The Role of Prediagnosis Audiovestibular Dysfunction Versus Distress, Illness-Related Cognitions, and Behaviors in Predicted Ongoing Dizziness Handicap

Abstract

Objective People with chronic vestibular diseases experience variable degrees of self-perceived disability. However, longitudinal data examining the predictive validity of relevant clinical variables alongside psychological variables are limited. The present study examined whether these factors predict self-reported dizziness handicap 3 months after assessment and diagnosis. Methods Patients were recruited from a waiting list of a tertiary neuro-otology clinic and completed standardized mood, cognitive, behavioral, and dizziness handicap questionnaires before and 3 months after their initial consultation and diagnosis. All patients were clinically assessed and underwent comprehensive audiovestibular investigations. Results Seventy-three percent of participants responded at follow-up ( n = 135, 73% female, mean [standard deviation] age = 54.23 [17.53] years), of whom 88% were diagnosed with a neurotological condition. There were significant improvements in handicap, depression, and anxiety at 3 months. Thirty (22%) of 135 showed clinically meaningful improvement in handicap. The percentage of case-level depression and anxiety remained the same. Negative illness perceptions and symptom responses reduced, although participants still tended to view their condition negatively. Vestibular tests and type of diagnosis were not associated with self-reported handicap. Most baseline psychological variables significantly correlated with handicap at 3 months. When adjusting for baseline handicap and demographics, the baseline psychological variables only explained a significant ~3% of the variance in dizziness handicap at follow-up, with baseline handicap explaining most of the variance. All-or-nothing behavior was the most significant predictor. Conclusions Tertiary patients with vertigo and dizziness report negative illness perceptions and cognitive and behavioral responses to symptoms that are associated with self-reported handicap over time. Future studies are needed to investigate whether targeting these factors alongside traditional treatment approaches improves handicap in patients with chronic dizziness.

The INVEST trial: a randomised feasibility trial of psychologically informed vestibular rehabilitation versus current gold standard physiotherapy for people with Persistent Postural Perceptual Dizziness

“…Reductions in avoidance and resting in response to symptoms was also greater in INVEST. It was surprising that all-or-nothing behaviour did not show a larger treatment effect, since our previous prospective data found this to be a strong predictor and was a predominant feature of INVEST [ 17 , 18 ]. Both groups improved so this may also reflect similarities between the interventions in terms of pacing and graded exercise.…”

“…To address this gap, we developed a combined CBT-VRT intervention based on existing research data and theoretical modelling of the psychological factors that contribute to dizziness handicap [ 17 , 18 ]. Based on those findings and working in partnership with patient representatives, we developed a patient manual.…”

Protocol for a randomised controlled feasibility study of psychologically informed vestibular rehabilitation for people with persistent dizziness: INVEST trial

“…For individuals experiencing persistent dizziness, a CBT protocol which remains contextually anchored to their experience of living with dizziness may ultimately promote better engagement with rehabilitation and improve health outcomes. We conducted a theoretical modelling prospective study which revealed the importance of a variety of illness-specific cognitive and behavioural factors in the experience of dizziness-related disability [ 17 , 18 ]. This was drawn together with a review of the literature to develop a model specific to dizziness (article in preparation), and we then used intervention mapping techniques [ 19 , 20 ] to design an intervention and detailed manual which integrated CBT methods into traditional VR.…”

What Predicts Improvement of Dizziness after Multimodal and Interdisciplinary Day Care Treatment?

“…The impact of the baseline extent of dizziness-associated handicap on follow-up was also found in other studies. In therapy-naive patients with chronic vestibular diseases, the baseline handicap explained that most of the variance correlated with the handicap at a 3-month follow-up [ 23 ]. In patients with functional vertigo and dizziness subjected to a multimodal psychosomatic inpatient treatment, the vertigo-related handicap at admission was the only significant predictor of vertigo-related handicap at follow-up [ 14 ].…”