer W, Peters A, Meisinger C, Heier M, Rathmann W, Bamberg F, Grill E. Lack of association of MRI determined subclinical cardiovascular disease with dizziness and vertigo in a cross-sectional population-based study. PLoS One 2017; 12:e0184858. [PMID: 28910373 PMCID: PMC5599022 DOI: 10.1371/journal.pone.0184858] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 09/03/2017] [Indexed: 12/01/2022] Open
Abstract
Objective We investigated the association between subclinical cardiovascular diseases assessed by MRI examination and symptoms of dizziness and vertigo in participants of a population-based sample. Methods Data from 400 participants (169 women) aged from 39 to 73 of a cross-sectional MRI sub-study of the “Kooperative Gesundheitsforschung in der Region Augsburg” (KORA) FF4 study from the south of Germany was used. MRI determined subclinical cardiovascular diseases include left and right ventricular structure and function as well as the presence of carotid plaque and carotid wall thickness. Cerebrum diseases include white matter lesions (WML) and cerebral microbleeds (CMB). The main outcomes of dizziness and vertigo were assessed by standardized interview. Logistic regression models were applied and adjusted odds ratios (OR) with 95% confidence intervals (CI) were provided. Results Lifetime and 12-month prevalence of dizziness and vertigo were 30% (95%CI 26% to 35%) and 21% (95%CI 17% to 26%) respectively in this sample. On multivariable analysis, cardiac and carotid measurements were not associated with dizziness and vertigo excluding orthostatic vertigo (20%, 95CI 16% to 24%). Only in male participants, there was a significant association between WML and the presence of dizziness and vertigo (OR = 2.95, 95%CI 1.08 to 8.07). There was no significant association of CMB with dizziness and vertigo. However, CMB and WML were tending to associate with a higher risk of dizziness and vertigo in the whole sample (CMB: OR = 1.48, 95%CI 0.70; 3.15; WML: OR = 1.71, 95%CI 0.80 to 3.67;), in persons with prediabetes and diabetes (WML: OR = 2.71, 95%CI 0.89 to 8.23) and in men with normal glucose metabolism (CMB: OR = 2.60, 95%CI 0.56 to 12.0; WML: OR = 3.08, 95%CI 0.58 to 16.5). Conclusions In this sample of participants without manifest cardiovascular diseases, subclinical left and right ventricular function and carotid structure were consistently not associated with dizziness and vertigo. Subclinical cerebrum measurements, however, tend to increase the risk for dizziness and vertigo, especially in men and in persons with prediabetes or diabetes.
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Affiliation(s)
- Roberto Lorbeer
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- * E-mail:
| | - Holger Hetterich
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Ralf Strobl
- Institute of Medical Information Processing, Biometrics and Epidemiology, LMU Munich, Munich, Germany
| | - Anina Schafnitzel
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Hannah Patscheider
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Andreas Schindler
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Wieland Sommer
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
- German Center for Cardiovascular Disease Research (DZHK e.V.), Munich, Germany
| | - Christa Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Epidemiology, LMU Munich, UNIKA-T Augsburg, Augsburg, Germany
| | - Margit Heier
- Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany
- KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany
| | - Wolfgang Rathmann
- Department of Biometrics and Epidemiology, German Diabetes Center, Duesseldorf, Germany
| | - Fabian Bamberg
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Eva Grill
- Institute of Medical Information Processing, Biometrics and Epidemiology, LMU Munich, Munich, Germany
- German Center for Vertigo and Balance Disorders, LMU Munich, Munich, Germany
- Munich Center of Health Sciences (MC-Health), LMU Munich, Munich, Germany
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Reitmeir P, Linkohr B, Heier M, Molnos S, Strobl R, Schulz H, Breier M, Faus T, Küster DM, Wulff A, Grallert H, Grill E, Peters A, Graw J. Common eye diseases in older adults of southern Germany: results from the KORA-Age study. Age Ageing 2017; 46:481-486. [PMID: 27974306 PMCID: PMC5405752 DOI: 10.1093/ageing/afw234] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Indexed: 12/18/2022] Open
Abstract
