Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4433_Библиотеки_им_академика_М_И_Перельмана
.pdf
154 BAlAnCE FunCtion AssEssmEnt And mAnAgEmEnt
https://t.me/medicina_free
The responses and point values associated with them
are “Never” (zero points), “A few times” (1 to 3 times a
year [one point]), “Several times” (4 to 12 times a year
[two points]), “Quite often” (on average, more than
once a month [three points]), and “Very often” (on
average, more than once a week [four points]).
Responses obtained from 138 patients were analyzed using a factor analysis to determine what factor (i.e., subscale) structure existed in this device.
The investigators employed the data from the factor
analysis to create two primary subscales: the vertigo
subscale and the anxiety and autonomic symptom
subscale, each containing two further subscales. The
vertigo (VER) subscale comprised a “vertigo of short
duration” subscale (VSH) and an “acute attack of vertigo” subscale (VACU). The anxiety and autonomic
(AA) symptom subscale comprised items on somatization (SOM; e.g., heavy feeling in the arms and legs) and
autonomic symptoms (AU; e.g., feeling faint, about to
black out).
The concurrent and construct validities of this
scale were reported to be robust. For example, patients
with spontaneous episodic vertigo had higher acute
vertigo and total vertigo scores. Patients with positional vertigo demonstrated intermediate acute vertigo
and total vertigo scores. Magnitude of scores on the AA
subscale was significantly correlated with measures
of state and trait anxiety (i.e., r = .55 and .44, respectively). Both the AA and VER subscales were significantly correlated (i.e., r = .33 and .37, respectively) with
self-reported handicap. There was no predictable relationship between quantitative measures of vestibular
system function (e.g., percent caloric response asymmetry) and subscale or total scores on the VSS.
Dizziness Handicap Inventory (DHI)
In response to a perceived need to have a standardized measure of self-report activity limitation and
participation restriction resulting from dizziness and
unsteadiness, Jacobson and Newman (1990) developed a measure called the DHI. The initial version of
the DHI consisted of 37 statements that were generated
based on the authors’ experience evaluating patients
who were dizzy, light-headed, or unsteady. The items
did not contain the word “dizzy” or “dizziness” but
instead contained the phrase “your problem” (e.g.,
Because of your problem, are you depressed?). The
items were grouped a priori into “subscales” based on
their content alone. The subscales were labeled “functional” (i.e., the item was designed to probe how “the
problem” affected the patient’s ability to execute normal everyday activities), “emotional” (i.e., the item was
designed to probe how “the problem” affected their
emotional well-being), and “physical” (i.e., the item
was designed to probe how “the problem” was affected
by movement of the head or head and body together).
The patient was asked to respond to each item by
choosing either a “yes,” “sometimes,” or “no” response.
In scoring the DHI, a “yes” response is awarded four
points, a “sometimes” response is awarded two points,
and a “no” response is awarded zero points. The initial 37-item version of the DHI was administered to 63
consecutive patients (mean age, 49 years), resulting in
an item reduction down to 25. The 25-item DHI was
then administered to 106 consecutive patients (mean
age, 48 years). The construct validity of the DHI was
established in this investigation. Subjects were asked
to state whether their dizziness occurred occasionally
(<12 times/year), frequently (>12 times/year but not
continuously), or continuously. For the total DHI score
and functional and emotional subscales, an increase in
event frequency did result in an increase in subscale
scores. This did not occur for the physical subscale.
An unexpected finding was no significant relationship between subject age and total and subscale scores.
Jacobson and Newman (1990) did not evaluate gender
effects; however, this was later evaluated by Robertson
and Ireland (1995), who reported increased self-report
handicap for females for the physical subscale (p = .02)
and total DHI score (p = .02).
In a third investigation, Jacobson and Newman
(1990) assessed the short-term (i.e., within a single day)
test-retest reliability of the DHI for 14 patients (mean
age, 45 years). Pearson product-moment correlation
coefficients were high for total (r = .97) and subscale
scores (i.e., functional subscale r = .94, emotional subscale r = .97, and physical subscale r = .92). From this
data set it was possible to establish the 95% confidence
interval (CI) for change. The standard error of measurement was 6.23 points, suggesting that pretreatment and
posttreatment scores would have to differ by at least
points (i.e., 95% CI for a true change) for the change
18
to have occurred not due to chance alone. The final version of the DHI is shown in Figure 8–2.
In an attempt to develop severity categories on
the DHI, Jacobson and McCaslin (unpublished data)
calculated interquartile ranges for the total DHI score
for a clinical sample of 200 consecutive dizzy patients.
