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144 BALANCE FUNCTION ASSESSMENT AND MANAGEMENT
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WORLD HEALTH ORGANIZATION ICIDH
The International Classification of Impairments, Disabilities, and Handicaps (ICIDH) is a classification system developed by the WHO in 1980 used for describing
the consequences of health conditions, wherein the
terms impairment, disability, and handicap were differentiated from one another and operationally defined
(WHO, 1980). In 2001, the WHO updated its classification system into what is now called the International
Classification of Functioning Disability and Health
(ICF) (Centers for Disease Control and Prevention,
2002). The new system includes a taxonomy that permits the description of the magnitude of disability and
handicap for diseases and disorders that are identified
in the ICD-10 coding system. Additionally, the new
ICF classification system acknowledges contextual factors that include both exogenous, environmental factors
(e.g., social norms, political factors, institutions), and
endogenous personal factors (e.g., coping skills, education, past experience). Collectively, these factors can
influence the magnitude of both activity limitations
and participation restrictions. In the ICF, neither the
term disability nor handicap is used. Instead, these data
are captured as activity limitations and participation
restrictions that occur as a result of changes in body
function and structure that result from a disease or disorder. Formal definitions of these components of ICF
are shown in Table 8–1. Concepts and definitions from
WHO and ICF are often incorporated into the development of DRQoL measures (Alghwiri, Marchetti, &
Whitney, 2011).
TOOLS FOR MEASURING DRQoL
Factors to Consider When Selecting a
Tool for Clinical or Research Application
When choosing a questionnaire to assess DRQoL, careful consideration should be given to the content of
the tool (e.g., domains of assessment) as well as to its
ultimate application (e.g., to assess treatment-related
change). An appropriate measure to include in an evaluation should be supported by evidence demonstrating that it is acceptable to the patient, reliable, valid,
and responsive (i.e., sensitive to change). The adequacy
of each of these latter criteria should be based on evidence discerned from the psychometric characteristics
of the selected measurement tool. Furthermore, a number of practical issues need to be considered prior to
using a specific measure in clinical practice or when
incorporating a dizziness questionnaire as part of a
research methodology. These include such factors as
ease of administration (i.e., burden on the patient, cli-
Table 8–1. Definitions from the ICF
Body functions: physiologic functions of body systems
Body structures: anatomic parts of the body such as
organs, limbs, and their components
Impairments: problems in body function or structures
such as significant deviation or loss
Activity: execution of a task or action by an individual
Participation: involvement in a life situation
Activity limitations: difficulties an individual may have in
executing activities (i.e., formerly referred to as disability)
Participation restrictions: problems an individual may
experience in involvement in life situations (i.e., formerly
referred to as handicap)
Environmental factors:
and attitudinal environment in which people live and
conduct their lives.
Source: Centers for Disease Control and Prevention (2002), p. 10.
make up the physical, social,
8. AssEssing dizzinEss-rElAtEd QuAlity oF liFE 145
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nician, or researcher), scoring, and interpretation. The
psychometric property of responsiveness is especially
important when selecting a measure that will be used
to detect treatment-related DRQoL changes (Friscia,
Morgan, Sparto, Furman, & Whitney, 2014). Prior to
choosing a DRQoL tool, clinicians and/or researchers
should understand these factors and select a tool that
both is psychometrically sound and fits their specific
needs. The reader is directed to Fitzpatrick et al. (1998)
for a tutorial on psychometric properties of self-report
quality-of-life measures and to Hyde (2000) for additional information regarding scoring methods frequently utilized in DRQoL tools.
General and Disease-Specific
Measurement Tools
Self-report measures can be classified as “general” or
“disease/disorder specific.” General scales assess constructs that are relevant to a broad range of health conditions (e.g., anxiety, personality traits). The advantage
of using a general measurement tool is that the results
can be compared across patient groups of various disorders (i.e., results are generalizable). For example, one
could measure levels of anxiety in patients with dizziness and compare that with levels of anxiety in patients
with rheumatoid arthritis. However, there are several
disadvantages to using general scales. First, the instrument has to cover a wide range of disorders; thus it may
be lengthy and time-consuming and include questions
irrelevant to the patient. Second, general questionnaires may be unresponsive to small changes in your
specific patient. Last, results from general questionnaires may be confounded by other health problems.
