To construct a new vestibular screening tool to identify likely vestibular disorders and guide referral of dizzy patients presenting to hospital and to test the vestibular screening tool for construct and discriminative validity and reliability of physiotherapy assessors.
Emergency and acute hospital wards of a metropolitan hospital.
Adults (N=114) presenting to hospital with dizziness (mean age, 67.36±14.88y; 57% women).
Main Outcome Measures
Three vestibular screening tools (3, 4, and 5 items) were investigated. Physiotherapy vestibular diagnostic tests categorized patients as vestibular or nonvestibular patients. Subsets of patients were assessed twice by 2 physiotherapists (n=20) and twice by the same physiotherapist (n=30).
Each of the vestibular screening tools had a good fit to the Rasch measurement model. Factor analysis demonstrated individual items loaded across 1 factor, confirming unidimensionality of the 3 vestibular screening tools, and Cronbach α determined internal consistency. The 4-item vestibular screening tool had the greatest area under the curve using receiver operator curve analysis (.894), with highest sensitivity (83%) and specificity (84%) for identifying vestibular disorders (cutoff value ≥4/8). Sensitivity of the 3- and 5-item versions was lower than the 4-item vestibular screening tool (80%). The 4-item vestibular screening tool scores showed high intrarater (κ item scores, .831–1; intraclass correlation coefficient [ICC] total, .988) and interrater (κ item scores, .578–.921; ICC total, .878) reliability.
The 4-item vestibular screening tool is a reliable, valid tool for screening dizzy patients presenting to hospital, with unidimensional construct validity, high sensitivity, and specificity for identifying likely vestibular disorders. The vestibular screening tool could be used clinically to streamline referrals of dizzy patients to vestibular clinics.
List of abbreviations:AUC (area under the curve), BPPV (benign paroxysmal positional vertigo), DHI (Dizziness Handicap Inventory), ED (emergency department), HINTS (head impulse nystagmus type test of skew), ROC (receiver operator curve)
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- Disconnect between charted vestibular diagnoses and emergency department management decisions: a cross-sectional analysis from a nationally representative sample.Acad Emerg Med. 2009; 16: 970-977
- Asymmetric vestibular function in the elderly might be a significant contributor to hip fractures.Scand J Rehabil Med. 2000; 32: 56-60
- Observation of vestibular asymmetry in a majority of patients over 50 years with fall-related wrist fractures.Acta Otolaryngol. 2001; 121: 481-485
- Risk factors associated with visiting or not visiting the accident & emergency department after a fall.BMC Health Serv Res. 2013; 13: 286
- Rising annual costs of dizziness presentations to U.S. emergency departments.Acad Emerg Med. 2013; 20: 689-696
- Frontline providers harbor misconceptions about the bedside evaluation of dizzy patients.Acta Otolaryngol. 2008; 128: 601-604
- Overreliance on symptom quality in diagnosing dizziness: results of a multicenter survey of emergency physicians.Mayo Clin Proc. 2007; 82: 1319-1328
- Vestibular rehabilitation for unilateral peripheral vestibular dysfunction.Cochrane Database Syst Rev. 2015; 1: CD005397
- Clinical practice guideline: benign paroxysmal positional vertigo.Otolaryngol Head Neck Surg. 2008; 139: S47-S81
- Physical therapy for central vestibular dysfunction.Arch Phys Med Rehabil. 2006; 87: 76-81
- Vestibular rehabilitation for migraine-associated dizziness.Int Tinnitus J. 2005; 11: 81-84
- Vestibular rehabilitation.FA Davis, Philadelphia2000
- HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging.Stroke. 2009; 40: 3504-3510
- The development of the Dizziness Handicap Inventory.Arch Otolaryngol Head Neck Surg. 1990; 116: 424-427
- Measuring outcome from vestibular rehabilitation, part II: refinement and validation of a new self-report measure.Int J Audiol. 2009; 48: 24-37
Wittink DR, and Bayer LR. The measurement imperative. Marketing Research 2003;15:19.
- Vestibular system disorder.in: Schapira A.H. Neurology and clinical neuroscience. Mosby Elsevier, Philadelphia2007: 337-353
- Vestibular migraine.Semin Neurol. 2013; 33: 212-218
- Reasonable mean square fit values.Rasch Measurement Transactions. 1994; 8: 370
- Predictors of future falls in Parkinson disease.Neurology. 2010; 75: 116-124
- Adaptability to perturbation as a predictor of future falls: a preliminary prospective study.J Geriatr Phys Ther. 2010; 33: 50-55
- The kappa statistics in reliability studies: use, interpretation, and sample size requirements.Phys Ther. 2005; 83: 257-268
- Falls, aging, and disability.Phys Med Rehabil Clin North Am. 2010; 21: 357-373
- Measuring outcome from vestibular rehabilitation, part i: qualitative development of a new self-report measure.Int J Audiol. 2008; 47: 169-177
- Assessing the validity of the dynamic gait index in a balance disorders clinic: an application of Rasch analysis.Phys Ther. 2013; 93: 809-818
- Functional gait assessment: concurrent, discriminative, and predictive validity in community-dwelling older adults.Phys Ther. 2010; 90: 761-773
Published online: August 24, 2015
Supported by Prince Charles Hospital Foundation Novice Research (grant no. NR2013-228).
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.