This assessment suggested that a DHI total score of 0
to 14 points could be classified as no activity limitation and participation restriction, a score of 16 to 26
could be classified as mild activity limitation and participation restriction, a score of 28 to 44 points could
be classified as moderate activity limitation and participation restriction, and a total score of 46 points or
Dizziness Handicap Inventory
Instructions:The purpose of this questionnaire is to identify difficulties that you may be experiencing because
https://t.me/medicina_free
of your dizziness or unsteadiness. Please answer “yes,” “no,” or “sometimes” to each question. Answer each
question as it pertains to your dizziness problem only.
Some-
Yes times No
(4) (2) (0)
P1. Does looking up increase your problem?
E2. Because of your problem do you feel frustrated?
F3. Because of your problem do you restrict your travel for business or recreation?
P4. Does walking down the aisle of a supermarket increase your problem?
F5. Because of your problem do you have difficulty getting into or out of bed.
F6. Does your problem significantly restrict your participation in social activities
such as going out to dinner, the movies, dancing, or to parties?
F7. Because of your problem do you have difficulty reading?
P8. Does performing more ambitious activities like sports, dancing, household
chores, such as sweeping or putting dishes away, increase your problem?
E9. Because of your problem are you afraid to leave your home without having
someone accompany you?
E10. Because of your problem have you been embarrassed in front of others?
P11. Do quick movements of your head increase your problem?
F12. Because of your problem do you avoid heights?
P13. Does turning over in bed increase your problem?
F14. Because of your problem is it difficult for you to do strenuous housework or
yardwork?
E15. Because of your problem are you afraid people may think that you are intoxicated?
P16. Because of your problem is it difficult for you to go for a walk by yourself?
P17. Does walking down a sidewalk increase your problem?
E18. Because of your problem is it difficult for you to concentrate?
F19. Because of your problemisit difficult for youto walk around your housein the dark?
E20. Because of your problem are you afraid to stay home alone?
E21. Because of your problem do you feel handicapped?
E22. Has your problem placed stress on your relationships with members of your
family and friends?
E23. Because of your problem are you depressed?
F24. Does your problem interfere with your job or household responsibilities?
P25. Does bending over increase your problem?
F = FUNCTIONAL E = EMOTIONALP = PHYSICAL TOTA LSCORE
figure 8–2. The Dizziness Handicap Inventory (DHI). Note. Maximum self-report handicap is 100 points. From Jacob-
son, G. P., and Newman, C. W. (1990). The development of the Dizziness Handicap Inventory. Archives of Otolaryn-
gology-Head and Neck Surgery, 116, 424–427. Copyright © 1990 American medical Association. All rights reserved.
See text for details. Reprinted with the permission of the publisher.
155
156 BALANCE FUNCTION ASSESSMENT AND MANAGEMENT
https://t.me/medicina_free
greater could be classified as a severe activity limitation
and participation restriction. These values are reasonably close to those reported by Kinney, Sandridge, and
Newman (1997), who using a smaller patient sample
(n = 51) suggested that total DHI scores were: 0 to 14
points, 16 to 34 points, 36 to 52 points, and >54 points
for the no handicap, mild, moderate, and severe handicap groups, respectively.
Shortened versions of the DHI have been developed. A 10-item screening version of the DHI (DHI-S)
was initially developed by Jacobson and Calder (1998).
The response format was identical to the DHI. Thus,
with a 10-item scale, the maximum score was 40 points
and the minimum score was 0 points. Items comprised
by the DHI-S represented those items having the highest item-total correlation coefficients from the Jacobson
and Newman (1990) investigation. The 95% CI for change
was four points. The DHI-S is shown in Figure 8–3.
Several investigators have attempted to establish
the criterion validity of the DHI. Jacobson, Newman,
Hunter, and Balzer (1991) conducted Pearson productmoment correlations between DHI total and subscale
scores and balance function test results. The authors
reported that, in general, there were no significant relationships observed between DHI total and subscale
scores and electronystagmographic (ENG) or rotational
test variables. There was a significant weak-to-moderate correlation, however, observed between the sensory
organization test (SOT) condition 5 (i.e., eyes closed,
platform sway-referenced) on computerized dynamic
posturography and DHI total (r = −.40), functional (r =
−.44), and emotional (r = −.42) subscales. That is, as self-
Dizziness Handicap Inventory —Screening Version
Instructions:The purpose of this questionnaire is to identify difficulties that you may be experiencing because
of your dizziness or unsteadiness. Please answer “yes,” “no,” or “sometimes” to each question. Answer each
question as it pertains to your dizziness problem only.
Some-
Yes times No
(4) (2) (0)
F1. Because of your problem do you restrict your travel for business or recreation?
F2. Does your problem significantly restrict your participation in social activities
such as going out to dinner, going to the movies, dancing, or to parties?
