Search

Introduction: Among individuals with dizziness, there is an increased prevalence of psychosocial comorbidity compared to the general population. Increased psychosocial comorbidity among people with dizziness is associated with disability and poorer outcomes in vestibular rehabilitation. However, there is less knowledge regarding the association between psychosocial factors and mobility outcomes in people with dizziness. Therefore, the purpose of this study was to assess the association between psychosocial factors and future activity, participation, and community mobility among people with dizziness. The secondary aim of this study was to explore the constructs measured using patient-reported outcomes associated with psychosocial factors in this population. Materials and methods: We conducted a prospective cohort study with an in-person baseline assessment and a follow-up assessment completed at 3-months via computerized questionnaires. We measured psychosocial factors at baseline using the Hospital Anxiety and Depression Scale (HADS), the Patient Health Questionnaire 4-item (PHQ-4), the Vestibular Activities Avoidance Instrument (VAAI), and the Dizziness Catastrophizing Scale (DCS). We measured community mobility and participation at baseline and 3-month follow-up using the Life Space Assessment (LSA) and Vestibular Activities and Participation Measure (VAP). To determine the associations between baseline anxiety and depression symptoms, fear avoidance, catastrophizing beliefs and mobility and disability measures, we used simple linear regression and repeated measures ANOVA. We used exploratory factor analysis to identify constructs measured using patient-reported outcomes of psychosocial factors. Results: There were 100 participants who completed the baseline assessment [mean age (SD) = 49.2 (15.7) years; 73% female] and 68 participants completed the questionnaire at the 3-month follow-up. In bivariate analyses, baseline VAAI, HADS-A, HADS-D, PHQ-4 depression, and VAP were associated with LSA, and baseline VAAI, HADS-D, PHQ-4 depression, and LSA were associated with VAP at 3-month follow-up (all p < 0.05). In adjusted multivariate analyses, baseline VAP had a large effect (F = 11.65, p = 0.001, η 2 = 0.18) and HADS-D had a moderately large effect (F = 4.09, p = 0.048, η 2 = 0.07) on LSA score at 3-month follow-up. Baseline VAAI had a large effect (F = 23.35, p < 0.001, η 2 = 0.3) on VAP at 3-month follow-up. The exploratory factor analysis of the VAAI, HADS, PHQ-4, and DCS resulted in 4 factors measuring constructs of fear avoidance, anxiety, depression, and catastrophization. Discussion: We found that baseline psychosocial factors were related to future measures of activity and participation as well as community mobility in people with dizziness. Specifically, baseline activity and participation levels and depressive symptoms were significantly associated with future community mobility and baseline fear avoidance beliefs were significantly associated with future activity and participation. Patient-reported outcome measures of psychosocial factors appear to measure unique constructs, which may indicate that a small number of different outcome measures may be needed to gather important prognostic information to manage individuals with dizziness well. [ABSTRACT FROM AUTHOR]

Background Neighborhood walkability may encourage greater out-of-home travel (ie, community mobility) to support independent functioning in later life. We examined associations between a novel walkability audit index and Global Positioning System (GPS)-derived community mobility in community-dwelling older adults. We compared associations with the validated Environmental Protection Agency (EPA) National Walkability Index and further examined moderation by clinical walking speed. Methods Participants were 146 older adults (Mean  = 77.0 ± 6.5 years, 68% women) at baseline of a randomized trial to improve walking speed. A walkability index (range: 0–5; eg, land-use mix, crosswalks, and so on) was created using Google Street View audits within 1/8-mile of the home. Participants carried a GPS device for 5–7 days to derive objective measures of community mobility (eg, time spent out of home, accumulated distance from home). Results Each 1 SD (~1.3-point) greater walkability audit score was associated with a median 2.16% more time spent out of home (95% confidence interval [95% CI]: 0.30–4.03, p  = .023), adjusting for individual demographics/health and neighborhood socioeconomic status. For slower walkers (4-m walking speed <1 m/s), each 1 SD greater audit score was also associated with a median 4.54 km greater accumulated distance from home (95% CI: 0.01–9.07, p (interaction) = .034). No significant associations were found for the EPA walkability index. Conclusions Walkability immediately outside the home was related to greater community mobility, especially for older adults with slower walking speeds. Results emphasize the need to consider the joint influence of local environment and individual functioning when addressing community mobility in older populations. [ABSTRACT FROM AUTHOR]

