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Liu DT, Mueller CA, Sedaghat AR. A scoping review of Rasch analysis and item response theory in otolaryngology: Implications and future possibilities. Laryngoscope Investig Otolaryngol 2024; 9:e1208. [PMID: 38362194 PMCID: PMC10866592 DOI: 10.1002/lio2.1208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/18/2023] [Indexed: 02/17/2024] Open
Abstract
Objective Item response theory (IRT) is a methodological approach to studying the psychometric performance of outcome measures. This study aims to determine and summarize the use of IRT in otolaryngological scientific literature. Methods A systematic search of the Medline, Embase, and the Cochrane Library databases was performed for original English-language published studies indexed up to January 28, 2023, per the following search strategy: ("item response theory" OR "irt" OR "rasch" OR "latent trait theory" OR "modern mental test theory") AND ("ent" OR "otorhinolaryngology" OR "ear" OR "nose" OR "throat" OR "otology" OR "audiology" OR "rhinology" OR "laryngology" OR "neurotology" OR "facial plastic surgery"). Results Fifty-five studies were included in this review. IRT was used across all subspecialties in otolaryngology, and most studies utilizing IRT methodology were published within the last decade. Most studies analyzed polytomous response data, and the most commonly used IRT models were the partial credit and the rating scale model. There was considerable heterogeneity in reporting the main assumptions and results of IRT. Conclusion IRT is increasingly being used in the otolaryngological scientific literature. In the otolaryngology literature, IRT is most frequently used in the study of patient-reported outcome measures and many different IRT-based methods have been used. Future IRT-based outcome studies, using standardized reporting guidelines, might improve otolaryngology-outcome research sustainably by improving response rates and reducing patient response burden. Level of evidence 2.
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Affiliation(s)
- David T. Liu
- Department of Otorhinolaryngology, Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - Christian A. Mueller
- Department of Otorhinolaryngology, Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - Ahmad R. Sedaghat
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
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Lira MDGDA, Whitney SL, Chaves TC, de Figueiredo-Ribeiro KMOB. Brazilian Version of the Vestibular Activities and Participation Measure: Cross-Cultural Adaptation, Validity, and Reliability. J Otolaryngol Head Neck Surg 2024; 53:19160216241250353. [PMID: 39109789 PMCID: PMC11307343 DOI: 10.1177/19160216241250353] [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: 02/20/2024] [Accepted: 03/31/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Vestibular Activities and Participation Measure (VAP) subscales assess the effect of vestibular disorders on activity and participation. This study aimed to perform the cross-cultural adaptation and assess the validity, internal consistency, reliability, and measurement error of the Brazilian version of VAP subscales. METHODS The cross-cultural adaptation followed the translation, synthesis, back-translation, review by a committee of experts, and pretesting phases. Structural validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), while Spearman's correlation between VAP subscales and the Dizziness Handicap Inventory (DHI) was used to assess construct validity. Cronbach's alpha measured internal consistency. Intraclass correlation coefficient (ICC) assessed intra- and inter-rater reliability, and measurement error was calculated by using the standard error of measurement (SEM) and minimal detectable change (MDC). RESULTS Additional information was included in the Brazilian version of the Vestibular Activities and Participation measure (VAP-BR) after approval by one of the developers of the instrument to improve the understanding among individuals. One factor was found in the EFA for each subscale with 50% explained variance. Regarding CFA, the subscales 1 (S1) and 2 (S2) presented, respectively, adequate model fit indices (ie, comparative fit index of 0.99 and 0.97, and standardized root mean square residual of 0.04 for both subscales), but a very low factor load in item 6 of S1 (0.08). Chronbach's alpha was 0.80 (S1) and 0.82 (S2). For intra-rater assessment, the S1 and S2 presented an ICC of 0.87 and 0.90, SEM of 0.01 and 1.16, and MDC of 0.39 and 0.46, respectively. When assessed by 2 different raters, SEM values were 1.03 and 1.53, and MDC values were 2.85 and 4.23 for S1 and S2, respectively; both subscales showed an ICC of 0.92. Correlations between DHI and VAP subscales presented coefficients above 0.57. CONCLUSION The Brazilian version of VAP subscales presents good measurement properties and may assist health professionals in identifying activity limitations and participation restrictions in individuals with vestibular disorders.
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Affiliation(s)
| | - Susan L. Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thais Cristina Chaves
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
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Gerb J, Brandt T, Dieterich M. Different approaches to test orientation of self in space: comparison of a 2D pen-and-paper test and a 3D real-world pointing task. J Neurol 2023; 270:642-650. [PMID: 36342523 PMCID: PMC9886631 DOI: 10.1007/s00415-022-11446-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022]
Abstract
Spatial orientation is based on a complex cortical network with input from multiple sensory systems. It is affected by training, sex and age as well as cultural and psychological factors, resulting in different individual skill levels in healthy subjects. Various neurological disorders can lead to different patterns or specific deficits of spatial orientation and navigation. Accordingly, numerous tests have been proposed to assess these abilities. Here, we compare the results of (1) a validated questionnaire-based self-estimate of orientation/navigation ability (Santa Barbara Sense of Direction Scale, SBSODS) and (2) a validated pen-and-paper two-dimensional perspective test (Perspective Taking Spatial Orientation Test, SOT) with (3) a newly developed test of finger-arm pointing performance in a 3D real-world (3D-RWPT) paradigm using a recently established pointing device. A heterogeneous group of 121 participants (mean age 56.5 ± 17.7 years, 52 females), including 16 healthy volunteers and 105 patients with different vestibular, ocular motor and degenerative brain disorders, was included in this study. A high correlation was found between 2D perspective task and 3D pointing along the horizontal (azimuth) but not along the vertical (polar) plane. Self-estimated navigation ability (SBSODS) could not reliably predict actual performance in either 2D- or 3D-tests. Clinical assessment of spatial orientation and memory should therefore include measurements of actual performance, based on a 2D pen-and-paper test or a 3D pointing task, rather than memory-based questionnaires, since solely relying on the patient's history of self-estimated navigation ability results in misjudgments. The 3D finger-arm pointing test (3D-RWPT) reveals additional information on vertical (polar) spatial performance which goes undetected in conventional 2D pen-and-paper tests. Diseases or age-specific changes of spatial orientation in the vertical plane should not be clinically neglected. The major aim of this pilot study was to compare the practicability and capability of the three tests but not yet to prove their use for differential diagnosis. The next step will be to establish a suitable clinical bedside test for spatial memory and orientation.