E3. Because of your problem are you afraid to leave your home without having
someone accompany you?
E4. Because of your problem have you been embarrassed in front of others?
P5. Does walking down a sidewalk increase your problem?
E6. Because of your problem is it difficult for you to concentrate?
F7. Because of your problem is it difficult for you to walk around your house
in the dark?
E8. Because of your problem are you depressed?
F9. Does your problem interfere with your job or household responsibilities?
P10. Does bending over increase your problem?
F = FUNCTIONAL E = EMOTIONALP = PHYSICAL TOTA LSCORE
figure 8–3. Dizziness Handicap Inventory-Screening Version (DHI-S). Note. Maximum self-report handicap is
40points. From Jacobson, G. P., and Calder, J. H. (1998). A screening version of the Dizziness Handicap Inventory
(DHI-S). American Journal of Otology, 19, 804–808. Note. The boldface items also appear in the “Short Form of the
Dizziness Handicap Inventory” (Tesio et al., 1999). Note: See text for details. The DHI-S is reprinted with the permission
of Wolters Kluwer Health.
8. ASSESSING DIZZINESS-RELATED QUALITY OF LIFE 157
https://t.me/medicina_free
report activity limitation and participation restriction
increased, postural stability scores decreased. Some
researchers have reported findings in agreement with
the latter authors (Perez, Martin, & Garcia-Tapia, 2003),
while others have observed no significant correlations
between DHI and SOT (Robertson & Ireland, 1995).
Finally, Whitney, Wrisley, Brown, and Furman
(2004) evaluated the relationship between the DHI and
five functional measures of balance including performance on the Dynamic Gait Index (DGI), Five Times
Sit to Stand Test (FTSST), the Activities-Specific Balance
Confidence (ABC) Scale, gait speed, and the Timed Up
and Go (TUG) test. Patients were then stratified into
“mild (0 to 30 points),” “moderate (31 to 60 points),”
and “severe (61 to 100)” self-report handicap groups
based on their total DHI scores. The investigators also
asked the patients to keep a record of the numbers of
falls that occurred during the four weeks prior to the
visit when the evaluation was conducted. The results
are shown in Table 8–8 from Whitney et al. (2004).
There were significant group differences observed on
the DGI, FTSST, ABC, and number of falls. That is, the
patients with the greatest total DHI scores were also
the patients with the greatest functional impairments.
The authors concluded that patients with total DHI
scores exceeding 60 points are most likely significantly
functionally impaired and at increased risk for falling.
It bears mentioning that the factor structure of the
DHI has been evaluated by both Asmundson, Stein,
and Ireland (1999) and Perez, Garmendia, Garcia-Granero, Martin, and Garcia-Tapia (2001). Remember that
the subscales of the DHI were developed empirically.
This means that we grouped items into subscales based
on their content without determining whether our sub-
jective judgments could withstand a statistical challenge. Both sets of investigators evaluating the factor
structure of the DHI observed findings which did not
support the initial, a priori assignment of individual
items into the original three subscales. It was suggested
that the subscale structure might be altered and/or the
total score be used as a single global measure of selfreport dizziness activity limitation and participation
restriction. Since these two reports were published we
have abandoned the calculation of subscale scores and
use only the DHI total score in our clinical practice.
Activities-Specific Balance Confidence Scale
In 1995, Powell and Myers reported the development
of a device that was designed to serve as a measure of
“situation-specific” balance confidence in communitydwelling elderly who are functioning at a moderate to
high level of mobility and independence. The device is
the ABC Scale and consists of a standardized question:
“How confident are you that you will not lose your
balance or become unsteady when you . . . ,” which
is followed by 16 conditions (e.g., “walk around the
house?” or “walk up or down stairs?”).
This measure is a departure from other instruments in that it evaluates self-efficacy. Assessment of
self-efficacy beliefs is important to estimate the confidence an individual has for performing a set of skills
required to succeed at a specific task or goal (Bandura,
1986). Self-efficacy also influences choices of activities
and motivational levels that contribute to a patient’s
acquisition and refinement of new abilities as well as
effort, resilience, and perseverance in the face of difficulties (Smith & West, 2006).
table 8–8. Medians or Means and Standard Deviations of the DGI, TUG, FTSST, ABC, Number of
Reported Falls in the Past Four Weeks, and Gait Speed for Each of the Three DHI Groups
Median DGI 19 (n = 23) 17 (n = 41) 12 (n = 18) p < 0.05
Mean TUG (s) 12 ± 3 (n = 22) 11 ± 4 (n = 43) 14 ± 5 (n = 17) p = 0.79
Mean FISST (s) 15 ± 5 (n = 19) 15 ± 5 (n = 39) 20 ± 9 (n = 15) p < 0.05
Mean ABC 74 ± 14 (n = 23) 55 ± 22 (n = 44) 28 ± 16 (n = 18) p < 0.001
Fallers 1 (n = 23) 1 (n = 43) 6 (n = 18) p < 0.001
Gait speed (m/s) 1.02 ± 0.2 (n = 17) 1.04 ± 0.2 (n = 37) 0.9 ± 0.2 (n = 16) p = 0.15
Source: Data found in Whitney, S. L., Wrisley, D. M., Brown, K. E., and Furman, J. M. (2004). Is perception of handicap
related to functional performance in persons with vestibular dysfunction? Otology and Neurotology, 25, 139–143.