Table 8–2 lists the general/generic questionnaires that
have either been shown to have good reliability and/or
validity in populations of dizzy patients or have been
used to assess convergent validity in the development
of dizziness-specific questionnaires. These scales assess
constructs including quality of life, general health/disability, anxiety, depression, and coping.
In contrast to general scales, disease-specific measurement tools are designed to assess constructs particular to a condition or illness of interest. The advantages
of using a disease-specific scale include the following:
(1) all items are, by definition, relevant to the patient;
(2) the measures tend to be brief to administer; (3) the
content validity is often high as items are specific to
the needs and concerns of the patient; and (4) diseasespecific scales are considered more appropriate for measuring treatment outcome. The greatest disadvantage to
using a disease-specific tool is the loss of generalizability because scores cannot be compared across disease
conditions. The Dizziness Handicap Inventory (DHI;
Jacobson & Newman, 1990) is one of the first, the most
heavily studied, and most often utilized disease-specific
measurement tool used for patients with dizziness.
Since the DHI’s creation in 1990, numerous additional
questionnaires have been developed specifically for
patients with dizziness, vertigo, and/or unsteadiness.
Tables 8–3 through 8–7 show each of the dizzinessspecific questionnaires available to clinicians and researchers. In addition to psychometric factors, such as
validity and reliability, one must also consider what
domains of function you want to measure. We have categorized the 21 dizziness-specific questionnaires based
on the construct(s) each aims to quantify. Categories
include those tools aimed to measure dizziness symptoms, activity limitation/participation restriction, a mix
of symptoms impact on DRQoL, or tools designed to
measure the effects of specific diseases within a dizzy
population (i.e., Ménière’s disease) or age group (i.e.,
pediatrics). Several pediatric-specific questionnaires
have recently been developed to address complaints of
dizziness and vertigo in children. These are included
in Table 8–7.
It is beyond the scope of this chapter to present
an in-depth discussion regarding the psychometric
characteristics of each dizziness-specific questionnaire
available to the clinician or researcher. Several of the
most heavily researched and used questionnaires are
discussed in greater detail in the following sections of
this chapter.
table 8–2. General/Generic Scales Often Used in Dizzy Populations for Clinical Research, Clinical
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Assessment, and
Name Purpose
Outcomes
Basic Symptom Inventory-53 (BSI-53)
Derogatis & Melisaratos, 1983; Ruckenstein &
(
Staab, 2001)
Beck Anxiety Index (BAI)
(Beck, Epstein, Brown, & Steer, 1988)
Beck Depression Inventory (BDI)
(Beck, Ward,
1961)
European Quality of Life Scale (EQ-5D)
(EuroQoL Group, 1990)
General Health Questionnaire (GHQ-12)
Goldberg & Hillier, 1979)
(
Hospital Anxiety and Depression Scale
(HADS)
(Zigmond & Snaith, 1983)
Medical Outcomes Study Short form (SF-36)
(Stewart, Hays, & Ware, 1988)
Patient Intentions Questionnaire (PIQ)
(
Salmon & Quine, 1989)
Mendelson, Mock, & Erbaugh,
To reflect the psychological systems of
psychiatric, medical, and normal individuals
To measure the severity of anxiety in
psychiatric populations
Measures characteristic attitudes and
symptoms of depression
To describe and measure health states and
health outcome
Focuses on the inability to carry out normal
functions and the appearance of new and
distressing experiences
To determine levels of anxiety and depression
in an outpatient setting
Yields an eight-scale profile of functional
health and well-being
To measure patients’ expectations and what
they want from the clinician during a given
visit
PRIME-MD Patient Health Questionnaire
(PHQ)
(
Spitzer, Kroenke, & Williams, 1999)
Sense of Coherence Scale (SOC)
(Antonovsky, 1993)
Sickness Impact Profile (SIP)
(Gilson et al., 1975)
State-Trait Anxiety Inventory (STAI)
Spielberger, 1984)
(
Ways of Coping
(Folkman & Lazarus, 1980)
World Health Organization Disability
Assessment Schedule II (WHO-DAS II)
(Ustun et al., 2010)
World Health Organization Quality of Life–
Brief (WHOQoL-Brief)
(WHOQOL, 1995)
Diagnostic tool for mental health disorders
