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Wolf J, Limburg K, Sattel H, Lahmann C. Perceived illness consequences predict the long-term course of handicap in patients with vertigo and dizziness beyond vestibular abnormality. J Psychosom Res 2023; 172:111401. [PMID: 37315402 DOI: 10.1016/j.jpsychores.2023.111401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Vertigo and dizziness (VD) affect one third of the population during their lifetime. VD patients are oftentimes severely handicapped. One current study showed that illness perceptions, emotional as well as behavioral responses to illness were associated with VD-related handicap at 3-months follow-up. However, no study has yet investigated this association for a period longer than six months. This study aimed to investigate long-term associations of cognitive, emotional, and behavioral factors with VD-related handicap. METHODS In a naturalistic longitudinal study design, n = 161 patients with VD were examined at baseline, at 6-months follow-up, and at 12-months follow-up. Participants underwent neurological and psychiatric examinations as well as comprehensive psychological assessments using self-report questionnaires. RESULTS During the study period VD-related handicap decreased significantly (Cohen's d = .35, p < .001). Cognitive, emotional, and behavioral factors remained without significant change during the study period. Vestibular testing as well as the type of diagnosis were not associated with changes in VD-related handicap. Changes in perceived illness consequences (ß = .265, p < .001), depression (ß = .257, p < .001), and anxiety (ß = .206, p = .008) significantly predicted the course of VD-related handicap over 12 months, while the presence vs. absence of vestibular abnormality did not. CONCLUSION Our results extend findings that cognitive and emotional factors including perceived illness consequences, depression, and anxiety are associated with the long-term course of VD-related handicap and may provide therapeutic targets to improve long-term outcomes in patients with VD.
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Affiliation(s)
- Johannes Wolf
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians-University Munich, Munich, Germany.
| | - Karina Limburg
- Department of Conservative Orthopedics, Manual Medicine, and Pain Medicine, SANA Hospital, Munich, Germany
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Hospital Rechts der Isar, Technical University Munich, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Freiburg, Albert-Ludwigs-University Freiburg, Germany
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La Touche R, Castillejos-Carrasco-Muñoz R, Tapia-Toca MC, Pardo-Montero J, Lerma-Lara S, de la Rosa-Díaz I, Sorrel-Luján MÁ, Paris-Alemany A. Development and validation of the dizziness fear-avoidance behaviours and beliefs inventory for patients with vestibular disorders. PeerJ 2023; 11:e15940. [PMID: 37663281 PMCID: PMC10473040 DOI: 10.7717/peerj.15940] [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] [Received: 03/15/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
The purpose of this study is to present the development and analysis of the factorial structure and psychometric properties of a new self-administered questionnaire (Dizziness Fear-Avoidance Behaviours and Beliefs Inventory (D-FABBI)) designed to measure fear-avoidance behaviors and cognitions related to dizziness disability. A mixed-method design combining a qualitative study with an observational and cross-sectional study was employed to develop (content validity) and psychometrically validate (construct validity, reliability, and convergent/discriminant validity) a new instrument. A total of 198 patients with vestibular disorders (acute vestibular syndrome (AVS), 23.2%; chronic vestibular syndrome (CVS), 35.4%; and episodic vestibular syndrome (EVS) 41.4%) were recruited. Sociodemographic characteristics, the Dizziness Handicap Inventory (DHI) and the Hospital Anxiety and Depression Scale (HADS) and D-FABBI were evaluated. The final version of the D-FABBI consists of 17 items distributed across two subscales: activities of daily living fear-avoidance and movement fear-avoidance. The D-FABBI showed high internal consistency (Cronbach α = 0.932; 95% CI [0.91-0.94]) and so did the subscales (Cronbach α > 0.8). The exploratory structural equation model and confirmatory factor analysis provided better fit results, with a comparative fit index and root mean square error of approximation values of 0.907 to 0.081. No floor or ceiling effects were identified. There was a positive, significant, and moderate-strong magnitude correlation with the total DHI (r = 0.62) and low-moderate with respect to the HADS depression (r = 0.35) and HADS anxiety subscales (r = 0.26). The patients with CVS had a higher D-FABBI score than those with AVS or EVS. The D-FABBI appears to be a valid and reliable instrument for measuring the fear-avoidance behaviors and cognition related to dizziness disability of patients with vestibular disorders.