Mild DHI
(0–30) (n = 23)
Moderate DHI
(31–60) (n = 44)
Severe DHI
(61–100) (n = 18)
Significance
Level
158 BAlAnCE FunCtion AssEssmEnt And mAnAgEmEnt
https://t.me/medicina_free
On the ABC Scale, patients are asked to rate on a
scale of 0 to 100% how confident they are performing
the activities. In addition to the individual item scores,
an average score is calculated across all items. Items
in the ABC Scale were derived from interviews with
both clinicians and patients. Clinicians were asked to
“name the 10 most important activities essential to
independent living that, while requiring some position
change or walking, would be safe and nonhazardous
to most elderly persons.” Patients were asked, “Are
you afraid of falling during any normal daily activities, and if so, which ones?” Based on their responses,
12 unique items were generated. Additionally, 4 items
from the Falls Efficacy Scale (i.e., “light housekeeping,” “reaching,” “simple shopping,” and “walking
around the house”) were included in the ABC Scale.
The investigators pointed out that the words in the
instruction set — “will not lose your balance or become
unsteady” — were chosen as losses of balance may, but
do not have to, progress to a fall.
Internal consistency reliability was high for items
in the ABC Scale (i.e., coefficient alpha = 0.96). A stepwise deletion of items did not improve the coefficient
alpha. The test-retest reliability of the ABC Scale has
been found to be excellent using a two-week interval
(r = .92) (Powell & Myers, 1995) or a four-week interval (r = .91) (Miller, Deathe, & Speechley, 2003). Powell
and Myers (1995) reported moderate correlations (r =
.49) between scores from the ABC Scale and the Physical Self-Efficacy Scale (Ryckman, Robbins, Thornton,
& Cantrell, 1982) and the Falls Efficacy Scale (Tinetti,
Richman, & Powell, 1990). More recently, the ABC
Scale demonstrated concurrent validity (r = −0.84)
with another measure of self-efficacy, namely the Falls
Efficacy Scale–International (Morgan, Friscia, Whitney, Furman, & Sparto, 2013). Additionally, Miller et
al. (2003) reported a strong positive correlation (r =
.72) between scores on the ABC Scale and scores on the
Two-Minute Walking test and a strong negative correlation between scores on the ABC Scale and those
on the TUG test. That is, as the elapsed time to complete
the TUG test decreased, balance confidence increased.
Vestibular Disorders Activities
of Daily Living Scale
In 2000, Cohen and Kimball reported their experiences
developing a device designed to assess what impact
(if any) vertigo and disequilibrium had on a patient’s
ability to carry out activities of daily living, namely, the
Vestibular Disorders Activities of Daily Living Scale
(VADL).
Item generation for the VADL was facilitated
through systematic consultation with 31 occupational
and physical therapists. The 30 items were empirically
subgrouped into functional (self-care and “intimate
activities”), ambulation (walking and climbing stairs),
and instrumental (“home management,” productivity,
and leisure activities) subscales.
An initial iteration of the VADL underwent psychometric testing. In response to each of the 30 probe
items, patients were requested to respond along a
10-point continuum (or not applicable, NA). A “1”
response represents the ability of the patient to carry
out the activity completely independently (i.e., “I am
not disabled, perceive no change in performance from
before developing an inner ear impairment”), whereas
a “10” response represents the patient’s inability to perform the activity at all (i.e., “I no longer perform the
activity due to vertigo or a balance problem”). Scores
ranged from 1 to 8 on the total scale, 1 to 5 for the functional subscale, 1 to 8 on the ambulation subscale, and
1 to 10 on the instrumental subscale. According to the
investigators, most subjects scored between 1 and 4
points. The result of this administration showed that
items were either answered with the NA response or
showed poor internal consistency/reliability. The final
28-item scale demonstrated strong internal consistency/reliability (alpha = 0.97 for total score, 0.92 for
functional subscale, 0.96 for ambulation subscale, and
0.91 for the instrumental subscale). The test-retest reliability (i.e., two-hour intertest interval) of the VADL
was found to be excellent for the total score (rc = 1.00,
95% CI = 0.99–1.00), functional subscale (rc = 0.87, 95%
CI = 0.67–0.95), ambulation subscale (rc = 0.95, 95% CI
= 0.87–0.98), and instrumental subscale (rc = 0.97, CI =
0.92–0.99).