used by health care professionals
To assess how people view life and to identify
general coping resources used to maintain
To measure quality of life and level of
dysfunction that result from disability or illness
To measure trait and state anxiety and to
distinguish anxiety from depressive syndromes
To measure the thoughts and actions people
use to handle stressful situations
To assess health and disability across all
diseases, including mental, neurological, and
addictive disorders
To assess individual perceptions of quality
of life in the context of their culture and
value system, personal goals, standards, and
concerns
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table 8–3. Tools Designed to Measure Dizziness Symptoms
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Name (Reference) Validation Items, Subscales Scoring Purpose, Examples
European
Evaluation of
Vertigo (EEV)
Megnigbeto,
(
Sauvage, &
Launois, 2001)
Modified Falls
Efficacy Scale
(MFES)
(Hill,
Schwarz,
Kalogeropoulos, &
Gibson, 1996)
Motion Sensitivity
Quotient (MSQ)
(
Smith-Wheelock,
Shepard, & Telian,
1991)
Validated in adults
with episode of
vertigo occurring
during the previous
week (n = 123)
Validated in
healthy community
dwelling elderly
adults (n = 111)
and in older adults
referred to a Falls
and Balance Clinic
(n = 68)
Validated in 15
dizzy patients
Five items (illusion
of movement,
duration of the
illusion, motion
intolerance,
neurovegetative
signs, instability)
14 activities Rated on a
16 questions
regarding dizziness
with movement
0 to 4-point scale To assess vertigo
10-point visual
analogue scale
from “not at all
confident” to
“completely
confident”
Yields two scores:
intensity (1- to
5-point scale) and
duration (1- to
3-point scale)
Total score is the
sum of the intensity
and duration
scores
symptoms and
associated
vestibular
symptoms
independent of
handicap
e.g., rate
your “motion
intolerance”
To measure selfperceived fear of
falling during the
performance of 14
common activities
e.g., “How confident
are you that you
can use public
transport without
falling?”
To quantify
the severity of
symptoms evoked
by movements
e.g., supine to
sitting (rate intensity
and duration of
dizziness or vertigo)
Visual Vertigo
Analog Scale
(VVAS)
Dannenbaum,
(
Chilingaryan, &
Fung, 2011)
Vertigo Symptom
Scale (VSS)
(Yardley, Masson,
Verschuur, Haacke,
& Luxon, 1992)
Validated in adults
with vestibular
diseases (n = 102)
Validated in adults
with dizziness and/
or vertigo (n = 127)
Nine items that
typically induce
visual vertigo
36 items total
Two subscales:
(1) vertigo severity,
and (2) autonomic
and anxiety
symptoms
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Patients rate the
intensity of their
dizziness on each
item by drawing a
vertical line on a
10-cm anchored
line
Six-point scale: 0
(never) to 5 (very
often)
To provide a
quantitative
evaluation of visual
vertigo
e.g., “
Rate the
dizziness you
experience when
under fluorescent
lights”
To assess and
differentiate
symptoms of
vertigo from
autonomic/ anxiety
symptoms
e.g., “How often
in the past month
have you had
the following
symptoms: nausea,
vomiting?”
table 8–4. Tools Designed to Measure Dizziness Handicap and Quality of Life
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Name (Reference) Validation Items, Subscales Scoring Purpose, Examples
ActivitiesSpecific Balance
Confidence Scale
(ABC)
(Powell & Myers,
1995)
Dizziness Handicap
Inventory (DHI)
(Jacobson &
Newman, 1990)
Vestibular
Disorders Activities
of Daily Living
(VADL)
(Cohen & Kimball,
2000)
Validated in
communitydwelling adults 65
years and older
(n = 60)
Validated in
adults referred for
vestibular testing (n
= 106)
Validated in adults
seen for vestibular
rehabilitation (n =
94)
16 items
25 items, three
subscales
(emotional,
functional,
physical)
28 items, three
subscales
(functional,
ambulation,
instrumental)
Scores range from
0 (no confidence)
to 100 (complete
confidence)
Items rated
and scored as
“yes” (4 points),
“sometimes” (2
points), and “no” (0
points)
10-point scale:
1 (independent) to
10 (too difficult, no
longer perform)
To assess loss
of balance
confidence in
senior citizens and
to discriminate
between “fallers”
and “nonfallers”
e.g., “How confident
are you that
you will not lose
your balance or
become unsteady
when you walk up
or down stairs?”
To evaluate the
self-perceived
handicapping
effects imposed by
vestibular system
disease
Does looking
e.g., “
up increase your
problem?”
