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Background: Dizziness and comorbid anxiety may cause severe disability of patients with vestibulopathy, but can be addressed effectively with rehabilitation. For an individually adapted treatment, a structured assessment is needed. The Vertigo Symptom Scale (VSS) with two subscales assessing vertigo symptoms (VSS-VER) and associated symptoms (VSS-AA) might be used for this purpose. As there was no validated VSS available in German, the aim of the study was the translation and cross-cultural adaptation in German (VSS-G) and the investigation of its reliability, internal and external validity., Methods: The VSS was translated into German according to recognized guidelines. Psychometric properties were tested on 52 healthy controls and 202 participants with vestibulopathy. Internal validity and reliability were investigated with factor analysis, Cronbach's α and ICC estimations. Discriminant validity was analysed with the Mann-Whitney-U-Test between patients and controls and the ROC-Curve. Convergent validity was estimated with the correlation with the Hospital Anxiety Subscale (HADS-A), Dizziness Handicap Inventory (DHI) and frequency of dizziness., Results: Internal validity: factor analysis confirmed the structure of two subscales. Reliability: VSS-G: α = 0.904 and ICC (CI) =0.926 (0.826, 0.965). Discriminant validity: VSS-VER differentiate patients and controls ROC (CI) =0.99 (0.98, 1.00). Convergent validity: VSS-G correlates with DHI (r = 0.554) and frequency (T = 0.317). HADS-A correlates with VSS-AA (r = 0.452) but not with VSS-VER (r = 0.186)., Conclusions: The VSS-G showed satisfactory psychometric properties to assess the severity of vertigo or vertigo-related symptoms. The VSS-VER can differentiate between healthy subjects and patients with vestibular disorders. The VSS-AA showed some screening properties with high sensitivity for patients with abnormal anxiety.

Background: It is known that anxiety and depression influence the level of disability experienced by persons with vertigo, dizziness or unsteadiness. Because higher prevalence rates of disabling dizziness have been found in women and some studies reported a higher level of psychiatric distress in female patients our primary aim was to explore whether women and men with vertigo, dizziness or unsteadiness differ regarding self-perceived disability, anxiety and depression. Secondly we planned to investigate the associations between disabling dizziness and anxiety and depression., Method: Patients were recruited from a tertiary centre for vertigo and balance disorders. Participants rated their global disability as mild, moderate or severe. They filled out the Dizziness Handicap Inventory and the two subscales of the Hospital Anxiety Depression Scale (HADS). The HADS was analysed 1) by calculating the median values, 2) by estimating the prevalence rates of abnormal anxiety/depression based on recommended cut-off criteria. Mann-Whitney U-tests, Chi-square statistics and odds ratios (OR) were calculated to compare the observations in both genders. Significance values were adjusted with respect to multiple comparisons., Results: Two-hundred and two patients (124 women) mean age (standard deviation) of 49.7 (13.5) years participated. Both genders did not differ significantly in the mean level of self-perceived disability, anxiety, depression and symptom severity. There was a tendency of a higher prevalence of abnormal anxiety and depression in men (23.7%; 28.9%) compared to women (14.5%; 15.3%). Patients with abnormal depression felt themselves 2.75 (95% CI: 1.31-5.78) times more severely disabled by dizziness and unsteadiness than patients without depression. In men the OR was 8.2 (2.35-28.4). In women chi-square statistic was not significant. The ORs (95% CI) of abnormal anxiety and severe disability were 4.2 (1.9-8.9) in the whole sample, 8.7 (2.5-30.3) in men, and not significant in women., Conclusions: In men with vertigo, dizziness or unsteadiness emotional distress and its association with self-perceived disability should not be underestimated. Longitudinal surveys with specific pre-defined co-variables of self-perceived disability, anxiety and depression are needed to clarify the influence of gender on disability, anxiety and depression in patients with vertigo, dizziness or unsteadiness.

