Head-mounted vibrotactile stimulation produced significant improvement in postural stability in subjects with BVL undergoing SOT 5 and 6 testing with no effect on subjective visual vertical during DSVV testing.
Objective
Test performance of a focused dizziness questionnaire’s ability to discriminate between peripheral and non-peripheral causes of vertigo.
Study Design
Prospective multi-center
Setting
Four academic centers with experienced balance specialists
Patients
New dizzy patients
Interventions
A 32-question survey was given to participants. Balance specialists were blinded and a diagnosis was established for all participating patients within 6 months.
Main outcomes
Multinomial logistic regression was used to evaluate questionnaire performance in predicting final diagnosis and differentiating between peripheral and non-peripheral vertigo. Univariate and multivariable stepwise logistic regression were used to identify questions as significant predictors of the ultimate diagnosis. C-index was used to evaluate performance and discriminative power of the multivariable models.
Results
437 patients participated in the study. Eight participants without confirmed diagnoses were excluded and 429 were included in the analysis. Multinomial regression revealed that the model had good overall predictive accuracy of 78.5% for the final diagnosis and 75.5% for differentiating between peripheral and non-peripheral vertigo. Univariate logistic regression identified significant predictors of three main categories of vertigo: peripheral, central and other. Predictors were entered into forward stepwise multivariable logistic regression. The discriminative power of the final models for peripheral, central and other causes were considered good as measured by c-indices of 0.75, 0.7 and 0.78, respectively.
Conclusions
This multicenter study demonstrates a focused dizziness questionnaire can accurately predict diagnosis for patients with chronic/relapsing dizziness referred to outpatient clinics. Additionally, this survey has significant capability to differentiate peripheral from non-peripheral causes of vertigo and may, in the future, serve as a screening tool for specialty referral. Clinical utility of this questionnaire to guide specialty referral is discussed.
GST is a reliable specific test of gaze stability which has diagnostic and rehabilitative applications in patients with vestibular dysfunction. Reduced contralesional velocities may help explain oscillopsia in patients with unilateral dysfunction.
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