Purpose a population-based study in the region of Augsburg (Germany, KORA) was used to identify the prevalence of eye diseases and their risk factors in a sample of aged individuals. Methods data originated from the KORA-Age study collected in 2012 and 822 participants (49.6% women, 50.4% men, aged 68–96 years) were asked standardised questions about eye diseases. Positive answers were validated and specified by treating ophthalmologists. Additional information came from laboratory data. Polymorphic markers were tested for candidate genes. Results we received validations and specifications for 339 participants. The most frequent eye diseases were cataracts (299 cases, 36%), dry eyes (120 cases, 15%), glaucoma (72 cases, 9%) and age-related macular degeneration (AMD) (68 cases, 8%). Almost all participants suffering from glaucoma or from AMD also had cataracts. Cataract surgery was associated with diabetes (in men; OR = 2.24; 95% confidence interval [CI] 1.11–4.53; P = 0.025) and smoking (in women; OR = 6.77; CI 1.62–28.35; P = 0.009). In men, treatments in airway diseases was associated with cataracts (glucocorticoids: OR = 5.29, CI 1.20–23.37; P = 0.028; sympathomimetics: OR = 4.57, CI 1.39–15.00; P = 0.012). Polymorphisms in two genes were associated with AMD (ARMS2: OR = 2.28, CI 1.48–3.51; P = 0.005; CFH: OR = 2.03, CI 1.35–3.06; P = 0.010). Conclusion combinations of eye diseases were frequent at old age. The importance of classical risk factors like diabetes, hypertension and airway diseases decreased either due to a survivor bias leaving healthier survivors in the older age group, or due to an increased influence of other up to now unknown risk factors.
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Affiliation(s)
- Peter Reitmeir
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Birgit Linkohr
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Institute of Epidemiology II, Neuherberg, Germany
| | - Margit Heier
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Institute of Epidemiology II, Neuherberg, Germany
| | - Sophie Molnos
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Institute of Epidemiology II, Neuherberg, Germany
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Research Unit Molecular Epidemiology, Neuherberg, Germany
| | - Ralf Strobl
- Ludwig-Maximilians-Universität, Institute for Medical Information Processing, Biometry and Epidemiology, Munich, Germany
- Ludwig-Maximilians-Universität, German Center for Vertigo and Balance Disorders, Munich, Germany
| | - Holger Schulz
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Institute of Epidemiology I, Neuherberg, Germany
| | - Michaela Breier
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Institute of Epidemiology II, Neuherberg, Germany
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Research Unit Molecular Epidemiology, Neuherberg, Germany
| | - Theresa Faus
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Institute of Developmental Genetics, Neuherberg, Germany
| | - Dorothea M. Küster
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Institute of Epidemiology II, Neuherberg, Germany
| | - Andrea Wulff
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Harald Grallert
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Institute of Epidemiology II, Neuherberg, Germany
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Research Unit Molecular Epidemiology, Neuherberg, Germany
| | - Eva Grill
- Ludwig-Maximilians-Universität, Institute for Medical Information Processing, Biometry and Epidemiology, Munich, Germany
- Ludwig-Maximilians-Universität, German Center for Vertigo and Balance Disorders, Munich, Germany
| | - Annette Peters
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Institute of Epidemiology II, Neuherberg, Germany
| | - Jochen Graw
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Institute of Developmental Genetics, Neuherberg, Germany
- Address correspondence to: J. Graw, Tel: +49-89-3187-2610;
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21
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Rethorn Z, Barlow SJ, Gavlick E. Differential diagnosis of a patient referred to physical therapy for dizziness: a case report. Physiother Theory Pract 2017; 33:254-259. [PMID: 28339331 DOI: 10.1080/09593985.2017.1288281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
STUDY DESIGN Case report. BACKGROUND Dizziness is a common and debilitating condition across the lifespan. Patients with this complaint must be carefully examined to determine the cause of dizziness, rule out the presence of central nervous system dysfunction, and determine the appropriateness of physical therapy intervention. CASE DESCRIPTION A 90-year-old male was referred to physical therapy six months after the onset of dizziness. A thorough history was taken and examination was performed. Signs consistent with central nervous system dysfunction and peripheral vestibular dysfunction were observed. The patient was treated for the peripheral vestibular disorder and referred back to his physician for further testing. Imaging revealed that the patient had idiopathic normal pressure hydrocephalus. DISCUSSION This case illustrates the need for physical therapists to perform thorough examinations of patients with a primary complaint of dizziness and properly interpret positive central signs, indicating a potential need for referral to a physician or other healthcare provider when they appear.