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Affiliation(s)
- Roy La Touche
- Motion in Brains, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Spain
- Department of Physiotherapy, Centro superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - María Cruz Tapia-Toca
- Instituto de Otorrinolaringología y Cirugía de Cabeza y Cuello de Madrid, Madrid, Spain
| | - Joaquín Pardo-Montero
- Motion in Brains, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
- Department of Physiotherapy, Centro superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Sergio Lerma-Lara
- Motion in Brains, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
- Department of Physiotherapy, Centro superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Irene de la Rosa-Díaz
- Motion in Brains, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
- Department of Physiotherapy, Centro superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Alba Paris-Alemany
- Motion in Brains, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Spain
- Departamento de Radiología, Rehabilitación y Fisioterapia. Facultad de Enfermería, Fisioterapia y Podología. Universidad Complutense de Madrid, Madrid, Spain
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Picariello F, Chilcot J, Chalder T, Herdman D, Moss-Morris R. The Cognitive and Behavioural Responses to Symptoms Questionnaire (CBRQ): Development, reliability and validity across several long-term conditions. Br J Health Psychol 2023; 28:619-638. [PMID: 36690909 DOI: 10.1111/bjhp.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/07/2022] [Accepted: 01/06/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Cognitive and behavioural responses to symptoms can worsen or maintain the severity of symptoms across long-term conditions (LTCs). Although the Cognitive and Behavioural Responses Questionnaire (CBRQ) has been used in research, its original development and psychometric properties as a transdiagnostic measure have not been reported. Our aim was to evaluate the psychometric properties of the CBRQ and a recently proposed short version, across different LTCs. DESIGN Psychometric validation study. METHODS Confirmatory factor analysis (CFA) tested the factor structure of the CBRQ in two datasets from the CBRQ's original development; (chronic fatigue syndrome, N = 230; and multiple sclerosis, N = 221) and in additional groups: haemodialysis (N = 174), inflammatory bowel disease (N = 182) and chronic dizziness (N = 185). Scale reliability and construct validity were assessed. The factor structure of the shortened CBRQ (CBRQ-SF) was also assessed. RESULTS CFA revealed that a 7-or 8-factor structure had generally appropriate fit supporting the originally proposed 7 factors (Fear avoidance, Damage beliefs, Catastrophising, Embarrassment avoidance, Symptom focusing, All-or-nothing behaviour and Avoidance/Resting behaviour). Omega coefficients indicated satisfactory internal reliability. Correlations with related constructs suggested construct validity. The scale appeared sensitive to change. The CBRQ-SF also displayed good psychometric quality, with a better model fit than the CBRQ. CONCLUSIONS The CBRQ and the shortened version were shown to be reliable and valid at assessing a range of cognitive and behavioural responses to symptoms, highlighting the multi-symptom, transdiagnostic properties of this questionnaire. Further research is necessary to determine the test-retest reliability and sensitivity to change of the CBRQ and CBRQ-SF and a thorough evaluation of the content validity of the items.