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Affiliation(s)
- J Gerb
- Department of Neurology, University Hospital, Ludwig-Maximilians University, Munich, Germany.
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians University, Munich, Germany.
| | - T Brandt
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians University, Munich, Germany
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians University, Munich, Germany
- Hertie Senior Professor for Clinical Neuroscience, Ludwig-Maximilians University, Munich, Germany
| | - M Dieterich
- Department of Neurology, University Hospital, Ludwig-Maximilians University, Munich, Germany
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians University, Munich, Germany
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians University, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, 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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Katzenberger B, Koller D, Strobl R, Kisch R, Sanftenberg L, Voigt K, Grill E. Exposure to anticholinergic and sedative medication is associated with impaired functioning in older people with vertigo, dizziness and balance disorders-Results from the longitudinal multicenter study MobilE-TRA. Front Pharmacol 2023; 14:1136757. [PMID: 36937862 PMCID: PMC10020174 DOI: 10.3389/fphar.2023.1136757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction: Anticholinergic and sedative medication is prescribed for various conditions in older patients. While the general association between anticholinergic and sedative medication and impaired functioning is well established, its specific role in older individuals with vertigo, dizziness, and balance disorders (VDB) is still incompletely understood. The objective of this study was to investigate, whether an exposure to anticholinergic and sedative medication is associated with lower generic and lower vertigo-specific functioning in older patients with VDB. Methods: Data originates from the longitudinal multicenter study MobilE-TRA with two follow-ups, conducted from 2017 to 2019 in two German federal states. Exposure to anticholinergic and sedative medication was quantified using the drug burden index (DBI). Generic functioning was assessed by the Health Assessment Questionnaire Disability Index, appraising the amount of difficulties in performing activities of daily living (ADL). Vertigo-specific functioning was measured using the Vestibular Activities and Participation (VAP) questionnaire, assessing patient-reported functioning regarding activities of daily living that are difficult to perform because of their propensity to provoke VDB (Scale 1) as well as immediate consequences of VDB on activities and participation related to mobility (Scale 2). Longitudinal linear mixed models were applied to assess the association of exposure to anticholinergic and sedative medication at baseline and the level of generic and vertigo-specific functioning status over time. Results: An overall of 19 (7 from Bavaria) primary care physicians (mean age = 54 years, 29% female) recruited 158 (59% from Bavaria) patients with VDB (median age = 78 years, 70% female). Anticholinergic and sedative medication at baseline was present in 56 (35%) patients. An exposure to anticholinergic and sedative medication at baseline was significantly associated with lower generic functioning [Beta = 0.40, 95%-CI (0.18; 0.61)] and lower vertigo-specific functioning [VAP Scale 1: Beta = 2.47, 95%-CI (0.92; 4.02)], and VAP Scale 2: Beta = 3.74, 95%-CI [2.23; 5.24]). Conclusion: Our results highlight the importance of a close monitoring of anticholinergic and sedative medication use in older patients with VDB. When feasible, anticholinergic and sedative medication should be replaced by equivalent alternative therapies in order to potentially reduce the burden of VDB.
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Affiliation(s)
- Benedict Katzenberger
- Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, Ludwig Maximilian University of Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Munich Center of Health Sciences, Ludwig Maximilian University of Munich, Munich, Germany
- *Correspondence: Benedict Katzenberger,
| | - Daniela Koller
- Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, Ludwig Maximilian University of Munich, Munich, Germany
- Munich Center of Health Sciences, Ludwig Maximilian University of Munich, Munich, Germany
| | - Ralf Strobl
- Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, Ludwig Maximilian University of Munich, Munich, Germany
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Munich, Germany
| | - Rebecca Kisch
- Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, Ludwig Maximilian University of Munich, Munich, Germany
| | - Linda Sanftenberg
- Institute of General Practice and Family Medicine, University Hospital Munich, Munich, Germany
| | - Karen Voigt
- Department of General Practice/Medical Clinic III, Faculty of Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, Ludwig Maximilian University of Munich, Munich, Germany
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Munich, Germany
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Referral trajectories in patients with vertigo, dizziness and balance disorders and their impact on health-related quality of life and functioning: results from the longitudinal multicenter study MobilE-TRA. J Neurol 2022; 269:6211-6221. [PMID: 35353231 PMCID: PMC9618552 DOI: 10.1007/s00415-022-11060-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 11/27/2022]
Abstract
Background Due to reported barriers in the management of patients with vertigo, dizziness and balance problems (VDB), referral trajectories starting from primary care might be determined by other factors than medical necessity. The objective of this paper was to examine the impact of disease-related and other determinants on referral trajectories of older patients with VDB and to investigate, how these trajectories affect the patients’ functioning and health-related quality of life (HRQoL). Methods Data originate from the longitudinal multicenter study MobilE-TRA, conducted in two German federal states. Referrals to neurologists or ear-nose-throat (ENT) specialists were considered. Referral patterns were visualized using a state sequence analysis. Predictors of referral trajectories were examined using a multinomial logistic regression model. Linear mixed models were calculated to assess the impact of referral patterns on the patients’ HRQoL and functioning. Results We identified three patterns of referral trajectories: primary care physician (PCP) only, PCP and neurologist, and PCP and ENT. Chances of referral to a neurologist were higher for patients with a neurological comorbidity (OR = 3.22, 95%-CI [1.003; 10.327]) and lower for patients from Saxony (OR = 0.08, 95%-CI [0.013; 0.419]). Patients with a PCP and neurologist referral pattern had a lower HRQoL and lower functioning at baseline assessment. Patients with unspecific diagnoses also had lower functioning. Conclusion Referral trajectories were determined by present comorbidities and the regional healthcare characteristics. Referral trajectories affected patients’ HRQoL. Unspecific VDB diagnoses seem to increase the risk of ineffective management and consequently impaired functioning. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11060-8.
