This study was aimed at (1) determining the risk of falls in patients with chronic dizziness/ vertigo using the Timed Up and Go test (TUG), Dynamic Gait Index (DGI), Functional Gait Assessment (FGA), and Activities-specific Balance Confidence (ABC) scale, and (2) investigating the correlations and agreements among the measurements results of assessment by the aforementioned methods in these patients. A total of 52 patients with dizziness/vertigo were included in the study, and the risk of falls in these patients was evaluated by the TUG, DGI, FGA, and ABC scale. We analyzed the correlations and agreements in the fall risk assessed by the aforementioned methods using Spearman's rank correlation and kappa statistics. Of the 52 patients, 11 (21.2), 26 (50), 29 (55.8), and 18 (34.6) patients were assessed as being at a risk of falls by the TUG, DGI, FGA, and ABC scale, respectively. The results of the assessments by the above methods showed significant good correlations and agreement. However, the kappa coefficients for some results were low (TUG-DGI: k 0.423, TUG-FGA: k 0.351, TUG-ABC scale: k 0.299, DGI-FGA: k 0.885, DGI-ABC scale: k 0.385, and FGA-ABC scale: k 0.294). Risk factors for falls in patients with dizziness and vertigo include disturbances of psychological balance and gait. Multiple methods to assess the fall risk may yield more accurate results than assessment by one method alone.
There are few reports in Japan of investigation of the effect of vestibular rehabilitation (VR) by physical therapists (PT). This study was aimed at examining the effectiveness of vestibular rehabilitation therapy (VRT) for patients with unilateral peripheral vestibular disorder. The subjects were nine patients with chronic unilateral peripheral vestibular disorder. PTs provided VR, consisting of eye movement exercises, body balance exercises, walking exercises, daily activity movement exercises, to the subjects once a month. The subjects were instructed to perform one to three sets of customized home exercises a day. For this study, the results of the Timed Up & Go test (TUG), Dynamic Gait Index evaluation (DGI), Functional Gait Assessment (FGA) and Activities-Specific Balance Confidence Scale evaluation (ABC) conducted before the start of the VRT and at one month, two months and three months after the start of VRT were compared. The results revealed a significant difference in the results of the DGI and FGA recorded before the start of the intervention and at three months after the start of the intervention later (p 0.05 for both). In both the DGI and FGA, the number of subjects below the cutoff value for the risk of falls decreased after the intervention. There were no significant differences in the results of the TUG or ABC recorded before and after the start of the intervention, although the number of subjects falling below the cutoff value for the risk of falls decreased in the ABC. VR might improve the vestibular function and may need to be continued for more than three months. DGI and FGA were useful for the evaluation of patients with chronic unilateral vestibular disorder. TUG was not suitable for the evaluation of patients with chronic unilateral
Objectives:
This study investigated the effects of a supervised home-based vestibular rehabilitation program using a booklet on gait function and dizziness in patients with chronic peripheral vestibular hypofunction.
Methods:
This was a non-blinded, randomized, controlled trial. Patients (n=42) with chronic peripheral vestibular hypofunction were randomly divided into the vestibular rehabilitation group (VR group; n=20) or the control group (n=22). Patients in the VR group received a supervised home-based vestibular rehabilitation program using a booklet in addition to physician care for 4 weeks. The physical therapist checked the home program when the VR group visited the outpatient clinic once a week. Patients in the control group received physician care only during the trial period. The primary outcome was functional gait assessment (FGA). The secondary outcomes were the dynamic gait index (DGI) and the dizziness handicap inventory (DHI).
Results:
Two-way repeated measures analysis of variance showed a significant interaction for FGA, DGI, DHI total, and DHI emotional scores (P<0.05) with the VR group improving more than the control group. No significant interactions were found for DHI physical and DHI functional scores (P≥0.05).
Conclusions:
The home-based vestibular rehabilitation program in this study was effective in improving gait function and dizziness in patients with chronic peripheral vestibular hypofunction. Regular supervision may have improved adherence to home exercise and contributed to the effectiveness of vestibular rehabilitation.
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