To assess selfperceived
disablement
in patients
with vestibular
impairments
by assessing
independence in
routine activities of
daily living
e.g., “
Indicate
the level that
most accurately
describes how you
perform the task:
Carrying things
while walking”
Vertigo Handicap
Questionnaire
(VHQ)
(Yardley & Putman,
1992)
Validated in adults
with chronic
dizziness and/or
vertigo complaints
from 6 months to 5
years (n = 84)
25 items, four
subscales
(restriction of
activity, social
anxiety, fears about
vertigo, severity of
vertigo attacks)
148
5-point scale:
0 (no handicap)
to 4 (maximum
handicap)
To assess patientperceived common
beliefs, behavior,
and difficulties
(i.e., handicap)
associated with
vertigo
table 8–5. Tools Designed to Measure a Blend of Symptoms, Disability, Handicap, and/or Quality of Life
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Name (Reference) Validation Items, Subscales Scoring Purpose, Examples
Dizziness Belief
Scale (DBS)
Yardley, Beech, &
(
Weinman, 2001)
Dizzy Factor
Inventory (DFI)
(Hazlett,
Waranch, 1996)
Dizziness Needs
Assessment
(DiNA)
(Kruschinski,
Klaassen, Breull,
Broll, & HummersPradier, 2010)
UCLA Dizziness
Questionnaire
(UCLA-DQ)
(Honrubia, Bell,
Harris, Baloh, &
Fisher, 1996)
Tusa, &
Validated in adults
with complaints
of dizziness and
disequilibrium
(n = 159)
Validated in
adults referred
to neurologist for
complaints of
dizziness (n = 184)
Validated in
German-speaking
adults 65 years
and older seen
by general
practitioners and
reporting dizziness
(n = 123)
Validated in
adults seen in
neurotology clinic
with complaints of
dizziness (n = 362)
Eleven beliefs
about negative
consequences of
dizziness
44 items, three
subscales
(symptom factors,
responses of
significant others
to dizzy patient,
activity level)
18 items, four
subscales
(handicap and
mobility, empathy
and help, causes,
doctor realizes
suffering)
Five items:
frequency, severity,
limitation of daily
activities, general
quality of life, fear
of dizziness
Five-point scale:
strongly agree to
strongly disagree
Five-point scale:
word anchors
change according
to content of item
Seven-point Likert
scale
Five-point ranking
scale with anchors
specific to item
To evaluate the
negative anticipated
consequences of
dizziness,
e.g., “When
dizzy
down”
To be used as
preliminary
screening device
and to aid in the
selection of further
diagnostic testing or
treatment strategies
To assess priorities of
elderly patients with
dizziness
To obtain an
overview of patient’s
subjective analysis
of their condition
and provide the
clinician with
information not
usually available at
the time of the visit,
e.g., “When I am
dizzy, my symptoms
are most often: (1)
very mild, (2) mild,
(3) moderate, (4)
moderate to severe,
(5) severe”
I am
I will let people
Vestibular
Activities and
Participation
(VAP)
(Alghwiri et al.,
2012)
Validated in
adults (n = 58)
with balance or
vestibular disorders
34 items Five-point
scale indicating
level of difficulty
with an item from
“none” to “unable
to do”
149
Likert
To examine activities
and participation
according to
the International
Classification of
Functioning Disability
and Health,
e.g., “Because of
your dizziness/
imbalance, how
much difficulty did
you have recently
in carrying out your
daily routine?”
table 8–5.