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Concurrent validity of the Vestibular/Ocular Motor Screening (VOMS) tool with the Dizziness Handicap Inventory (DHI) among adolescents with vestibular symptoms/impairment following concussion. Phys Ther Sport 2021; 53:34-39. [PMID: 34785482 DOI: 10.1016/j.ptsp.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine whether the Vestibular/Ocular Motor Screening (VOMS) tool demonstrates concurrent validity with the Dizziness Handicap Inventory (DHI) in a sample of concussed athletes referred for vestibular therapy and whether DHI items were predictive of VOMS outcomes. DESIGN Cross-sectional cohort study. SETTING Concussion specialty/vestibular therapy clinic. METHODS Adolescents (n = 55; 15.4 ± 1.6 years) with diagnosed sport-related concussion (SRC) with vestibular symptoms and/or impairment between October 2018-February 2020. Patients completed VOMS and DHI at initial visit. Seven individual VOMS and twenty-five DHI items, VOMS and DHI total score and three DHI sub-scales, were compared with Spearman correlations. Three backwards linear regression (LR) models were built to predict 1. VOMS vestibular symptoms, 2. VOMS ocular symptoms, and 3. near-point of convergence-distance (NPC-distance) using individual DHI items as predictors. RESULTS Spearman correlations (p) identified DHI items with moderate to strong associations for VOMS items. DHI sub-scales demonstrated moderate-to-strong correlations with VOMS items (p = 0.30-0.59). Total DHI score demonstrated a moderate-to-strong association with HSAC (p = 0.30), VSAC (p = 0.32), and SP (p = 0.61). Results from the LRs predicting VOMS ocular symptoms (R (Alsalaheen et al., 2010) = 0.56; p < 0.001), and VOMS vestibular symptoms (R (Alsalaheen et al., 2010) = 0.23; p = 0.01), and NPC-distance (R (Alsalaheen et al., 2010) = 0.56; p < 0.001) included significant DHI predictors. CONCLUSIONS There was moderate-to-strong associations between VOMS and 56% of DHI items (i.e., p > 0.30).
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Baydan-Aran M, Aran OT, Tokgöz-Yılmaz S. Vestibular activities and participation measure: Turkish validity and reliability. J Vestib Res 2021; 32:367-372. [PMID: 34744035 DOI: 10.3233/ves-210094] [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: 11/15/2022]
Abstract
BACKGROUND International Classification of Functioning, Disability and Health (ICF) has an important role in rehabilitation in terms of assessments. In the field of vestibular rehabilitation, Vestibular Activities of Participation (VAP) measure is the first assessment developed in a perspective of ICF. OBJECTIVE It was aimed to adapt cross-culturally and analyze psychometric properties of VAP into Turkish Language. METHODS The VAP was translated into Turkish language by the authors and back translated by a blind native English speaker. The final version was applied to 310 participants. Internal consistency was analyzed with Cronbach's alpha and test-retest reliability analyzed with Intraclass Correlation coefficient (ICC). Validity of the scale investigated with Exploratory and Confirmatory Factor analysis (EFA and CFA). RESULTS Cronbach's alpha reliability coefficient was found 0.94, and the reliability of the subscales ranged from 0.75 to 0.95; ICC was found 0.94. VAP resulted 8-factor structure and explained 88%of the total variance. In CFA (χ2) / df ratio shows good agreement with 2.472 and the goodness of fit indices of TLI (0.814), CFI (0.893) and RMSEA (0.075) showed acceptable fit. CONCLUSIONS This study showed that VAP-Turkish version is valid and reliable in Turkish speaking populations, and might be used to determine impact of vestibular disorders on activities and participation.
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Affiliation(s)
- Mine Baydan-Aran
- Department of Audiology, Faculty of Health Sciences, Ankara University, Ankara, Turkey
| | - Orkun Tahir Aran
- Occupational Therapy Department, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Suna Tokgöz-Yılmaz
- Department of Audiology, Faculty of Health Sciences, Ankara University, Ankara, Turkey
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Vivar G, Strobl R, Grill E, Navab N, Zwergal A, Ahmadi SA. Using Base-ml to Learn Classification of Common Vestibular Disorders on DizzyReg Registry Data. Front Neurol 2021; 12:681140. [PMID: 34413823 PMCID: PMC8367819 DOI: 10.3389/fneur.2021.681140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/30/2021] [Indexed: 01/16/2023] Open
Abstract
Background: Multivariable analyses (MVA) and machine learning (ML) applied on large datasets may have a high potential to provide clinical decision support in neuro-otology and reveal further avenues for vestibular research. To this end, we build base-ml, a comprehensive MVA/ML software tool, and applied it to three increasingly difficult clinical objectives in differentiation of common vestibular disorders, using data from a large prospective clinical patient registry (DizzyReg). Methods: Base-ml features a full MVA/ML pipeline for classification of multimodal patient data, comprising tools for data loading and pre-processing; a stringent scheme for nested and stratified cross-validation including hyper-parameter optimization; a set of 11 classifiers, ranging from commonly used algorithms like logistic regression and random forests, to artificial neural network models, including a graph-based deep learning model which we recently proposed; a multi-faceted evaluation of classification metrics; tools from the domain of “Explainable AI” that illustrate the input distribution and a statistical analysis of the most important features identified by multiple classifiers. Results: In the first clinical task, classification of the bilateral vestibular failure (N = 66) vs. functional dizziness (N = 346) was possible with a classification accuracy ranging up to 92.5% (Random Forest). In the second task, primary functional dizziness (N = 151) vs. secondary functional dizziness (following an organic vestibular syndrome) (N = 204), was classifiable with an accuracy ranging from 56.5 to 64.2% (k-nearest neighbors/logistic regression). The third task compared four episodic disorders, benign paroxysmal positional vertigo (N = 134), vestibular paroxysmia (N = 49), Menière disease (N = 142) and vestibular migraine (N = 215). Classification accuracy ranged between 25.9 and 50.4% (Naïve Bayes/Support Vector Machine). Recent (graph-) deep learning models classified well in all three tasks, but not significantly better than more traditional ML methods. Classifiers reliably identified clinically relevant features as most important toward classification. Conclusion: The three clinical tasks yielded classification results that correlate with the clinical intuition regarding the difficulty of diagnosis. It is favorable to apply an array of MVA/ML algorithms rather than a single one, to avoid under-estimation of classification accuracy. Base-ml provides a systematic benchmarking of classifiers, with a standardized output of MVA/ML performance on clinical tasks. To alleviate re-implementation efforts, we provide base-ml as an open-source tool for the community.
