Abstract
Objectives
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.
Design
Methodologic study.
Setting
Emergency and acute hospital wards of a metropolitan hospital.
Participants
Adults (N=114) presenting to hospital with dizziness (mean age, 67.36±14.88y; 57%
women).
Intervention
Not applicable.
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).
Results
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.
Conclusions
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.
Keywords
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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 24, 2015
Footnotes
Supported by Prince Charles Hospital Foundation Novice Research (grant no. NR2013-228).
Disclosures: none.
Identification
Copyright
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