A subsequent investigation by Cohen and colleagues (Cohen et al., 2000) compared a sample of normal individuals with two patient groups (i.e., benign
paroxysmal positional vertigo [BPPV] and chronic
vestibulopathy) to determine how the patient groups
differed in their total and subscale scores. The investigators compared results of the VADL with those
obtained on measures of vestibular impairment.
Finally, the authors compared the responses obtained
from patients with those obtained from their caregivers/significant others to assess levels of concordance.
The investigators found that VADL and DHI scores
were moderately correlated. That is, greater levels of
self-report functional independence were associated
with lesser levels of self-report activity limitation and
participation restriction. Not surprisingly, the normal
subjects appeared less impaired than the patients on
8. AssEssing dizzinEss-rElAtEd QuAlity oF liFE 159
https://t.me/medicina_free
the total and subscale scores. Patients felt they were
more independent than perceived by their caregivers/
significant others.
No significant relationships were observed between
VADL total or subscale scores and vertigo intensity. The
latter observations are similar to the finding reported
earlier by Jacobson and Newman (1990). Vertigo frequency was weakly correlated with total VADL score
and instrumental subscale score, another finding similar to that reported by Jacobson and Newman (1990).
Additionally, weak but significant relationships were
observed among SOT conditions 5 and 6 and composite score (Equitest protocol) and VADL total and
functional and instrumental subscale scores. This relationship was similar to that observed by Jacobson et al.
(1991) for the DHI.
In light of high test-retest reliability, the authors
contend that the VADL may be of use in the pre- and
posttreatment assessments of patients who have undergone vestibular rehabilitative therapy. Cohen and Kimball (2003) used the VADL as an outcome measure in an
investigation to determine whether vestibular rehabilitative therapy could have a positive impact on activities
of daily living. Specifically, the investigators evaluated
whether a home program of head movement exercises
could decrease vertigo and improve functional independence and psychosocial functioning in a subgroup
of patients with a diagnosis of chronic, uncompensated,
peripheral vestibular system impairment. Finally, the
authors sought to determine whether chronologic age
or length of time since onset of symptoms would have
an effect on the efficacy of therapy. Subjects were asked
to rate both the frequency and the intensity of their vertigo on a 10-point scale (i.e., 10 being the maximum
worse situation in each case). Subjects also completed
the Vertigo Handicap Questionnaire, the VSS, the DHI,
and the VADL. Subjects were then assigned to one of
three treatment groups, each requiring subjects to perform stereotyped repetitive head movements five times
per day. Subjects assigned to Group 1 were asked to
perform slow head movements while they were seated.
Subjects in Group 2 were asked to perform rapid head
movements while both seated and standing. Subjects in Group 3 were asked to do the same exercises
as those in Group 2 but had their progress monitored
and their efforts reinforced by a weekly telephone call.
These home exercises were performed for four weeks
and then the dependent variables were remeasured.
The investigators reported that improvements in vertigo intensity occurred for all treatment groups over
a six-month period, with the greatest improvements
occurring in the first 30 to 45 days. These changes were
highly associated with changes in VADL total scores
(p = .004). Vertigo frequency also decreased signifi-
cantly over a six-month period, with the greatest
changes occurring in the first 30 to 45 days across all
groups. These improvements in vertigo frequency were
associated with significant improvements in VADL
total score (p = 0.03) and ambulation subscale score (p =
0.03). These significant changes in VADL total score
and ambulation subscale score were associated with
like changes in the DHI total score. The strong relationship between scores on the VADL and the DHI was
proof of convergent validity of the VADL. Finally, from
a practical perspective the findings of this investigation
suggested that even a minimal home exercise program
could effect positive changes in patient symptoms.
examPles of hoW the dhi has been
used as a tool to assess outComes
Tables 8–9 and 8–10 summarize representative published reports of how the DHI has been used to assess
changes in DRQoL following nonmedical, medical, or
surgical treatment. For these investigations, a statistically significant reduction in self-perceived dizziness
activity limitation and participation was used as evidence of subjective benefit (the treatment was effective).