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Affiliation(s)
- Gerome Vivar
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany.,Computer Aided Medical Procedures, Department of Informatics, Technical University Munich, Munich, Germany
| | - Ralf Strobl
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany.,Department of Biometry and Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Eva Grill
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany.,Department of Biometry and Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Nassir Navab
- Computer Aided Medical Procedures, Department of Informatics, Technical University Munich, Munich, Germany
| | - Andreas Zwergal
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany.,Department of Neurology, University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Seyed-Ahmad Ahmadi
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany.,Computer Aided Medical Procedures, Department of Informatics, Technical University 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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11
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Strobl R, Grözinger M, Zwergal A, Huppert D, Filippopulos F, Grill E. A Set of Eight Key Questions Helps to Classify Common Vestibular Disorders-Results From the DizzyReg Patient Registry. Front Neurol 2021; 12:670944. [PMID: 33995265 PMCID: PMC8116658 DOI: 10.3389/fneur.2021.670944] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/17/2021] [Indexed: 12/20/2022] Open
Abstract
Precise history taking is the key to develop a first assumption on the diagnosis of vestibular disorders. Particularly in the primary care setting, algorithms are needed, which are based on a small number of questions and variables only to guide appropriate diagnostic decisions. The aim of this study is to identify a set of such key variables that can be used for preliminary classification of the most common vestibular disorders. A four-step approach was implemented to achieve this aim: (1) we conducted an online expert survey to collect variables that are meaningful for medical history taking, (2) we used qualitative content analysis to structure these variables, (3) we identified matching variables of the patient registry of the German Center for Vertigo and Balance Disorders, and (4) we used classification trees to build a classification model based on these identified variables and to analyze if and how these variables contribute to the classification of common vestibular disorders. We included a total of 1,066 patients with seven common vestibular disorders (mean age of 51.1 years, SD = 15.3, 56% female). Functional dizziness was the most frequent diagnosis (32.5%), followed by vestibular migraine (20.2%) and Menière's disease (13.3%). Using classification trees, we identified eight key variables which can differentiate the seven vestibular disorders with an accuracy of almost 50%. The key questions comprised attack duration, rotational vertigo, hearing problems, turning in bed as a trigger, doing sport or heavy household chores as a trigger, age, having problems with walking in the dark, and vomiting. The presented algorithm showed a high-face validity and can be helpful for taking initial medical history in patients with vertigo and dizziness. Further research is required to evaluate if the identified algorithm can be applied in the primary care setting and to evaluate its external validity.
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Affiliation(s)
- Ralf Strobl
- Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-Universität München (LMU) Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders, University Hospital Munich, Ludwig-Maximilians-Universität München (LMU) Munich, Munich, Germany
| | - Michael Grözinger
- Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-Universität München (LMU) Munich, Munich, Germany
| | - Andreas Zwergal
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Ludwig-Maximilians-Universität München (LMU) Munich, Munich, Germany.,Department of Neurology, University Hospital Munich, Ludwig-Maximilians-Universität München (LMU) Munich, Munich, Germany
| | - Doreen Huppert
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Ludwig-Maximilians-Universität München (LMU) Munich, Munich, Germany.,Department of Neurology, University Hospital Munich, Ludwig-Maximilians-Universität München (LMU) Munich, Munich, Germany
| | - Filipp Filippopulos
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Ludwig-Maximilians-Universität München (LMU) Munich, Munich, Germany.,Department of Neurology, University Hospital Munich, Ludwig-Maximilians-Universität München (LMU) Munich, Munich, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-Universität München (LMU) Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders, University Hospital Munich, Ludwig-Maximilians-Universität München (LMU) Munich, Munich, Germany.,Munich Centre of Health Sciences, Ludwig-Maximilians-Universität München (LMU) Munich, Munich, Germany
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12
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Dunlap PM, Marchetti GF, Sparto PJ, Staab JP, Furman JM, Delitto A, Whitney SL. Exploratory Factor Analysis of the Vestibular Activities Avoidance Instrument. JAMA Otolaryngol Head Neck Surg 2021; 147:144-150. [PMID: 33237289 DOI: 10.1001/jamaoto.2020.4203] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance Fear avoidance is a behavioral response to dizziness that can lead to chronic symptoms and maladaptation of the vestibular system, but there is no valid and reliable clinical measure of fear avoidance for persons with dizziness. Although the Vestibular Activities Avoidance Instrument (VAAI) was developed to identify fear avoidance beliefs in persons with dizziness, it was considered too long for clinical use. Objective To continue development of the VAAI for clinical use by reducing its length and by assessing the internal consistency and construct validity through associations with measures of disability, quality of life, and psychological well-being. Design, Setting, and Participants This prospective cohort study conducted from February 2018 to December 2019 at a tertiary care balance disorders clinic and in outpatient physical therapy clinics in the United States included 404 adults with dizziness. Main Outcomes and Measures Participants completed the 81-item VAAI, the Vestibular Activities and Participation (VAP) measure, the 12-Item Short Form Health Survey (SF-12), and the Hospital Anxiety and Depression Scale (HADS) at baseline. Exploratory factor analysis of the VAAI was conducted to reduce the number of items. Internal consistency of the reduced VAAI was determined by calculating the Cronbach α. Convergent validity was assessed by examining the associations between the reduced VAAI and the VAP, the SF-12, and the HADS using Spearman correlation coefficients. Results Data from 404 adults (mean [SD] age, 54.0 [17.0] years; 64.6% women) were included in the analyses. The exploratory factor analysis indicated that 2 factors explained the underlying constructs of the 81-Item VAAI. The first factor was retained and measured the construct of fear avoidance. The VAAI was reduced to 9 items (VAAI-9). The VAAI-9 showed excellent internal consistency (Cronbach α = 0.92) and was positively associated with the VAP (ρ = 0.81) and the HADS anxiety (ρ = 0.47) and depression (ρ = 0.64) subscales, and negatively associated with physical (ρ = -0.76) and mental (ρ = -0.47) health-related quality of life. Conclusions and Relevance These findings indicate that the VAAI-9 is a short, internally consistent, valid measure of fear avoidance and is associated with quality of life, activity limitations and participation restrictions, and psychological well-being. The next steps in the development of the VAAI-9 will include validation in an external sample, assessment of test-retest validity, and prospective investigations of its association with future disability.
