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

Abstract

Background: Vertigo and dizziness are common in community-dwelling people and can be treated in specialized multidisciplinary settings. To develop tailored interventions, however, we have to explore risk factors for favorable and unfavorable outcomes. Methods: We prospectively investigated patients with chronic vertigo and dizziness subjected to our 5-day multimodal and interdisciplinary day care treatment in the Center for Vertigo and Dizziness of Jena University Hospital, Germany. The Vertigo Severity Scale (VSS), the Body Sensations Questionnaire (BSQ), the Hospital Anxiety and Depression Scale (HADS), the Agoraphobic Cognitions Questionnaire (ACQ), the Mobility Inventory (MI), and the burden and intensity of dizziness (using a visual analogue scale) were assessed at baseline (n = 754) and after 6 months (n = 444). In addition, 14 Likert-scaled questions were used to quantify the change in personal attitude and behavior towards the complaints after 6 months. Results: Dizziness-related burden and intensity improved with a large effect size. The largest improvement was seen in the attitudes towards dizziness, the understanding of somatic causes, and the perceived ability to influence dizziness. However, the ability to work and to carry out professional activity was improved to a lesser extent. The overall improvement of dizziness was associated with the absence of a depressive mood, a short duration of vertigo, a lower VSS, a lower perceived intensity of vertigo, and distinct vertigo diagnoses, namely Meniere’s disease, vestibular migraine, vestibular neuritis, vestibular paroxysmia, and vestibular schwannoma. Worsening of dizziness/vertigo was associated with depressive symptoms, permanent vertigo, distinct vertigo diagnoses (central vertigo, multisensory deficit), and a higher perceived burden due to vertigo. Conclusion: The six-month outcome of patients with dizziness presented to a specialized outpatient clinic appears to be favorable. Nevertheless, people with the abovementioned risk factors at baseline have less benefit and probably need adapted and tailored vertigo interventions to improve long-term outcome.

Tolerance to Dizziness Intensity Increases With Age in People With Chronic Dizziness

“…This was a subgroup analysis of a larger longitudinal observational study in people with chronic dizziness attending a specialized vertigo center ( 17 ). The study was approved by the local ethics committee (Ethics Committee of the Friedrich-Schiller-University Jena, Number 5426-02/18), and written informed consent for study participation was obtained from all patients.…”

Pathophysiology and Therapy of Associated Features of Migraine

“…It has received many names in the past [ 186 , 189 , 190 ], and recently, more conditions have been found to fall possibly under the current umbrella of what is considered today VM [ 191 ], as well as some diagnoses classified as functional disorders today that may, in the near future, be included. The mere fact of having a diagnosis has proven to be a positive predictor for the improvement of dizziness [ 192 ]. However, currently, VM still remains largely underdiagnosed [ 193 ].…”

Literature review and two study cases of vestibular paroxysmia from an otorhinolaryngology centre

“…Increasingly, mention is made of the "mixed" nature of dizziness, so that dysfunction of various receptors in the balance system (such as, for example, sensory weakness in the joints, dysfunction of the labyrinth, peripheral neuropathy) and disorders of central information processing (dementia-like changes, degenerative processes of the central nervous system) overlap to form a multifaceted picture [7,8]. Difficulties in the daily life of patients, resulting in a higher incidence of depressive disorders and chronic fatigue syndrome, among others, or adaptive difficulties in learning and work, illustrate how this problem is one that requires researchers to constantly update and improve diagnosis and therapy [9,10].…”