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Name (Reference) Validation Items, Subscales Scoring Purpose, Examples
continued
Vestibular
Disability Index
(VDI)
(Prieto,
Cobo, & Alonso,
1999)
Vestibular
Rehabilitation
Benefit
Questionnaire
(VRBQ)
(Morris, Lutman, &
Yardley, 2009)
table 8–6. Tools Designed to Measure the Effects of Specific Diseases on Quality of Life
Name (Reference) Validation Items, Subscales Scoring Purpose, Examples
Santed,
Validated in
Spanish-speaking
adults (n = 130)
referred to E
and neurology
clinics for vertigo,
dizziness, and/or
imbalance
Validated in adults
(n = 124) referred
for vestibular
rehabilitation
therapy
NT
36 items, two
subscales
(
Symptom
Subscale, HealthRelated Quality of
Life Subscale)
22 items, three
subscales
(Dizziness and
Anxiety,
Provoked
Quality of
Motion-
Dizziness,
Life)
Six-point Likert
scale: 1 (all the
time) to 6 (none of
the time)
Seven-point
bipolar scale: −6
(not at all dizzy) to
6 (extremely dizzy)
To assess symptoms
and quality of life in
dizzy patients
To assess outcome
of vestibular
rehabilitation
therapy, especially
for longitudinal
application,
Moving my
e.g., “
head slowly from
side to side makes
me feel . . . ”
Ménière’s Disease
Patient-Oriented
Severity Index
(MD-POSI)
Gates, 2000)
(
Penn Acoustic
Neuroma Quality
of Life Scale
(PANQOL)
(
Shaffer, Cohen,
Bigelow, &
Ruckenstein, 2010)
Validated in adults
Ménière’s
with
disease enrolled in
a Meniett device
clinical trial
(n = 61)
Validated in adults
with acoustic
neuromas
(n = 143)
20 items
26 items, seven
domain scores
(anxiety, facial
dysfunction,
general health,
balance, hearing
loss, energy, and
pain)
Six-point scale: 0
(none) to 5 (worse
ever)
Five-point Likert
scale: 1 (strongly
disagree) to 5
(strongly agree)
To quantify the
morbidity (balance,
hearing, memory)
Ménière’s disease
of
and effects of the
disease on the
personal, social,
and occupational
aspects of a
patient’s life,
e.g., “
During my
most recent typical
Ménière’s attacks
I had trouble with
hearing”
To assess quality of
life in patients with
acoustic neuromas,
e.g., “I act differently
around people
because of
problems moving my
face”
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8. ASSESSING DIZZINESS-RELATED QUALITY OF LIFE 151
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Tab le 8–7. Tools Designed Specifically to Measure Symptoms, Activity Limitation/Participation, and/or
Dizziness-Related Quality of Life in Children
Name (Reference) Validation Items, Subscales Scoring Purpose, Examples
Pediatric Vestibular
Symptom
Questionnaire
(PVSQ)
(Pavlou et al. 2016)
Pediatric Visually
Induced Dizziness
Questionnaire
(PVID)
(Pavlou et al. 2017)
Pediatric Dizziness
Handicap
Inventory for
Patient Caregivers
(pDHI-PC)
(McCaslin et al.
2015)
Validated in both
healthy children
(n = 168) and
children with
post-concussion
dizziness or a
vestibular disorder
(n = 56) ages 6–17
Validated in
healthy children
(n = 169) and
children with
primary migraine,
concussion, or
vestibular disorder
diagnosis (n = 114)
ages 6–17
Validated in
caregivers of
children, ages 5–12,
being evaluated for
dizziness (n = 56)
10 items with an
11th question
asking whether
symptoms
prevent activity
participation and,
if yes, to include
which ones
11 items Four-point scale:
21 items Items rated
Four-point scale:
0 (never) to 3
(most of the time);
a “don’t know”
category is also
included
0 (never) to 3
(most of the time);
a “don’t know”
category is also
included
and scored as
“yes” (4 points),
“sometimes”
(2points), and “no”
(0 points)
To identify and
quantify the severity
of subjective
vestibular
symptoms, such
as dizziness or
unsteadiness, in
children
To quantify the
presence and
severity of visually
induced dizziness
in children, such as
symptoms induced
by crowds or
scrolling computer
screens
To identify children
with significant
handicap/disability
due to dizziness
Commonly Used Self-Report
Tools for Assessing DRQoL
Vertigo Symptom Scale (VSS)
The VSS was developed by Yardley, Todd, Lacoudraye Harter, and Ingham (1992) and Yardley, Masson,
Verschuur, Haacke, and Luxon (1992) in an effort to
address the known relationship between vertigo, anxiety, and emotional disturbance. Increased vigilance
directed toward sensations of disequilibrium and vertigo can result in increases in anxiety and depression,
in turn resulting in panic and agoraphobia. This can
further escalate into a hyperventilation syndrome
that may have the effect of creating chronic vertigo
and so on. In fact, as noted by Yardley, Masson, et al.
(1992) and Yardley, Todd, et al. (1992), patients with
spells of vertigo may experience the same symptoms
during a spell (e.g., dizziness/unsteadiness, nausea,
trembling, and sweating) that patients with panic disorder experience during a panic attack. The authors
stated that their goal in creating the VSS was to develop
a self-report measure of vertigo severity that was not
contaminated “by symptomatology caused by anxiety, and which could therefore be used, in preference
to vestibular test results, to examine the relative influence of vertigo and anxiety on reported handicap
and distress.”