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Affiliation(s)
- Pamela M Dunlap
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gregory F Marchetti
- Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania
| | - Patrick J Sparto
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jeffrey P Staab
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota.,Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Joseph M Furman
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anthony Delitto
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
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13
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Habs M, Strobl R, Grill E, Dieterich M, Becker-Bense S. Primary or secondary chronic functional dizziness: does it make a difference? A DizzyReg study in 356 patients. J Neurol 2020; 267:212-222. [PMID: 32852579 PMCID: PMC7718176 DOI: 10.1007/s00415-020-10150-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 12/20/2022]
Abstract
In 2017, the term “persistent postural-perceptual dizziness” (PPPD) was coined by the Bárány Society, which provided explicit criteria for diagnosis of functional vertigo and dizziness disorders. PPPD can originate secondarily after an organic disorder (s-PPPD) or primarily on its own, in the absence of somatic triggers (p-PPPD). The aim of this database-driven study in 356 patients from a tertiary vertigo center was to describe typical demographic and clinical features in p-PPPD and s-PPPD patients. Patients underwent detailed vestibular testing with neurological and neuro-orthoptic examinations, video-oculography during water caloric stimulation, video head-impulse test, assessment of the subjective visual vertical, and static posturography. All patients answered standardized questionnaires (Dizziness Handicap Inventory, DHI; Vestibular Activities and Participation, VAP; and Euro-Qol-5D-3L). One hundred and ninety-five patients (55%) were categorized as p-PPPD and 162 (45%) as s-PPPD, with female gender slightly predominating (♀:♂ = 56%:44%), particularly in the s-PPPD subgroup (64%). The most common somatic triggers for s-PPPD were benign paroxysmal positional vertigo (27%), and vestibular migraine (24%). Overall, p-PPPD patients were younger than s-PPPD patients (44 vs. 48 years) and showed a bimodal age distribution with an additional early peak in young adults (about 30 years of age) beside a common peak at the age of 50–55. The most sensitive diagnostic tool was posturography, revealing a phobic sway pattern in 50% of cases. s-PPPD patients showed higher handicap and functional impairment in DHI (47 vs. 42) and VAP (9.7 vs. 8.9). There was no difference between both groups in EQ-5D-3L. In p-PPPD, anxiety (20% vs. 10%) and depressive disorders (25% vs. 9%) were more frequent. This retrospective study in a large cohort showed relevant differences between p- and s-PPPD patients in terms of demographic and clinical features, thereby underlining the need for careful syndrome subdivision for further prospective studies.
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Affiliation(s)
- Maximilian Habs
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Munich, Germany.
- Department of Neurology, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Ralf Strobl
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Eva Grill
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Marianne Dieterich
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Neurology, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Sandra Becker-Bense
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Munich, Germany
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14
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Wu P, Yang M, Hu Y, Li H. Cross-cultural adaptation and validation of the Chinese version of the vestibular activities and participation measure. J Vestib Res 2020; 29:171-179. [PMID: 31450524 PMCID: PMC9249305 DOI: 10.3233/ves-190675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND: The activities and participation component of the International Classification of Functioning, Disability and Health (ICF) has gained increasing recognition in rehabilitation field. The vestibular activities and participation measure (VAP) was the first instrument using the ICF to evaluate activities and participation outcomes for vestibular research and clinical practice. OBJECTIVES: This study aimed to cross-culturally adapt the VAP into Chinese language and to examine the psychometric properties of the Chinese version of VAP (VAP-C). METHODS: A standard “forward-backward” translation procedure was followed and the results were presented to the panel of experts and consensus was sought. Internal consistency was assessed using Cronbach’s alpha and test-retest reliability examined by intraclass correlation coefficient (ICC). Convergent validity was determined by calculating the Pearson’s correlation coefficient between the VAP-C and the Visual Analog Scale (VAS) and the Dizziness Handicap Inventory (DHI). Discriminative validity for test subjects versus control subjects was evaluated by Receiver Operating Characteristic curve (ROC) analysis. RESULTS: Minor revisions were made during translation to ensure semantic equivalence and to suit Chinese culture. A total of 121 patients complaining of dizziness or vertigo due to peripheral vestibular disorders (test subjects) and 41 control subjects were enrolled. Cronbach’s alpha was 0.94 for the VAP-C total scale and greater than 0.80 for the two subscales. ICC for the VAP-C total scale was 0.78, and for subscale one was 0.77 and subscale two 0.76. The VAP-C had strong correlations (r = 0.85–0.88) with the VAS and fair to moderate correlations (r = 0.23–0.53) with DHI. Through ROC analysis, we found the VAP-C discriminated significantly between patients and control subjects. Based on the estimate of Youden J, the optimal cut-off values for VAP-C total and the two subscales were established. CONCLUSIONS: The VAP-C shows evidence of reliability and validity, which can be applied for evaluating the impact of the vestibular disorder on patients’ activities and participation in Chinese language populations.
