Analysis of Factors Affecting the Outcomes of In-hospitalized Vestibular Rehabilitation in Patients With Intractable Dizziness

Group Vestibular Rehabilitation Program: A Cost-Effective Outpatient Management Option for Dizzy Patients

OBJECTIVES

This study was performed to evaluate the effectiveness of our novel group vestibular rehabilitation therapy (G-VRT) and to analyze the factors affecting outcomes.

STUDY DESIGN

Retrospective case series.

SETTING

Tertiary referral center.

PATIENTS

Patients with chronic dizziness who received G-VRT between December 2019 and July 2020.

INTERVENTION

The G-VRT program consisted of a 1-hour physical therapy session by an otologist in a small group setting.

MAIN OUTCOME MEASURES

Dizziness Handicap Inventory, visual analog scale, functional level scales, and video head impulse test, as well as the compliance to the program, were evaluated.

RESULTS

All scores of dizziness questionnaires were significantly improved after G-VRT ( p < 0.001). The overall vestibule-ocular reflex gain calculated by video head impulse test increased compared to the initial scores, whereas the average PR scores of all three semicircular canals significantly decreased from the initial scores, indicating enhanced vestibular compensation ( p < 0.05). Enrolled patients showed high compliance to the program.

CONCLUSION

G-VRT program is a cost-effective and efficient way to provide relief for chronic dizzy patients. Further case-control studies in a larger group, as well as comparative studies with generic or customized vestibular exercise, will be needed to validate the clinical value of G-VRT.

Factors affecting the outcome of vestibular rehabilitation in patients with peripheral vestibular disorders

OBJECTIVE

Previous studies have reported that developmental, environmental, medical, psychological, visual, and other sensory-related factors can influence the outcome of vestibular rehabilitation. However, only a few studies have used patient's daily lives as the main outcome. In addition, in some studies, rehabilitation was not supervised by a physical therapist. This study aimed to determine the factors associated with the outcome of physical-therapist-supervised vestibular rehabilitation in patients with peripheral vestibular disorders, with the impact of dizziness on quality of life as the main outcome.

METHODS

This retrospective cohort study included 47 patients with peripheral vestibular disorders. A physical therapist provided 40 min of vestibular rehabilitation once a week for 4 weeks. Age, sex, disease duration, Dizziness Handicap Inventory (DHI), Timed Up-and-Go test (TUG), Dynamic Gait Index (DGI), Functional Gait Assessment (FGA), Activity-Specific Balance Confidence Scale (ABC scale), and Hospital Anxiety and Depression Scale (HADS) were investigated. Multiple regression analysis was performed, with the DHI rate of change before and after the intervention as the objective variable.

RESULTS

Vestibular rehabilitation improved all outcomes. In the multiple regression analysis, the ABC scale was identified as a factor that significantly influenced the DHI rate of change (β = -0.428, p < 0.01).

CONCLUSION

A higher ABC scale score was associated with a lower DHI rate of change (i.e., better improvement). Therefore, it may be important to assess psychological aspects, especially confidence in balance, when implementing vestibular rehabilitation in patients with peripheral vestibular disorders.

Factors Associated With Rehabilitation Outcomes in Patients With Unilateral Vestibular Hypofunction: A Prospective Cohort Study

OBJECTIVE

The purpose of this study was to determine factors associated with rehabilitation outcomes following vestibular rehabilitation (VR).

METHODS

In this prospective cohort study, 116 patients who completed at least 2 supervised sessions participated. Patient characteristics and comorbidities were recorded. Initial and discharge measures included symptom intensity, balance confidence, quality of life, percent of time symptoms interfere with life, perceived benefits of VR, gait speed, fall risk, visual acuity during head movement, and anxiety/depression. Intention-to-treat analyses were performed to determine outcomes at discharge. Bivariate correlations between independent (group characteristics and baseline measures) and dependent (discharge measures) variables were determined. Logistic regressions were performed to identify factors associated with whether a patient would have a normal score or meaningful change at discharge.

RESULTS

There was a large effect of VR with significant improvement for the group as a whole on each outcome measure. For each outcome measure, most patients improved. Based on preliminary logistic regression, 2 patient characteristics were associated with outcome: number of therapy visits predicted meaningful improvement in gait speed, and falls after the onset of the unilateral vestibular hypofunction (UVH) predicted meaningful change in the percent of time symptoms interfered with life. Initial Activities-Specific Balance Confidence Scale (ABC) and Dynamic Gait Index scores predicted normal ABC scores at discharge, and initial ABC scores predicted recovery of Dynamic Gait Index scores. Preliminary prediction models were generated for balance confidence, impact of dizziness on life, dynamic visual acuity, gait speed, and fall risk.

CONCLUSIONS

Therapists may use these findings for patient education or to determine the need for adjunct therapy, such as counseling.