Objective: The aim of this study was to demonstrate the use of the International Classification of Functioning, Disability and Health (ICF) to measure the effect of physiotherapy treatment., Design: A prospective cohort study with an additional case report., Patients: Individuals were eligible for the study if they were patients at the University Hospital of Zurich and had received physiotherapeutic interventions during their inpatient stay., Methods: Patient's functioning was assessed by physiotherapists at initiation of physiotherapeutic treatment and at discharge using ICF Core Sets., Results: A total of 425 patients were analysed, mean age 60 years, 42% female. The median of treatment days varied between 4 (intensive care unit) and 19 (low back pain). The majority of patients had improved or stable results; improvement was most prominent in the surgical and internal medicine group. The ICF category d450 "Walking" appears in 4 out of 6 ICF Core Sets, being only infrequently treated in intensive care unit and low back pain, Conclusion: Analysis showed that the ICF can be used to record precise information on patients' functioning in the acute hospital. Typical impairments and restrictions, intervention goals and trajectories of functioning could be documented. The qualifiers used in our clinical example were sensitive to change. Definitions of qualifiers, however, should be the subject of further research.

Objective: To operationalize items based on categories of the International Classification of Functioning, Disability and Health (ICF) relevant to patient problems that are addressed by physiotherapeutic interventions in the acute hospital, and to test the reliability of these items when applied by physiotherapists., Methods: A selection of 124 ICF categories was operation-alized in a formal decision-making and consensus process. The reliability of the newly operationalized item list was tested with a cross-sectional study with repeated measurements., Results: The item writing process resulted in 94 dichotomous and 30 polytomous items. Data were collected in a convenience sample of 28 patients with neurological, musculoske-letal, cardiopulmonary, or internal organ conditions, requiring physical therapy in an acute hospital. Fifty-six percent of the polytomous and 68% of the dichotomous items had a raw agreement of 0.7 or above, whereas 36% of all polytomous and 34% of all dichotomous items had a kappa coefficient of 0.7 and above., Conclusion: The study supports that the ICF is adaptable to professional and setting-specific needs of physiotherapists. Further research towards the development of reliable instruments for physiotherapists based on the ICF seems justified. :

Background: Investigating determinants of physical therapy workload in the acute care setting is essential for planning interventions, for justifying resource allocation, and for reimbursement., Objective: The objective of this study was to examine whether International Classification of Functioning, Disability and Health (ICF) intervention goals (ICF categories representing goals of physical therapy interventions typical for an acute care hospital) could predict physical therapy workload in the acute care hospital setting., Design: This investigation was a multicenter, observational cohort study., Methods: Patients were recruited from a representative sample of 32 acute care hospitals across Switzerland if they received physical therapy during their inpatient stay for the treatment of any injury or disease in 1 of 3 main diagnostic categories: musculoskeletal, neurological, and cardiopulmonary conditions. Physical therapists completed questionnaires at the time of the patients' discharge to report on ICF intervention goals. Information on workload was collected retrospectively from hospital documentation systems. Multivariable regression models were used to identify the intervention goals independently associated with workload., Results: The mean workload for 642 patients (mean age=61 years [SD=18 years], 45% women) was 370 minutes. The daily workload for interventions ranged from 33 minutes (cardiopulmonary conditions) to 49 minutes (neurological conditions). There were significant variations in workload across hospital sites and medical disciplines. The goal "maintaining a body position" emerged as a significant indicator of a higher workload for all condition groups; the goals "attention functions" and "transferring oneself" were indicators for neurological and musculoskeletal conditions, respectively., Limitations: Not all potential predictors of workload could be examined. Other, person- or setting-specific variables might have been relevant to workload. Case mix and clinical practice were representative only for Swiss hospitals., Conclusions: A small set of intervention goals were the major factors influencing physical therapy workload, independent of diagnosis or clinical specialty. Describing variability in physical therapists' practices in the acute care setting and relating these data to relevant patient-centered outcomes are the initial steps for improving resource allocation and reimbursement for interventions that maintain or improve functioning.