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Affiliation(s)
- Peixia Wu
- Department of Operation Room, Eye and ENT Hospital of Fudan University, China
| | - Mei Yang
- Department of Otorhinolaryngology, Eye and ENT Hospital of Fudan University, China
| | - Yan Hu
- School of Nursing, Fudan University, China
| | - Huawei Li
- Department of Otorhinolaryngology, Eye and ENT Hospital of Fudan University, China
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15
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Wu P, Cao W, Hu Y, Li H. Effects of vestibular rehabilitation, with or without betahistine, on managing residual dizziness after successful repositioning manoeuvres in patients with benign paroxysmal positional vertigo: a protocol for a randomised controlled trial. BMJ Open 2019; 9:e026711. [PMID: 31217316 PMCID: PMC6589014 DOI: 10.1136/bmjopen-2018-026711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Benign paroxysmal positional vertigo (BPPV) is recognised as the leading cause of peripheral vertigo in adults. The canalith repositioning procedure (CRP) can be used for effective treatment of BPPV. However, some patients experience residual dizziness (RD) even after successful CRP, resulting in a significant negative impact on their daily function and quality of life. Exercise-based vestibular rehabilitation (VR) has been proven as an effective method for managing dizziness and has been applied in patients with various vestibular disorders. However, the efficacy of VR to specifically target RD post-BPPV is unknown. This study aims to investigate the efficacy of VR, compared with betahistine or VR plus betahistine treatment, in the treatment of patients experiencing RD after successful CRP. METHODS AND ANALYSIS A randomised single-blinded controlled trial will be carried out to determine the efficacy of VR compared with betahistine or VR plus betahistine treatment in mitigating RD and improving balance function. Patients with BPPV who experience RD after successful CRP will be recruited. Participants will be randomised into one of three groups to receive VR, betahistine or VR plus betahistine. There will be 61 participants in each group. The primary outcomes will be changes in the patient's daily function as measured by the Vestibular Activities and Participation questionnaire and balance ability assessed by computerised dynamic posturography. The secondary outcomes will be dizziness-related handicap, otolith function and duration of RD symptoms. Outcome measures will be noted at baseline and at 2, 4 and 8 weeks post-randomisation. This study has the potential to reduce unnecessary anti-vertigo drug prescriptions and may lead to a general consensus regarding the use of VR as a first-line treatment for RD in patients with BPPV. ETHICS AND DISSEMINATION This trial received ethical approval from the Institutional Review Board of Eye and ENT Hospital of Fudan University (reference number 2017046). The study results will be disseminated via peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER NCT03624283; Pre-results.
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Affiliation(s)
- Peixia Wu
- Department of Nursing, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Wenzhu Cao
- Department of Intensive Care Unit, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai, China
| | - Huawei Li
- Department of Otorhinolaryngolohy, Eye and ENT Hospital of Fudan University, Shanghai, China
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16
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Nguyen N, Thalhammer R, Beutner K, Saal S, Servaty R, Klingshirn H, Icks A, Freyberg K, Vomhof M, Mansmann U, Le L, Müller M, Meyer G. Effectiveness of a complex intervention to improve participation and activities in nursing home residents with joint contractures (JointConEval): study protocol of a multicentre cluster-randomised controlled trial [DRKS-ID:DRKS00015185]. Trials 2019; 20:305. [PMID: 31142350 PMCID: PMC6542100 DOI: 10.1186/s13063-019-3384-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nursing home residents are frequently affected by joint contractures, which impacts their participation and daily activities. A complex intervention, the Participation Enabling Care in Nursing (PECAN), was previously developed and pilot tested to address their needs. Its effectiveness and safety will be evaluated in the present study. METHODS/DESIGN This multicentre cluster-randomised controlled trial will be conducted in 32 nursing homes spread over two regions of Germany. A total of 578 residents over 65 years old with joint contractures will be included. To compare the effect of the PECAN intervention with optimised standard care (usual care and an information session), randomisation will take place at a cluster level. The individually tailored intervention was designed using the biopsychosocial model in the International Classification of Functioning, Disability and Health (ICF) to reduce activity limitations and participation restrictions resulting from existing joint contractures by addressing barriers and by strengthening supportive factors on an individual level and an organisational level. The implementation strategy comprises a facilitators' workshop, a peer mentoring approach including a peer mentor visit and telephone peer counselling, an in-house information event, an information session for the nursing team and a training session on collegial consultation for the facilitators. The in-house information event will also take place in the nursing homes of the control group. The primary outcome is the residents' participation and activities after 12 months of follow-up as assessed using the PaArticular Scales. The secondary outcome is the residents' quality of life. A cost-effectiveness analysis (costs per additional resident who experienced a decrease of ten points in the participation or activities subscale of the PaArticular Scales) and a cost-utility analysis (costs per additional quality adjusted life year) will be conducted. We will investigate barriers and facilitators in a comprehensive process evaluation. DISCUSSION We expect a clinically relevant improvement of participation and activities in residents with joint contractures. Our findings will provide important insights regarding participation in the situation of the affected individuals. TRIAL REGISTRATION DRKS, DRKS00015185 . Registered on 1 August 2018. Universal Trial Number U1111-1218-1555. Registered on 26 July 2018.