IMPACT

Not all people with UVH improve following VR, but there is little research examining why. This study looked at multiple factors and identified number of visits and falls after onset of UVH as patient characteristics associated with outcomes following VR; these findings will help therapists create better predictive models.

Changes in cognitive function in patients with intractable dizziness following vestibular rehabilitation

The purpose of the present study was to investigate changes in cognitive functions, including visuospatial ability, attention, and executive function in patients with intractable dizziness following vestibular rehabilitation. The correlations between improvements in cognitive function and dizziness-related variables and emotional distress were also explored. During hospitalization for 5 days, participants were trained on a vestibular rehabilitation program. Participants completed questionnaires including the Dizziness Handicap Inventory (DHI), Hospital Anxiety and Depression Scale (HADS), and Trail Making Test (TMT), which were used to assess cognitive function. The center of gravity fluctuation measurement and timed up and go test (TUG), which were objective dizziness severity indexes, were performed before, 1 month after, and 4 months after hospitalization. Following vestibular rehabilitation, participants exhibited a significant improvement in the TMT, DHI, HADS, and TUG scores. Correlation analysis between the variables at each time point indicated that TMT scores positively correlated with TUG at baseline. The correlation between changes observed in the TUG and TMT scores was not significant. The degree of improvement of the TUG score did not bear a linear relationship with that of the TMT scores. However, these correlation results were not completely consistent with those in the multiply imputed dataset.

Development and Validation of the Voice Catastrophization Index

INTRODUCTION

Catastrophization is a cognitive distortion that has been studied in pain patients and found to be a significant factor in their disability and response to treatment. Dysphonia patients may demonstrate a similar behavior, suggesting the existence of voice catastrophization.

OBJECTIVE

To establish the validity of the Voice Catastrophization Index (VCI), a new instrument estimating voice symptoms catastrophization.

METHODS

A prospective study. Patients with and without voice conditions were administered with the VCI, Voice-Related Quality of Life (V-RQOL), and the Generalized Anxiety Disorder-7 (GAD-7)questionnaires. Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) rating was determined for patients with voice conditions.

RESULTS

Ninety-one patients participated, 65 with voice conditions and 26 without. 61.5% were females; mean age was 49.8 ± 15.7 years. The VCI score for patients with voice conditions was significantly higher, 22.46 ± 16.56, compared with 3.96 ± 10.79, respectively (P value < 0.0001). The VCI demonstrated moderate correlation with both V-RQOL and GAD-7 scores: -0.562 and 0.560, respectively (P value < 0.000001); however, it showed no correlation with the CAPE-V. The VCI's internal consistency with each of its three dimensions and 13 items was acceptable to strong. The reproducibility and stability was demonstrated in a subgroup of 26 patients; 81% of these patients had a difference of 10 or less points between the two evaluations.

CONCLUSIONS

The VCI accomplished the requirements of a scale's validity for estimation of voice symptoms catastrophization in voice patients. The potential role of voice catastrophization as a predictor of treatment response and tailoring can now be investigated using the VCI.

Is the Headache in Patients with Vestibular Migraine Attenuated by Vestibular Rehabilitation?

Background

Vestibular rehabilitation is the most effective treatment for dizziness due to vestibular dysfunction. Given the biological relationship between vestibular symptoms and headache, headache in patients with vestibular migraine (VM) could be improved by vestibular rehabilitation that leads to the improvement of dizziness. This study aimed to compare the effects of vestibular rehabilitation on headache and other outcomes relating to dizziness, and the psychological factors in patients with VM patients, patients with dizziness and tension-type headache, and patients without headache.

Methods

Our participants included 251 patients with dizziness comprising 28 patients with VM, 79 patients with tension-type headache, and 144 patients without headache. Participants were hospitalized for 5 days and taught to conduct a vestibular rehabilitation program. They were assessed using the Dizziness Handicap Inventory (DHI), Headache Impact Test (HIT-6), Hospital Anxiety and Depression Scale (HADS), and Somatosensory Catastrophizing Scale (SSCS) and underwent center of gravity fluctuation measurement as an objective dizziness severity index before, 1 month after, and 4 months after their hospitalization.

Results

The VM and tension-type headache groups demonstrated a significant improvement in the HIT-6 score with improvement of the DHI, HADS, SSCS, and a part of the objective dizziness index that also shown in patients without headache following vestibular rehabilitation. The change in HIT-6 during rehabilitation in the VM group was positively correlated with changes in the DHI and anxiety in the HADS. Changes in the HIT-6 in tension-type headache group positively correlated with changes in anxiety and SSCS.

Conclusion

Vestibular rehabilitation contributed to improvement of headache both in patients with VM and patients with dizziness and tension-type headache, in addition to improvement of dizziness and psychological factors. Improvement in dizziness following vestibular rehabilitation could be associated with the improvement of headache more prominently in VM compared with comorbid tension-type headache.