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Affiliation(s)
- Zachary Rethorn
- a Department of Physical Therapy , University of Tennessee at Chattanooga , Chattanooga , TN , USA
| | - Susan J Barlow
- a Department of Physical Therapy , University of Tennessee at Chattanooga , Chattanooga , TN , USA.,b Siskin Hospital for Rehabilitation , Chattanooga , TN , USA
| | - Emily Gavlick
- b Siskin Hospital for Rehabilitation , Chattanooga , TN , USA
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22
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Adams ME, Marmor S, Yueh B, Kane RL. Geographic Variation in Use of Vestibular Testing among Medicare Beneficiaries. Otolaryngol Head Neck Surg 2016; 156:312-320. [DOI: 10.1177/0194599816676450] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective There is a lack of consensus regarding the indications for vestibular testing in the evaluation of dizziness and balance disorders. Geographic variation in health services utilization is associated with lack of consensus. To understand the variation in current practice, we investigated the patterns of use of vestibular testing and diagnosis codes for dizziness and balance disorders among individuals ≥65 years of age across different regions of the United States. Study Design Cross-sectional study. Setting Medicare administrative claims data. Subjects and Methods Using the Summarized Denominator file, a sample of the US population linked to the Surveillance, Epidemiology, and End Results (SEER)–Medicare files (years 2000-2010), we identified persons who were ≥65 years of age. We used multivariable analyses to determine the factors associated with vestibular testing and diagnoses. Results Of the 231,984 eligible Medicare beneficiaries, 27% were diagnosed with dizziness and balance disorders. Patterns of use of vestibular tests (eye movement recording for spontaneous nystagmus, caloric testing, and rotary chair testing) varied significantly by geographic region. Rotary chair test utilization varied most. We found significant geographic variation in vestibular testing and diagnoses after controlling for age, sex, race, Medicaid participation, and rurality. Conclusions There may be opportunities to improve the consistency and efficiency of care for dizziness and balance disorders. It will be important to define appropriate levels of vestibular diagnostic testing and which tests add sufficient value to justify the costs. Further work is needed to better characterize the causes and consequences of variation in vestibular test utilization.