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Affiliation(s)
- Natalie Nguyen
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Saale Germany
| | - Regina Thalhammer
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
| | - Katrin Beutner
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Saale Germany
| | - Susanne Saal
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Saale Germany
| | - Ricarda Servaty
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
| | - Hanna Klingshirn
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Düsseldorf, Germany
| | - Kristina Freyberg
- Department of Medical Controlling, University Hospital Bonn, Bonn, Germany
| | - Markus Vomhof
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Düsseldorf, Germany
| | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Lien Le
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martin Müller
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Saale Germany
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17
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Kovacs E, Stephan AJ, Phillips A, Schelling J, Strobl R, Grill E. Pilot cluster randomized controlled trial of a complex intervention to improve management of vertigo in primary care (PRIMA-Vertigo): study protocol. Curr Med Res Opin 2018; 34:1819-1828. [PMID: 29565189 DOI: 10.1080/03007995.2018.1456413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/08/2018] [Accepted: 03/20/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Vertigo and dizziness are highly prevalent symptoms in primary care, frequently misdiagnosed. Based on a thorough need assessment, INDICORE (INform, DIagnose, COmmunicate, REfer), an evidence-based complex intervention has been developed to transfer knowledge of specialized tertiary clinics to primary care providers (PCPs), improve the referral process and, ultimately, improve the functioning and quality of life of patients with vertigo/dizziness. The main objective of the PRIMA-Vertigo pilot study is to examine whether the INDICORE intervention is feasible and sufficiently promising to warrant a larger trial. METHODS We plan to perform a single-blind, pragmatic cluster-randomized controlled pilot study with an accompanying process evaluation. PCPs will be the cluster units of randomization. Patients who consult these PCPs because of vertigo/dizziness symptoms will be included consecutively and considered the units of analysis. The intervention will be multi-faceted training on diagnostics targeted at the PCPs, supported by patient education material and a newly developed tool to structure the referral process. To balance the influence of non-specific effects, all clusters will receive generic communication training. EXPECTED RESULTS The process evaluation aims to provide results on the acceptability and feasibility of the INDICORE intervention components to PCPs and patients. Additionally, this study will provide a first estimate of the likely effectiveness of the intervention on patients' quality of life, functioning and participation. CONCLUSIONS The PRIMA-Vertigo pilot study will allow further tailoring of the INDICORE intervention to stakeholder needs before its effectiveness is evaluated in a large-scale main study.
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Affiliation(s)
- Eva Kovacs
- a Ludwig-Maximilians-Universität München, University Hospital - German Center for Vertigo and Balance Disorders , Germany
- b Ludwig-Maximilians-Universität München - Institute for Medical Information Processing, Biometrics and Epidemiology , Germany
| | - Anna-Janina Stephan
- b Ludwig-Maximilians-Universität München - Institute for Medical Information Processing, Biometrics and Epidemiology , Germany
| | - Amanda Phillips
- a Ludwig-Maximilians-Universität München, University Hospital - German Center for Vertigo and Balance Disorders , Germany
- b Ludwig-Maximilians-Universität München - Institute for Medical Information Processing, Biometrics and Epidemiology , Germany
| | - Jörg Schelling
- c Ludwig-Maximilians-Universität München, University Hospital - Institute for General Practice and Family Medicine , Germany
| | - Ralf Strobl
- a Ludwig-Maximilians-Universität München, University Hospital - German Center for Vertigo and Balance Disorders , Germany
- b Ludwig-Maximilians-Universität München - Institute for Medical Information Processing, Biometrics and Epidemiology , Germany
| | - Eva Grill
- a Ludwig-Maximilians-Universität München, University Hospital - German Center for Vertigo and Balance Disorders , Germany
- b Ludwig-Maximilians-Universität München - Institute for Medical Information Processing, Biometrics and Epidemiology , Germany
- d Ludwig-Maximilians-Universität München - Munich Center of Health Sciences , Germany
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18
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Alshehri MM, Sparto PJ, Furman JM, Fedor S, Mucha A, Henry LC, Whitney SL. The usefulness of the video head impulse test in children and adults post-concussion. J Vestib Res 2018; 26:439-446. [PMID: 28262647 DOI: 10.3233/ves-160598] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Dizziness after concussion have been reported in both youths and adults. It is not clear if the dizziness experienced post-concussion is from peripheral or central etiology. New technology has been developed to quickly and easily quantify the magnitude of peripheral vestibular disorders that is non-invasive and acceptable to youths and adults. The purpose of this study was to determine if youths and adults' post-concussion have evidence of decreased horizontal semicircular canal vestibulo-ocular reflex (VOR) gains as measured with the video head impulse test (vHIT), which would indicate a peripheral vestibular disorder. An additional purpose was to determine if VOR gain scores correlate with functional performance measures. DESIGN Descriptive cross sectional. SETTING Large medical center out-patient concussion program. PARTICIPANTS Fifty-six subjects with concussion. MAIN OUTCOMES/MEASURES Subjects completed the vHIT testing, the Dizziness Handicap Inventory (DHI), the Vestibular Activities and Participation (VAP) scale, the Pediatric Vestibular Symptom Questionnaire, gait speed assessment, the Dynamic Gait Index (DGI) and a verbal analog scale of symptom provocation before and after the vHIT testing. RESULTS There were no abnormal vHIT findings in any subject. Headaches, dizziness and nausea were significantly worse post vHIT testing (p < 0.05). Youths had better DGI and DHI scores than subjects older than 20 (p < 0.05). CONCLUSION The vHIT did not detect horizontal semicircular canal weakness in any of the subjects tested. In addition, older adults reported more activity and participation limitations than the younger subjects with concussion.
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Affiliation(s)
| | - Patrick J Sparto
- Departments of Physical Therapy and Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joseph M Furman
- Departments of Otolaryngology, Neurology, and Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sheri Fedor
- Centers for Rehab Services, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Anne Mucha
- Centers for Rehab Services, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Luke C Henry
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Susan L Whitney
- Departments of Physical Therapy and Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
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19
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Whitney SL, Alghadir A, Alghwiri A, Alshebber KM, Alshehri M, Furman JM, Mueller M, Grill E. The development of the ICF vestibular environmental scale. J Vestib Res 2018; 26:297-302. [PMID: 27392833 DOI: 10.3233/ves-160580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED People with vestibular disorders report changes in symptoms based on their environment with many situations increasing their symptoms. The purpose of this paper was to utilize the International Classification of Functioning Disability and Health (ICF) from the World Health Organization (WHO) to describe common environmental triggers for dizziness in persons living with balance and vestibular disorders. A multi-centre cross-sectional study was conducted with four different centres on three different continents, including patients from the United States (Pittsburgh), Germany (Munich), Jordan (Amman) and Saudi Arabia (Riyadh). SUBJECTS Three hundred eighty one persons with vestibular disorders participated. METHODS A 9-item questionnaire (the Vestibular Environmental Scale) was developed from existing ICF items, which were compared to Dizziness Handicap Inventory (DHI) scores. Sixty-five percent of participants reported that "quick movements in the vicinity" increased symptoms, "crowds" at 45%, and "design of buildings, e.g. narrow hallways, stairs, elevators" at 42%. The "crowds" item was a good positive predictor of psychogenic vertigo (OR 1.8, 95% Confidence Interval 1.03-3.16), while "food" (OR 0.47, 95% Confidence Interval 0.17-1.29) and "light" (OR 0.41 95% Confidence Interval 0.23-0.75) were negative predictors of psychogenic vertigo. There also was a positive correlation between the number of triggers and DHI score (Spearman correlation coefficient 0.47, p < 0.0001). Sixty-eight percent of the subjects reported an increase in symptoms with between 1 and 4 environmental triggers. In our cross cultural sample, environmental triggers affect dizziness in persons living with balance and vestibular disorders. The use of items from the ICF of the WHO may help to promote cross cultural sharing of information in persons with dizziness.