Alternatively, no change or an increase in reported activity limitation and participation restriction suggested no
improvement (i.e., the treatment was ineffective).
summary
The assessment of the vertiginous, “dizzy,” and
unsteady patient has evolved from a quantification of
impairment only to an assessment of impairment coupled with the measurement of the impact that impairment has on psychosocial function. The addition of
this information is valuable because there is generally
a weak predictive relationship between the two forms
of measurement. In this regard, Table 8–11 shows several examples of investigations illustrating a generally
poor relationship between impairment of the peripheral vestibular system and self-reported dizziness
activity limitation/participation restriction. Thus, selfreport measures provide unique data that can become
important — for example, in the assessment of severity
of a disease and in the quantification of improvement
following treatment.
patients with subjective and
https://t.me/medicina_free
those with objective BPPV
PRMs are equally effective for
V. Baseline total DHI scores
observed for both patients
with subjective and objective
the total DHI score were
Significant reductions in
BPP
were not significantly different.
Significant improvements
were observed for both
objective and subjective
BPPV groups. There was no
The adjuvant therapy of
significant group difference
in the magnitude of the
Both groups demonstrated
improvements
RMs are successful
P
anxiolytics may be helpful for
patients with BPPV even when
greater improvements for
DHI scores with significantly
significant improvements in
DRQoL and
V has a significant
negative effect on
BPP
the group that received the
added medication
The DHI-S (maximum
40 points) on average
those effects can be reduced
by performing the PRM
decreased from 17.19 points
prior to treatment to 9.70
points at posttreatment + 30
days
This adaptation of the DHI
Scores on a five-item and
V before the
that is sensitive to motion-
provoked vertigo can assist
clinicians in identifying
those individuals most likely
to have BPP
formal assessment has been
V
even a two-item adaptation
of the DHI (containing many
of the items from the physical
subscale) were predictive of
those patients with BPP
performed
V and then 30 days after a
of particle repositioning
maneuvers (PRMs) for
compared with objective
BPPV
patients with subjective BPPV
2013 63 patients with BPPV To determine the effectiveness
Authors Year Subjects Purpose Results Conclusions
Huebner, Lytle,
Doettl, Plyler, &
table 8–9. Examples of How the DHI Has Been Used in the Area of BPPV
Thelin
report dizziness handicap
for patients who are treated
with anxiolytics for residual
To determine changes in self-
V
randomly assigned
2012 73 patients with BPP
Song
Jung, Koo, Kim,
Kim, &
dizziness/vertigo after PRM
RM + medication
to PRM group or the
group
P
160
compared to a group who
did not receive anxiolytics
dizziness-related quality of
To assess the magnitude of
age of 60 years
2004 28 adults over the
Gamiz and
Lopez-Escamez
RM has been performed
life in a sample of elders with
BPP
P
performance on a custom
adaptation of the DHI would
To determine whether patient
2005 383 patients with a
Whitney, Marchetti,
be predictive of whether a
patient had BPPV
number of types of
vestibular diagnoses
Morris
&
The cartilage cap occlusion
https://t.me/medicina_free
represents an alternative to the
middle cranial fossa approach to
DHI score
postoperatively should be
considered for the elderly who
auditory symptoms showed the
SCD
Self-report handicap is significantly
improved after plugging the
superior canal. The greatest
improvements occurred for those
individuals with the highest preop
least net change in total
Canal occlusion is successful and
associated with improvement
in self-report dizziness disability
values. Those patients with primarily
handicap
Authors suggested that these
findings should be shared with
patients considering surgical
versus nonsurgical approaches to
There were
the removal of VS
DHI
The improvement in DHI score
often are unsteady
Significant change
DHI score (pre versus
Investigators suggested that
radiosurgery for vestibular
schwannoma was “the best
management strategy for the
majority of VS patients”
Group pre- and postoperative total
DHI scores were not significantly
different. Patients with total scores in
the moderate-severe range showed a
statistically significant change (those
will mild starting scores did not)
self-report dizziness handicap
before and following
cartilage cap occlusion in
superior semicircular canal
dehiscence
2013 20 patients To evaluate the change in
Preoperative handicap (mean = 44
points) was significantly reduced
postoperatively (mean postop
total score of 18 points) with the
exception of two patients
greater handicap than that
canal plugging to eliminate
To determine whether
patients
2008 19 adult
observed preoperatively
SCD is associated with
Mean follow-up time was 40 months.
Mean preop score was 70 points.
efficacy of posterior canal
significant
Mean postop score was 13 points.
