Affiliations: [a] Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA | [b] James H. Quillen VA Medical Center, Mountain Home, TN, USA | [c] Department of Physical Therapy, East Tennessee State University, Johnson City, TN, USA | [d] Shepherd Center, Atlanta, GA, USA | [e] Emory University, Atlanta, GA, USA | [f] Triage Staffing, Omaha, NE, USA | [g] Athletico Physical Therapy, Chicago, IL, USA | [h] State Home Health, New Orleans, LA, USA
Correspondence:
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Corresponding author: Susan J. Herdman, 1530 Mason Mill Rd NE, Atlanta, GA 30329, USA. Tel.: +1 404 372 3374; E-mail:sherdma@emory.edu
Abstract:
BACKGROUND: Vestibular rehabilitation (VR) improves symptoms and
function in some but not all patients with bilateral vestibular hypofunction
(BVH). OBJECTIVE: The purpose of this retrospective study was to examine
change following vestibular rehabilitation and to identify factors
associated with rehabilitation outcome in patients with BVH. METHODS: Data from 69 patients with BVH were analyzed. Factors
studied included patient characteristics, subjective complaints and physical
function. Outcome measures included symptom intensity, balance confidence,
quality of life, gait speed, fall risk, and dynamic visual acuity. Bivariate
correlations were used to examine relationships of patient characteristics
and baseline measures with outcome measures. One-way ANOVAs were used to
compare outcomes in patients with BVH versus unilateral vestibular
hypofunction (UVH). RESULTS: As a group, patients with BVH improved in all outcome
measures except disability following a course of vestibular rehabilitation
(VR); however, only 38-86% demonstrated a meaningful improvement,
depending on the specific outcome measure examined. Several factors measured
at baseline - age, DGI score, gait speed and perceived dysequilibrium -
were associated with outcomes. For example, greater age was related to
higher DVA scores at discharge; lower initial DGI scores were related to
higher Disability scores at discharge. Compared to patients with UVH,
reported previously [9], a smaller percentage of patients with BVH improve
and to a lesser extent. CONCLUSION: Consideration of baseline factors may provide guidance
for setting patient goals. Further research is needed determine what factors
predict outcome and to develop more effective treatment strategies for those
patients who do not improve.