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Affiliation(s)
- Meredith E. Adams
- Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Schelomo Marmor
- Department of Surgery and Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Bevan Yueh
- Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Robert L. Kane
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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Jahn K, Kressig RW, Bridenbaugh SA, Brandt T, Schniepp R. Dizziness and Unstable Gait in Old Age: Etiology, Diagnosis and Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:387-93. [PMID: 26157011 DOI: 10.3238/arztebl.2015.0387] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 03/18/2015] [Accepted: 03/18/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Dizziness and unsteady gait are common in the elderly but are too often dismissed as supposedly nonspecific, inevitable accompaniments of normal aging. For many affected persons, the factors leading to dizziness and gait impairment in old age are never identified, yet some of these factors can be specifically detected and treated. METHODS This review is based on publications (2005-2014) retrieved by a selective search in PubMed on the terms "aging," "dizziness," "elderly," "gait," "gait disorder," "geriatric," "locomotion," and "vertigo." RESULTS Dizziness interferes with the everyday activities of 30% of persons over age 70 and is so severe that it constitutes a reason for consulting a physician. The more common causes of dizziness and unsteady gait in old age are sensory deficits, such as bilateral vestibular failure, polyneuropathy, and impaired visual acuity; benign paroxysmal positioning vertigo; and central disorders such as cerebellar ataxia and normal-pressure hydrocephalus. Further relevant factors include sedative or antihypertensive medication, loss of muscle mass (sarcopenia), and fear of falling. Many elderly persons have multiple factors at the same time. Benign paroxysmal positioning vertigo can be effectively treated with specific physical maneuvers. Sedating drugs are indicated only for the treatment of acute rotatory vertigo and are not suitable for long-term use. Sarcopenia can be treated with physical training. CONCLUSION If a specific cause can be identified, dizziness and gait unsteadiness in old age can often be successfully treated. The common causes can be revealed by systematic clinical examination. Controlled clinical trials on the efficacy of treatments for elderly persons are urgently needed.
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Affiliation(s)
- Klaus Jahn
- German Center for Vertigo and Balance Disorders, Großhadern Hospital, Ludwig-Maximilian-Universität, München, Schön Klinik Bad Aibling, Basel University and University Center for Geriatrics and Rehabilitation, Felix Platter Hospital, Basel, Switzerland, Institute for Clinical Neurosciences, Großhadern Hospital, Ludwig-Maximilian-Universität, Munich, Neurological Clinic and Policlinic, Großhadern Hospital, Ludwig-Maximilian-Universität Munich
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Dizziness in older people: at risk of shared therapeutic nihilism between patient and physician. A qualitative study. BMC FAMILY PRACTICE 2016; 17:74. [PMID: 27421651 PMCID: PMC4947269 DOI: 10.1186/s12875-016-0474-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 06/09/2016] [Indexed: 02/08/2023]
Abstract
Background Dizziness-related impairment is a strong predictor for an unfavourable course of dizziness in older people. In this study we explored the experiences of older patients with significant dizziness-related impairment and their wishes and expectations regarding general practitioner (GP) care. Knowing the expectations and priorities of people with dizziness may enable the GP to provide tailor-made care, which in turn may substantially increase the quality of life and decrease the use and costs of health care. Methods We conducted a qualitative study with semi-structured interviews. We selected patients from ten Dutch general practices. Patients were invited to participate in the study if they were ≥ 65 years, visited their GP because of dizziness and were significantly impaired due to dizziness (Dizziness Handicap Inventory ≥ 30). We applied content analysis to the semi-structured interviews. Results Thirteen participants participated, seven were female. Analysis of the interviews resulted in the overall theme “Dizziness in older people: at risk of shared therapeutic nihilism by the patient and the GP”. Firstly, this can explained by the fact that participants frequently presented dizziness as a secondary complaint when they visited the GP for another complaint. Secondly, participants reported that the GP often could not help them with any treatment. Despite a poor therapeutic outcome, the vast majority of participants was satisfied how the GP handled their dizziness. Yet, understanding the cause of dizziness seems important for dizzy older patients. Conclusions Despite significant dizziness-related impairment, older dizzy patients may not present dizziness as main reason for encounter. Presenting dizziness as a secondary complaint may give GPs the - wrong - impression that the dizziness-related impairment is only mild. GPs need to be aware of this potential underreporting. Knowing the cause of dizziness seems important for older patients. Yet, GPs regularly did not succeed in identifying the underlying cause of dizziness. Therefore, GPs should manage the expectations of older dizzy patients regarding diagnosis and successful treatment, by informing them about the uncertainty and unpredictability of dizziness. We also recommend GPs to focus on improving functional ability; this is the key to escape from therapeutic nihilism by the GP. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0474-3) contains supplementary material, which is available to authorized users.