These differences were statistically
plugging for SCD
Baseline function was measured
and then measures were conducted
at follow-up intervals of 1, 3, 6, 12,
and 18 months postop.
with vestibular schwannoma
who are treated with gamma
knife surgery
Follow-up was between 6 months
postoperatively
no significant differences in
2008 55 patients To measure changes in
post treatment) was observed only
and +60 months.
in the total
balance function that might
occur with gamma knife
surgery
Zhu
Normal facial function and better
for the elderly group where balance
improved
hearing occurred in the radiosurgery
surgical removal or
group. DHI scores were statistically
better for the radiosurgery group
radiosurgery was the best
technique to treat small to
medium size schwannoma
Authors Year Subjects Purpose Results Conclusions
Bogle, Lundy,
Dependent Variable
table 8–10. Investigations of Treatments for Superior Canal Dehiscence (SCD) and Vestibular Schwannoma (VS) Where the DHI Was Used as a
Zapala, &
Copenhaver
Crane, Minor, &
Wackym, Hannley,
Runge-Samuelson,
Carey
Shaia et al. 2006 28 patients To examine the long-term
161
Park et al. 2011 59 patients To assess DRQoL in patients
Jensen, &
Pollock et al. 2006 82 patients To determine whether
As occurs with studies
https://t.me/medicina_free
of self-reported hearing
disability/handicap and hearing
impairment, the differences in total
score were significant only between
normal and bilateral loss groups
The DHI is providing information
that cannot be predicted on the
basis of impairment alone
The DHI is providing information
that cannot be predicted on the
basis of impairment alone
Although the patients with isolated
unilateral utricle impairments had
greater postural instability and
rocking sensation (not apparent
to others) there were no significant
group differences in self-report
dizziness disability handicap
Significant differences in DHI total
scores for comparisons between
normal and bilateral loss, and
between normal and unilateral loss
unilateral and bilateral impairments
There were
Significant differences in the total DHI
score were observed only between
those with normal examinations and
the three impaired groups.
unilateral compensated, unilateral
partially compensated, unilateral
uncompensated
no significant differences in the total
VEMP
The group with abnormal
Patients with abnormal c
showed significantly impaired
DHI score between impaired groups.
controls). Experimental groups
VEMP had better postural stability
postural stability when compared to
normals.
c
VEMP; Group 3,
Group 2, abnormal
caloric, normal c
were: Group 1, abnormal cVEMP,
normal caloric;
than the group with abnormal caloric
VEMP and abnormal
abnormal c
DHI compared to
VEMP did not differ
significantly on the
responses alone and the group
with both abnormal caloric testing
and abnormal cVEMP. Patients with
VEMP. All patients
VNG, rotary chair and
Group 4, normal caloric
and normal c
caloric;
underwent
the other impaired groups
an abnormal c
posturography testing
DHI total scores. Also
differences for
There were no significant group
there were no significant group
differences on the Hospital Anxiety
normal vestibular function test
results
oVEMP impairment), and 30 with
Depression Scale(HADS).
and
ta ble 8 –11. Examples of Investigations Illustrating the Poor Relationship Between Vestibular System Impairment and Measures of Dizziness
Authors Year Subjects Results Conclusions
Disability/Handicap
2000 N = 72, groups = normal exam,
Jacobson &
Calder
2003 N = 122, groups = normal results,
Jacobson &
McCaslin
McCaslin et al. 2011 N = 92, (62 patients, and 30
162
Pelosi et al. 2013 N = 61 (31 with isolated unilateral
8. AssEssing dizzinEss-rElAtEd QuAlity oF liFE 163
https://t.me/medicina_free
This chapter aimed to (1) introduce the reader to
contemporary concepts in classification of impairment,
disability, and handicap (i.e., dizziness-related activity
limitation and participation restriction); (2) describe
characteristics that define an appropriate measure of
dizziness DRQoL; (3) list the validated tools available
to measure DRQoL; (4) discuss, in detail, several of
the more commonly used devices for assessing these
spheres; and finally (5) summarize how one such measure has been used as a dependent variable in clinicbased research.
referenCes
Alghwiri, A. A., Marchetti, G. G., & Whitney, S. L. (2011). Con-
tent comparison of self-report measures used in vestibular
rehabilitation based on the International Classification of
Functioning, Disability and Health. Physical Therapy, 91(3),
346–357.
Alghwiri, A. A., Whitney, S. L., Baker, C. E., Sparto, P. J.,
Marchetti, G. F., Rogers, J. C., & Furman, J. M. (2012). The
development and validation of the vestibular activities
and participation measure. Archives of Physical Medicine
and Rehabilitation, 93(10), 1822–1831.
Antonovsky, A. (1993). The structure and properties of the
sense of coherence scale. Social Science and Medicine, 36(6),
725–733.
Asmundson, G. J., Stein, M. B., & Ireland, D. (1999). A factor
analytic study of the dizziness handicap inventory: Does
it assess phobic avoidance in vestibular referrals? Journal
of Vestibular Research, 9(1), 63–68.
Bandura, A. (1986). Social foundations of thought and action:
social cognitive theory. Englewood Cliffs, NJ: Prentice
A
Hall.