Background We examined the relationship between global positioning system (GPS) indicators of community mobility and incident hospitalizations, emergency department (ED) visits, and falls over 1-year in community-dwelling older adults. Methods We performed a secondary analysis of a randomized trial investigating a physical therapy intervention to improve mobility in older adults. One hundred and forty-eight participants (mean age: 76.9 ± 6.2 years; 65% female) carried a GPS device following the postintervention visit. Over 1-year, new hospitalizations, falls, and ED visits were reported. GPS indicators of community mobility included the median area and compactness of the standard deviation ellipse (SDE), the median percentage of time spent outside of home (TOH), and median maximum distance from home. Generalized linear models assessed the association between 1-year risk of outcomes and GPS measures adjusted for age, race, gender, body mass index, comorbidity burden, and fall history. Results The mean ± standard deviation of the median SDE area was 4.4 ± 8.5 km2, median SDE compactness 0.7 ± 0.2, median percentage TOH 14.4 ± 12.0%, and median maximum distance from home was 38 ± 253 km. Each 5% increase in median percentage TOH was associated with a 24% lower risk of hospitalization (incident rate ratio = IRR = 0.76, 95%CI: 0.61–0.95; p  = .01). The association persisted after covariate adjustment (IRR = 0.78, 95%CI: 0.63–0.98; p  = .03). No significant associations appeared for any GPS indicators with incident falls or ED visits. Conclusions Increased TOH was associated with a lower risk of incident hospitalization over 1 year among community-dwelling older adults. Restricted community mobility may be an indicator of activity limitations related to future health outcomes, but further study is warranted. [ABSTRACT FROM AUTHOR]

Background: It is important to understand the factors associated with life-space mobility so that mobility disability can be prevented/treated. The purpose of this study was to identify the association between mobility determinants and life space among older adults.Methods: This study was a cross-sectional analysis of 249 community-dwelling older adults (mean age = 77.4 years, 65.5% female, 88% White), who were recruited for a randomized, controlled, clinical intervention trial. Associations between cognitive, physical, psychosocial, financial, and environmental mobility determinants and the life-space assessment (LSA) at baseline were determined using Spearman's correlation coefficients and one-way analysis of variance. Multivariate analysis was performed using multivariable linear regression models.Results: The mean LSA score for the sample was 75.3 (SD = 17.8). Personal factors (age, gender, education, comorbidities), cognitive (Trail Making Test A and B), physical (gait speed, lower extremity power, 6-Minute Walk Test, Figure of 8 Walk Test, tandem stance, energy cost of walking, and Late-Life Function and Disability Function Scale), psychosocial (Modified Gait Efficacy Scale), and financial (neighborhood socioeconomic status) domains of mobility were significantly associated with LSA score. In the final regression model, age (β = -0.43), lower extremity power (β = 0.03), gait efficacy (β = 0.19), and energy cost of walking (β = -57.41) were associated with life space (R2 = 0.238).Conclusions: Younger age, greater lower extremity power, more confidence in walking, and lower energy cost of walking were associated with greater life space. Clinicians treating individuals with mobility disability should consider personal, physical, and psychosocial factors when assessing barriers to life-space mobility. [ABSTRACT FROM AUTHOR]

The purpose of this case report was to describe the evaluation and management of atypical benign paroxysmal positional vertigo (BPPV) in an adult with severe osteogenesis imperfecta. A 29-year-old male was referred to a physical therapist with extensive experience in vestibular rehabilitation who provided horizontal canal BPPV treatment with a canalith repositioning maneuver over two treatment sessions. The individual's symptoms had reduced by 65% and his nystagmus during the roll test was reduced. Extreme care is needed to safely reposition individuals living with severe osteogenesis imperfecta, but the repositioning can reduce symptoms and improve quality of life. Laryngoscope, 130:2241-2244, 2020. [ABSTRACT FROM AUTHOR]

Background and Objectives: The objective of this systematic review was to determine the outdoor environmental factors that are associated with increased risk of falls and fear of falling in middle-aged and older adults., Research Design and Methods: PubMed, Medline, EMBASE, APA Psych INFO, and CINAHL electronic databases were searched through August 2024 for studies that included participants 45 years or older, falls or fear of falling as an outcome, and measure the outdoor environment (i.e., uneven sidewalks, neighborhood disorder). Title and abstract screenings, full text screenings, and critical appraisal assessments were independently reviewed., Results: The search retrieved 7474 records, 627 full texts were reviewed, and 51 unique studies met the inclusion/exclusion criteria. The number of participants ranged from 12 to 6,720,937. There were 41 studies that included fall outcomes, 5 studies that included fear of falling outcomes, and 5 studies that included both outcomes. Micro-walkability (e.g., sidewalk quality) were the most frequently studied outdoor environmental characteristics and many studies found associations with falls and fear of falling. Macro-walkability (e.g., land use), crime and safety, socioeconomic, greenspace, terrain, physical disorder, and social features were studied to a lesser extent and had mixed findings., Discussion and Implications: The most consistent associations were found between micro-walkability features of the outdoor environment with falls whereas other environmental domains and fear of falling were studied to a lesser extent. Environmental contributors to falls should be considered in future research, policy implementation, and clinical interventions to reduce falls and their negative outcomes for older adults., (© The Author(s) 2025. Published by Oxford University Press on behalf of the Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: A low-cost home exercise system called VestAid has been developed to assist participants during vestibulo-ocular reflex gaze stabilization exercises outside of clinic visits. The system includes a tablet-based app for the participant and a web-based portal for the physical therapist that provides data to make judgments about exercise accuracy and performance., Objective: The purpose of this study was to assess the feasibility and acceptability of VestAid in a pilot study of 10 participants (mean age 45 [SD 19] years; 6 women) with various vestibular diagnoses., Methods: All participants completed twelve 30-second horizontal vestibulo-ocular reflex exercises in a seated position (6 "easy" and 6 "hard" exercises). The exercises differed by variations in the background color, pattern, and movement. One of the exercises was repeated to assess the test-retest reliability of the measure of gaze stability accuracy and head motion compliance during the exercise. Participants rated the difficulty of the exercises (0-10 where 0=easy, 10=difficult) and completed usability surveys., Results: Participants completed the VestAid session without adverse events. The responses from the usability survey demonstrate the acceptability of VestAid. The mean rating of the "easy" exercises was 2.7/10 (SD 1.9). The mean rating for the "difficult" exercises across participants was 4.8/10 (SD 2.1)., Conclusions: The consistency of the mean ratings of the participants with the exercise classifications ("easy" and "difficult") suggests that VestAid has clinical utility., (© Brooke N Klatt, Pedram Hovareshti, Lisa S Holt, Pamela M Dunlap, Chad Zalkin, Devendra Tolani, Susan L Whitney. Originally published in JMIR Rehabilitation and Assistive Technology (https://rehab.jmir.org).)