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Affiliation(s)
- Susan L. Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Alia Alghwiri
- Faculty of Rehabilitation Sciences, Department of Physical Therapy, The University of Jordan, Amman, Jordan
| | - Kefah M. Alshebber
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mohammed Alshehri
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joseph M. Furman
- Department of Otolaryngology and Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Martin Mueller
- Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. Munich, Germany and the German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Marchioninistr. Munich, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. Munich, Germany and the German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Marchioninistr. Munich, Germany
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DizzyReg: the prospective patient registry of the German Center for Vertigo and Balance Disorders. J Neurol 2017; 264:34-36. [PMID: 28271410 DOI: 10.1007/s00415-017-8438-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 02/24/2017] [Indexed: 10/20/2022]
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Alghwiri AA, Alghadir AH, Al-momani MO, Whitney SL. The activities-specific balance confidence scale and berg balance scale: Reliability and validity in Arabic-speaking vestibular patients. J Vestib Res 2016; 25:253-9. [DOI: 10.3233/ves-160568] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Alia A. Alghwiri
- Department of Physical Therapy, Faculty of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Ahmad H. Alghadir
- College of Applied Medical Sciences, King Saud University Riyadh, Saudi Arabia
| | - Murad O. Al-momani
- ORL-HNS Department, College of Medicine, King Saud University Riyadh, Saudi Arabia
| | - Susan L. Whitney
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Abstract
Data related to the efficacy of vestibular rehabilitation and its evolution as an intervention are provided. Concepts and various treatment strategies are described, with explanations of why people with uncompensated peripheral and central vestibular disorders might improve with rehabilitation. Various tests and measures are described that are commonly used to examine patients and determine their level of ability to participate in their environment. Factors that affect recovery, both positively and negatively, are described in order to better prognosticate recovery. A case utilizing many of the principles discussed is included to provide insight into how to utilize vestibular rehabilitation with a person with an uncompensated peripheral vestibular loss.
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Alghadir AH, Al-Momani M, Marchetti GF, Whitney SL. Cross-cultural adaptation and measurement properties of the Arabic version of the Fall Efficacy Scale International. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2015; 20:230-5. [PMID: 26166590 PMCID: PMC4710342 DOI: 10.17712/nsj.2015.3.20140728] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 04/27/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To translate the Falls Efficacy Scale International (FES-I) into Arabic according to the World Health Organization`s (WHO) criteria and to evaluate the concurrent validity of the FES-I in persons living with balance and vestibular disorders. METHODS This cross-sectional descriptive study included 43 persons with balance and vestibular disorders presenting to an outpatient dizziness center at King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia between June 2012 and May 2013. All participants completed the Arabic version of the FES-I and the Dizziness Handicap Inventory (DHI) during their assessment with the clinical audiologist. In addition, subjects completed the Dynamic Gait Index 4-item (DGI-4) gait test. An additional 55 control participants also completed the Arabic FES-I, the DGI-4, and the Arabic DHI. RESULTS Forty-three participants with vestibular disorders (36 females, 7 males) with a mean age of 32 years (standard deviation (SD) 10 years, range 18-56 years) and 55 control participants (27 females, 28 males) with a mean age of 33, (SD-12), and age range of 18-78 participated. The correlation between the Arabic FES-I and the Arabic DHI was 0.75 in patients and 0.77 in control participants. The correlation between the Arabic FES-I and the DGI-4 was r=-0.30 (p=0.003). CONCLUSION The Arabic FES-I has established concurrent validity and may be helpful for measuring an individual`s concern of falling in people with vestibular and balance disorders.
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Affiliation(s)
- Ahmad H. Alghadir
- From the Rehabilitation Research Chair, Department of Rehabilitation Sciences (Alghadir, Whitney), College of Applied Medical Sciences, Department of Ear, Nose and Throat (Al-Momani), King Saud University, Riyadh, Kingdom of Saudi Arabia, the Department of Physical Therapy (Marchetti), University of Duquesne, and the Department of Physical Therapy and Otolaryngology (Whitney), University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Murad Al-Momani
- From the Rehabilitation Research Chair, Department of Rehabilitation Sciences (Alghadir, Whitney), College of Applied Medical Sciences, Department of Ear, Nose and Throat (Al-Momani), King Saud University, Riyadh, Kingdom of Saudi Arabia, the Department of Physical Therapy (Marchetti), University of Duquesne, and the Department of Physical Therapy and Otolaryngology (Whitney), University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Gregory F. Marchetti
- From the Rehabilitation Research Chair, Department of Rehabilitation Sciences (Alghadir, Whitney), College of Applied Medical Sciences, Department of Ear, Nose and Throat (Al-Momani), King Saud University, Riyadh, Kingdom of Saudi Arabia, the Department of Physical Therapy (Marchetti), University of Duquesne, and the Department of Physical Therapy and Otolaryngology (Whitney), University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Susan L. Whitney
- From the Rehabilitation Research Chair, Department of Rehabilitation Sciences (Alghadir, Whitney), College of Applied Medical Sciences, Department of Ear, Nose and Throat (Al-Momani), King Saud University, Riyadh, Kingdom of Saudi Arabia, the Department of Physical Therapy (Marchetti), University of Duquesne, and the Department of Physical Therapy and Otolaryngology (Whitney), University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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