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Affiliation(s)
- Federica Picariello
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - Joseph Chilcot
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - Trudie Chalder
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - David Herdman
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK.,St George's University Hospitals NHS Foundation Trust, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
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赵 奕, 陈 钢, 李 育, 郑 智, 周 丽, 李 莹, 杨 捷, 吴 佳. [Application of computerized cognitive behavioral therapy in patients with persistent postural-perceptual dizziness]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:781-788. [PMID: 36217659 PMCID: PMC10128567 DOI: 10.13201/j.issn.2096-7993.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Indexed: 06/16/2023]
Abstract
Objective:A computerized cognitive behavioral therapy intervention program was constructed for patients with persistent postural-perception dizziness(PPPD) and its effects on dizziness symptoms, negative emotions and balance function were investigated. Methods:A randomized controlled trial design was used to select 86 patients with PPPD who were seen in the Department of Otorhinolaryngology Head and Neck Surgery, First Hospital of Shanxi Medical University from July 2020 to July 2021. Randomly assigned to the control group(43 patients) and the experimental group(43 patients). The control group was routinely treated with medication and vestibular rehabilitation, while the experimental group underwent computerized cognitive behavioral therapy for a total of 9 sessions over 8 weeks; their dizziness symptoms(DHI), negative affect(GAD-7, PHQ-9) and balance function(BBS) were compared at baseline, 4 and 8 weeks later. Results:After 4 and 8 weeks of intervention, the improvement of dizziness symptoms and negative mood in both groups had a between-group effect, time effect, and interaction effect(P<0.05). The improvement of balance function had only a time effect and interaction effect(P<0.05), and no difference in between-group effect was seen(P>0.05). Conclusion:Computerized cognitive behavioral therapy can be used as an adjunctive treatment to alleviate patients' dizziness, negative affect, and balance function, but no additional benefit has been seen in terms of balance function improvement.
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Affiliation(s)
- 奕雯 赵
- 山西医科大学第一医院耳鼻咽喉头颈外科(太原,030001)Department of Otorhinolaryngology Head and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - 钢钢 陈
- 山西医科大学第一医院耳鼻咽喉头颈外科(太原,030001)Department of Otorhinolaryngology Head and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - 育玲 李
- 山西医科大学第一医院护理部Department of Nursing, First Hospital of Shanxi Medical University
| | - 智英 郑
- 山西医科大学第一医院耳鼻咽喉头颈外科(太原,030001)Department of Otorhinolaryngology Head and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - 丽媛 周
- 山西医科大学第一医院耳鼻咽喉头颈外科(太原,030001)Department of Otorhinolaryngology Head and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - 莹 李
- 山西医科大学第一医院耳鼻咽喉头颈外科(太原,030001)Department of Otorhinolaryngology Head and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - 捷 杨
- 山西医科大学第一医院耳鼻咽喉头颈外科(太原,030001)Department of Otorhinolaryngology Head and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - 佳鑫 吴
- 山西医科大学第一医院耳鼻咽喉头颈外科(太原,030001)Department of Otorhinolaryngology Head and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, 030001, China
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Herdman D, Norton S, Murdin L, Frost K, Pavlou M, Moss-Morris R. The INVEST trial: a randomised feasibility trial of psychologically informed vestibular rehabilitation versus current gold standard physiotherapy for people with Persistent Postural Perceptual Dizziness. J Neurol 2022; 269:4753-4763. [PMID: 35397754 PMCID: PMC8994825 DOI: 10.1007/s00415-022-11107-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Persistent postural perceptual dizziness (PPPD) is a common and disabling functional neuro-vestibular disorder. We aimed to determine the feasibility and acceptability of conducting a randomised controlled trial of cognitive-behavioural therapy informed vestibular rehabilitation (INVEST intervention) designed for persistent dizziness. METHODS A two-armed parallel groups randomised feasibility study of INVEST vs. a time-matched gold standard vestibular rehabilitation (VRT) control. Participants with PPPD were recruited from a specialist vestibular clinic in London, UK. Participants were individually randomised using a minimisation procedure with allocation concealment. Measures of feasibility and clinical outcome were collected and assessed at 4 months. RESULTS Forty adults with PPPD were randomised to six sessions of INVEST (n = 20) or gold standard VRT (n = 20). Overall, 59% of patients screened met the inclusion criteria, of which 80% enrolled. Acceptability of INVEST, as assessed against the theoretical framework of acceptability (TFA), was excellent and 80% adhered to all 6 sessions. There were small to moderate treatment effects in favour of INVEST across all measures, including dizziness handicap, negative illness perceptions, symptom focussing, fear avoidance, and distress (standardised mean difference [SMD]g = 0.45; SMDg = 0.77; SMDg = 0.56; SMDg = 0.50, respectively). No intervention-related serious adverse events were reported. CONCLUSIONS The study results give strong support for the feasibility of a full-scale trial. Both arms had high rates of recruitment, retention, and acceptability. There was promising support of the benefits of integrated cognitive-behavioural therapy-based vestibular rehabilitation compared to gold standard vestibular rehabilitation. The study fulfilled all the a-priori criteria to advance to a full-scale efficacy trial. TRIAL REGISTRATION NUMBER ISRCTN10420559.