Background/introduction: In persons with vestibular disorders, disturbed vestibular input and accompanying dizziness can be associated with anxiety or depression. To avoid dizziness, persons with vestibular disorders can develop mal-adaptive fear avoidance behaviors which can negatively influence daily life functioning. The aims of this study were to (1) document different psychological factors in patients with vestibular disorders and healthy adults across cultures and (2) to assess the convergent validity of the 9-item Vestibular Activities Avoidance Instrument (VAAI), which quantifies fear avoidance beliefs., Methods: Psychological factors and disability were measured in Dutch-speaking healthy adults and English- and Dutch-speaking persons with vestibular disorders using the VAAI, the Dizziness Handicap Inventory (DHI), the Hospital Anxiety and Depression Scale (HADS) and the Activities-Specific Balance Confidence Scale (ABC). The convergent validity of the VAAI was investigated by performing correlation analyses between the VAAI, the DHI, the HADS, and the ABC., Results: A total of 151 Dutch-speaking healthy adults, 404 English-speaking participants with vestibular disorders, and 126 Dutch-speaking participants with vestibular disorders were included. Participants with vestibular disorders presented with higher levels of fear avoidance beliefs (VAAI), perceived disability (DHI), anxiety and depression (HADS), and lower confidence during balance activities (ABC) compared to healthy adults. Regarding the convergent validity of the VAAI, there were moderate to strong correlation coefficients ( r = 0.39-0.74) between fear avoidance and the DHI, HADS, and ABC in participants with vestibular disorders., Conclusions: Participants with vestibular disorders report a higher psychological burden compared to healthy adults. These results emphasize the importance of assessing psychological factors in persons with vestibular disorders. In addition, evidence was provided for convergent validity, supporting the VAAI as a valid outcome measure across cultures., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Van Laer, Dunlap, Vereeck, Hendriks, Sluydts and Whitney.)

Importance: Fear avoidance is a behavioral response to dizziness that can lead to chronic symptoms and maladaptation of the vestibular system, but there is no valid and reliable clinical measure of fear avoidance for persons with dizziness. Although the Vestibular Activities Avoidance Instrument (VAAI) was developed to identify fear avoidance beliefs in persons with dizziness, it was considered too long for clinical use., Objective: To continue development of the VAAI for clinical use by reducing its length and by assessing the internal consistency and construct validity through associations with measures of disability, quality of life, and psychological well-being., Design, Setting, and Participants: This prospective cohort study conducted from February 2018 to December 2019 at a tertiary care balance disorders clinic and in outpatient physical therapy clinics in the United States included 404 adults with dizziness., Main Outcomes and Measures: Participants completed the 81-item VAAI, the Vestibular Activities and Participation (VAP) measure, the 12-Item Short Form Health Survey (SF-12), and the Hospital Anxiety and Depression Scale (HADS) at baseline. Exploratory factor analysis of the VAAI was conducted to reduce the number of items. Internal consistency of the reduced VAAI was determined by calculating the Cronbach α. Convergent validity was assessed by examining the associations between the reduced VAAI and the VAP, the SF-12, and the HADS using Spearman correlation coefficients., Results: Data from 404 adults (mean [SD] age, 54.0 [17.0] years; 64.6% women) were included in the analyses. The exploratory factor analysis indicated that 2 factors explained the underlying constructs of the 81-Item VAAI. The first factor was retained and measured the construct of fear avoidance. The VAAI was reduced to 9 items (VAAI-9). The VAAI-9 showed excellent internal consistency (Cronbach α = 0.92) and was positively associated with the VAP (ρ = 0.81) and the HADS anxiety (ρ = 0.47) and depression (ρ = 0.64) subscales, and negatively associated with physical (ρ = -0.76) and mental (ρ = -0.47) health-related quality of life., Conclusions and Relevance: These findings indicate that the VAAI-9 is a short, internally consistent, valid measure of fear avoidance and is associated with quality of life, activity limitations and participation restrictions, and psychological well-being. The next steps in the development of the VAAI-9 will include validation in an external sample, assessment of test-retest validity, and prospective investigations of its association with future disability.