The scale consists of 36 items describing common
symptoms that are reported by, or observed in, patients
with vertigo. These items were derived from an interview study reported by Yardley, Todd, et al. (1992). The
scale is shown in Figure 8–1.
The patient is asked, “How often in the past
12 months have you had the following symptoms?”
(i.e., the symptoms include pains in the heart or chest
region, tension/soreness in muscles, feeling of pressure
in the ear). The patient is asked to circle the “appropriate number to indicate about how many times you
have experienced each of the symptoms listed . . . during the past 12 months, or since the vertigo started, if
(the patient has had) vertigo for less than one year.”
VERTIGO SYMPTOM SCALE
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Please circle the appropriate number to indicate about how many times you have experienced
each of the symptoms listed below during the past 12 months (or since the vertigostarted, if you
have had vertigo for less than one year).
The range of responses are:
01 23 4
Never A few times Several times Quite often Very often
(1–3 times (4–12 times (on average, more (on average, more
a year)ayear) than once a month) than once a week)
How often in the past 12 months have you had the following symptoms:
1. A feeling that things are spinning or moving around, lasting:
(PLEASE ANSWER ALL THE CATEGORIES)
a) less than 2 minutes 01234
b) up to 20 minutes 01234
c) 20 minutes to 1 hour 01234
d) several hours 01234
e) more than 12 hours 01234
2. Pains in the heart or chest region 01234
3. Hot or cold spells 01234
4. Unsteadiness so severe that you actually fall 01234
5. Nausea (feeling sick), stomach churning 01234
6. Tension/soreness in your muscles01234
7. A feeling of being lightheaded, “swimmy” or giddy, lasting:
(PLEASE ANSWER ALL THE CATEGORIES)
a) less than 2 minutes 01 23 4
b) up to 20 minutes 01234
c) 20 minutes to 1 hour 01234
d) several hours 01234
e) more than 12 hours 01234
8. Trembling, shivering 01234
9. Feeling of pressure in the ear(s) 01234
10. Heart pounding or fluttering 01234
figure 8–1. The Vertigo Symptoms Scale (VSS). From Yardley, L., and Hallam, R. S. (1996). Psychosocial
aspects of balance and gait disorders. continues
152
11. Vomiting 01234
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12. Heavy feeling in arms or legs 01234
13. Visual disturbances (e.g., blurring, flickering,
spots before the eyes) 01234
14. Headache or feeling of pressure in the head 01234
15. Unable to stand or walk properly without support01234
16. Difficulty breathing, short of breath 01 234
17. Loss of concentration or memory 01234
18. Feeling unsteady, about to lose balance, lasting:
(PLEASE ANSWER ALL THE CATEGORIES)
a) less than 2 minutes 01234
b) up to 20 minutes 01234
c) 20 minutes to 1 hours 01234
d) several hours 01234
e) more than 12 hours 01234
19. Tingling, prickling, or numbness in
partsof the body 01234
20. Pains in the lower part of your back 01234
21. Excessive sweating 01234
22. Feeling faint, about to black out 01234
Scoring, administration, validation, and statistical properties. To obtain a measure of vertigo
severity, simply sum the patient’s responses to the following items on the long version of the
VSS: 1a to 1e, 4, 5, 7a to 7e, 11, 15, 18a to 18e. A measure of somatic anxiety can be obtained
by summing items 2, 3, 6, 8 to 10, 12 to 14, 16, 17, 19 to 22.
The VSS scales and subscales have very good statistical reliability (Cronbach’s alpha
typically .80 or better) and the two subscales of the long form of the VSS are only modestly
correlated (.33). Test-retest reliability of both the VSS scales has been shown to be good.
The discriminant, concurrent, and predictive validity of the VSS have been well
established in U.K. patient samples, and have been confirmed cross-culturally in a Spanish
speaking Mexican sample. Both scales distinguish between patients complaining of
disorientation and healthy controls. The Vertigo scale is unrelated to standard measures of
anxiety and depression, but is correlated with handicap and with objective measures of
perceptual disorientation following vestibular surgery. The Autonomic/Anxiety scale is
correlated with measures of anxiety and depression and with objective measures of
psychophysiological arousal, and is a longitudinal predictor of change in symptoms, handicap,
and emotional distress over a seven-month period.
figure 8–1. continued In A. M. Bronstein, T. Brandt, and M. Woollacott (Eds.), Clinical Disorders of Bal-
ance, Posture and Gait. London, UK: Arnold. See text for details. Courtesy of Dr. Lucy Yardley.
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