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An
inventory for measuring clinical anxiety: Psychometric
properties. Journal of Consulting and Clinical Psychology,
56(6), 893–897.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh,
J. (1961). An inventory for measuring depression. Archives
of General Psychiatry, 4, 561–571.
Bogle, J. M., Lundy, L. B., Zapala, D. A., & Copenhaver, A.
(2013). Dizziness handicap after cartilage cap occlusion for
superior semicircular canal dehiscence. Otology and Neu-
rotology, 34(1), 135–140.
Centers for Disease Control and Prevention. (2002). Classifica-
tion of diseases, functioning, and disability. Retrieved from
http://www.cdc.gov/nchs/icd.htm
Cohen, H., & Kimball, K. T. (2000). Development of the ves-
tibular disorders activities of daily living scale. Archives
of Otolaryngology–Head and Neck Surgery, 126(7), 881–887.
Cohen, H. S., & Kimball, K. T. (2003). Increased independence
and decreased vertigo after vestibular rehabilitation. Oto-
laryngology–Head and Neck Surgery, 128(1), 60–70.
Cohen, H. S., Kimball, K. T., & Adams, A. S. (2000). Applica-
tion of the vestibular disorders activities of daily living
scale. Laryngoscope, 110(7), 1204–1209.
Crane, B. T., Minor, L. B., & Carey, J. P. (2008). Superior canal
dehiscence plugging reduces dizziness handicap. Laryngo-
scope, 118(10), 1809–1813.
Dannenbaum, E., Chilingaryan, G., & Fung, J. (2011). Visual
vertigo analogue scale: An assessment questionnaire for
visual vertigo. Journal of Vestibular Research, 21(3), 153–159.
Derogatis, L. R., & Melisaratos, N. (1983). The Brief Symptom
Inventory: An introductory report. Psychological Medicine,
13(3), 595–605.
EuroQoL Group. (1990). EuroQol — a new facility for the mea-
surement of health related quality of life. Health Policy,
16(3), 199–208.
Fitzpatrick, R., Davey, C., Buxton, M. J., & Jones, D. R. (1998).
Evaluating patient-based outcome measures for use in
clinical trials. Health Technology Assessment, 2(14), i–iv,
1–74.
Folkman, S., & Lazarus, R. S. (1980). An analysis of coping in
a middle-aged community sample. Journal of Health and
Social Behavior, 21(3), 219–239.
Friscia, L. A., Morgan, M. T., Sparto, P. J., Furman, J. M., &
Whitney, S. L. (2014). Responsiveness of self-report measures in individuals with vertigo, dizziness and unsteadiness. Otology and Neurotology, 35(5), 884–888.
Gamiz, M. J., & Lopez-Escamez, J. A. (2004). Health related
quality of life in patients over sixty years old with benign
paroxysmal positional vertigo. Gerontology, 50(2), 82–86.
Gates, G. A. (2000). Clinimetrics of Meniere’s disease. Laryn-
goscope, 110(3 Pt. 3), 8–11.
Gilson, B. S., Gilson, J. S., Bergner, M., Bobbit, R. A., Kressel, S.,
Pollard, W. E., & Vesselago, M. (1975). The sickness impact
profile. Development of an outcome measure of health
care. American Journal of Public Health, 65(12), 1304–1310.
Goldberg, D. P., & Hillier, V. F. (1979). A scaled version of the
General Health Questionnaire. Psychological Medicine, 9(1),
139–145.
Hazlett, R. L., Tusa, R. J., & Waranch, H. R. (1996). Devel-
opment of an inventory for dizziness and related factors.
Journal of Behavioral Medicine, 19(1), 73–85.
Hill, K. D., Schwarz, J. A., Kalogeropoulos, A. J., & Gibson, S.
J. (1996). Fear of falling revisited. Archives of Physical Medi-
cine and Rehabilitation, 77(10), 1025–1029.
Honrubia, V., Bell, T. S., Harris, M. R., Baloh, R. W., & Fisher,
L. M. (1996). Quantitative evaluation of dizziness characteristics and impact on quality of life. American Journal of
Otology, 17(4), 595–602.
Huebner, A. C., Lytle, S. R., Doettl, S. M., Plyler, P. N., &
Thelin, J. T. (2013). Treatment of objective and subjective
benign paroxysmal positional vertigo. Journal of the Ameri-
can Academy of Audiology, 24(7), 600–606.
Jacobson, G. P., & Calder, J. H. (1998). A screening version
of the Dizziness Handicap Inventory (DHI-S). American
Journal of Otology, 19(6), 804–808.
Jacobson, G. P., & Calder, J. H. (2000). Self-perceived balance
disability/handicap in the presence of bilateral peripheral
Соседние файлы в папке Библиотека им академика М.И. Перельмана