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Abstract
This chapter gives an overview of the epidemiology of dizziness, vertigo, and imbalance, and of specific vestibular disorders. In the last decade, population-based epidemiologic studies have complemented previous publications from specialized settings and provided evidence for the high burden of dizziness and vertigo in the community. Dizziness (including vertigo) affects about 15% to over 20% of adults yearly in large population-based studies. Vestibular vertigo accounts for about a quarter of dizziness complaints and has a 12-month prevalence of 5% and an annual incidence of 1.4%. Its prevalence rises with age and is about two to three times higher in women than in men. Imbalance has been increasingly studied as a highly prevalent complaint particularly affecting healthy aging. Studies have documented the high prevalence of benign paroxysmal positional vertigo (BPPV) and vestibular migraine (VM), as well as of comorbid anxiety at the population level. BPPV and VM are largely underdiagnosed, while Menière's disease, which is about 10 times less frequent than BPPV, appears to be overdiagnosed. Risk factor research is only at its beginning, but has provided some interesting observations, such as the consistent association of vertigo and migraine, which has greatly contributed to the recognition of VM as a distinct vestibular syndrome.
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Affiliation(s)
- H K Neuhauser
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
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26
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Mueller M, Whitney SL, Alghwiri A, Alshebber K, Strobl R, Alghadir A, Al-momani MO, Furman JM, Grill E. Subscales of the vestibular activities and participation questionnaire could be applied across cultures. J Clin Epidemiol 2014; 68:211-9. [PMID: 25500318 DOI: 10.1016/j.jclinepi.2014.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 09/30/2014] [Accepted: 10/17/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The objective of this study was to assess the objectivity, cross-cultural validity, and convergent validity of the Vestibular Activities and Participation (VAP) questionnaire among four countries, Germany, United States, Jordan, and Saudi Arabia. STUDY DESIGN AND SETTING This was a cross-sectional study conducted in four specialized outpatient dizziness clinics in Germany, United States, Jordan, and Saudi Arabia. RESULTS A total of 453 participants were included in the study. The Rasch analysis revealed two separate subscales. Subscale 1 items included focusing attention, lying down, standing, bending, lifting and carrying objects, and sports. Subscale 2 items included walking long distances, climbing, running, moving around within buildings other than home, using transportation, and driving. The Pearson product-moment correlation between the Dizziness Handicap Inventory and the summary score of the VAP subscale 1 was 0.66 and was 0.64 for subscale 2. CONCLUSION Owing to its shortness and intercultural adaptability, the new two-scale version of the VAP questionnaire lends itself to clinical practice and research across countries to estimate the effect of vertigo and dizziness on activity limitation and participation restrictions. Psychometrically sound summary scores can be calculated. More extended versions of the VAP can be used for comprehensive clinical assessment where summary scores are not needed or a more detailed documentation is warranted.
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Affiliation(s)
- Martin Mueller
- Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. 17, D-81377 Munich, Germany; German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Marchioninistr. 17, D-81377 Munich, Germany.
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Bridgeside Point 1 100 Technology Drive, Pittsburgh, PA 15219-3130, USA; Department of Otolaryngology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA 15213, USA; Department of Rehabilitation Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Alia Alghwiri
- Department of Physical Therapy, The University of Jordan, Queen Rania Street, Amman-11942, Jordan
| | - Kefah Alshebber
- Department of Physical Therapy, University of Pittsburgh, Bridgeside Point 1 100 Technology Drive, Pittsburgh, PA 15219-3130, USA
| | - Ralf Strobl
- Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. 17, D-81377 Munich, Germany; German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Marchioninistr. 17, D-81377 Munich, Germany
| | - Ahmad Alghadir
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia; Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Murad O Al-momani
- ENT Department, College of Medicine, King Saud University, Riyadh 12372-4392, Saudi Arabia
| | - Joseph M Furman
- Department of Otolaryngology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Eva Grill
- Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. 17, D-81377 Munich, Germany; German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Marchioninistr. 17, D-81377 Munich, Germany
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