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Affiliation(s)
- David Herdman
- Health Psychology, Institute of Psychiatry Psychology and Neuroscience, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sam Norton
- Health Psychology, Institute of Psychiatry Psychology and Neuroscience, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT, UK
- Centre for Rheumatic Diseases, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Louisa Murdin
- Guy's and St, Thomas' NHS Foundation Trust, London, UK
- Ear Institute, University College London, London, UK
| | - Kate Frost
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Marousa Pavlou
- Centre of Human and Applied Physiological Sciences, King's College London, London, UK
| | - Rona Moss-Morris
- Health Psychology, Institute of Psychiatry Psychology and Neuroscience, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT, UK.
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Prell T, Finn S, Zipprich HM, Axer H. What Predicts Improvement of Dizziness after Multimodal and Interdisciplinary Day Care Treatment? J Clin Med 2022; 11:jcm11072005. [PMID: 35407613 PMCID: PMC8999937 DOI: 10.3390/jcm11072005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Vertigo and dizziness are common in community-dwelling people and can be treated in specialized multidisciplinary settings. To develop tailored interventions, however, we have to explore risk factors for favorable and unfavorable outcomes. Methods: We prospectively investigated patients with chronic vertigo and dizziness subjected to our 5-day multimodal and interdisciplinary day care treatment in the Center for Vertigo and Dizziness of Jena University Hospital, Germany. The Vertigo Severity Scale (VSS), the Body Sensations Questionnaire (BSQ), the Hospital Anxiety and Depression Scale (HADS), the Agoraphobic Cognitions Questionnaire (ACQ), the Mobility Inventory (MI), and the burden and intensity of dizziness (using a visual analogue scale) were assessed at baseline (n = 754) and after 6 months (n = 444). In addition, 14 Likert-scaled questions were used to quantify the change in personal attitude and behavior towards the complaints after 6 months. Results: Dizziness-related burden and intensity improved with a large effect size. The largest improvement was seen in the attitudes towards dizziness, the understanding of somatic causes, and the perceived ability to influence dizziness. However, the ability to work and to carry out professional activity was improved to a lesser extent. The overall improvement of dizziness was associated with the absence of a depressive mood, a short duration of vertigo, a lower VSS, a lower perceived intensity of vertigo, and distinct vertigo diagnoses, namely Meniere’s disease, vestibular migraine, vestibular neuritis, vestibular paroxysmia, and vestibular schwannoma. Worsening of dizziness/vertigo was associated with depressive symptoms, permanent vertigo, distinct vertigo diagnoses (central vertigo, multisensory deficit), and a higher perceived burden due to vertigo. Conclusion: The six-month outcome of patients with dizziness presented to a specialized outpatient clinic appears to be favorable. Nevertheless, people with the abovementioned risk factors at baseline have less benefit and probably need adapted and tailored vertigo interventions to improve long-term outcome.
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Affiliation(s)
- Tino Prell
- Department of Geriatrics, Halle University Hospital, 06120 Halle, Germany;
| | - Sigrid Finn
- Center for Vertigo and Dizziness, Jena University Hospital, Friedrich Schiller University, 07743 Jena, Germany;
| | - Hannah M. Zipprich
- Center for Healthy Ageing, Jena University Hospital, Friedrich Schiller University, 07743 Jena, Germany;
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, 07743 Jena, Germany
- Correspondence: ; Tel.: +49-3641-9323454; Fax: +49-3641-9323402
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Herdman D, Picariello F, Moss-Morris R. Validity of the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) in Patients With Dizziness. Otol Neurotol 2022; 43:e361-e367. [PMID: 34999617 DOI: 10.1097/mao.0000000000003460] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS The Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) will be a valid and reliable combined measure of depression and anxiety in people with vertigo and dizziness. BACKGROUND Co-occurrence of depressive, anxiety, and somatic symptoms are common. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder Scale-7 (GAD-7) measure symptoms of depression and anxiety respectively, although measuring them separately may be suboptimal in people who have illness-related distress. There is some evidence that these scales can be combined in long-term conditions resulting in the PHQ-ADS, but validity is yet to be determined in people with vertigo and dizziness. METHODS Two separate datasets from a tertiary vestibular clinic were analyzed where the PHQ-ADS was completed at initial clinical assessment (n = 624) and while on a waiting list (n = 185). A cross-sectional design was used to examine the factor structure (confirmatory factor analysis), internal consistency (omega index), and construct validity (Pearson correlation coefficient) of the PHQ-ADS. Construct validity was determined against the dizziness handicap inventory (DHI). RESULTS A bi-factor PHQ-ADS model had good fit to the data (χ2 = 397.163, 249.763; comparative fit index [CFI] = 0.954, 0.919; Tucker-Lewis index [TLI] = 0.938, 0.892; root mean squared error of approximation [RMSEA] = 0.076, 0.098). The general distress factor explained 81 to 85% of the common variance between items. There were moderate to large significant positive correlations between the PHQ-ADS and DHI. CONCLUSION The PHQ-ADS appears to have good structural validity in patients with vertigo and dizziness. Clinicians and researchers can use this scale where a composite psychological measure is desired.
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Affiliation(s)
- David Herdman
- Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King's College London
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Federica Picariello
- Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King's College London
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King's College London
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Herdman D, Norton S, Pavlou M, Murdin L, Moss-Morris R. Protocol for a randomised controlled feasibility study of psychologically informed vestibular rehabilitation for people with persistent dizziness: INVEST trial. Pilot Feasibility Stud 2021; 7:156. [PMID: 34399847 PMCID: PMC8364941 DOI: 10.1186/s40814-021-00896-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 07/30/2021] [Indexed: 12/23/2022] Open
Abstract
Background Dizziness is a common complaint that often persists and leads to disability and distress. Several cognitive and behavioural responses may contribute to the neurobiological adaptations that maintain persistent vestibular symptoms. This paper will present the protocol of a two-arm parallel group feasibility randomised controlled trial designed to determine whether a fully powered efficacy trial is achievable by examining the feasibility of recruitment, acceptability and potential benefits of an integrated cognitive behavioural therapy and vestibular rehabilitation (CBT-VR) treatment for people with persistent dizziness. Methods Forty adult patients will be recruited from a tertiary vestibular clinic with persistent movement–triggered dizziness for 3 months or longer who have moderate–high levels of dizziness handicap. Participants will be 1:1 randomised, using a minimisation procedure, to six sessions of either CBT-VR (intervention arm) or VR only (control arm). Measures will be collected at baseline and 4 months post randomisation. The primary feasibility outcomes include descriptive data on numbers meeting eligibility criteria, rates of recruitment, numbers retained post randomisation, treatment adherence and an acceptability questionnaire. Treatment effects on self-report outcomes will be estimated to determine that 95% confidence intervals for the effects are consistent with anticipated effects and minimum clinically important differences, and to provide information needed for the power calculation of an efficacy trial. A nested qualitative study will be conducted post-intervention (intervention group only) to explore the acceptability of the intervention and identify any areas in need of improvement. Discussion If a trial of CBT-VR is feasible, acceptability data will be used to enhance the intervention if needed and refine the multicentre RCT protocol. Future studies will need to consider the training required for other physiotherapists to deliver the intervention. Trial registration ClinicalTrials.gov, ISRCTN 10420559 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00896-y.
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Affiliation(s)
- David Herdman
- Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sam Norton
- Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Marousa Pavlou
- Centre of Human and Aerospace Physiological Sciences, King's College London, London, UK
| | - Louisa Murdin
- Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Ear Institute, University College London, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.
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