Dizziness handicap inventory excel1/20/2024 ![]() ![]() EVS is defined as transient vertigo/dizziness lasting seconds to hours, generally including symptoms that suggest temporary dysfunction of the vestibular system (like nausea, nystagmus, and sudden falls). Disorders presenting with AVS include vestibular neuritis, labyrinthitis, stroke affecting vestibular structures, and traumatic vestibulopathy. AVS is defined as acute-onset, continuous vertigo/dizziness, lasting days to weeks, generally including symptoms that suggest new dysfunction of the vestibular system (like vomiting, nystagmus, and severe postural instability). Combining the mentioned vestibular symptoms with timing and triggers results in three vestibular syndromes, i.e., acute vestibular syndrome (AVS), episodic vestibular syndrome (EVS), and chronic vestibular syndrome (CVS). When assessing a patient with vestibular symptoms, the Bárány society recommends to focus on timing (onset, duration, and evolution of symptom) and triggers (actions, movements, or situations that provoke onset of symptoms) ( 11, 12). These vestibular symptoms are not specific in terms of etiology, not overlapping, and not hierarchical (a single patient can experience multiple symptoms) ( 13). The ICVD identifies four main vestibular symptoms, i.e., dizziness (“the sensation of disturbed or impaired spatial orientation without a false or distorted sense of motion”) vertigo (“the sensation of self-motion when no motion is present or the sensation of distorted self-motion during normal head movement”) vestibulovisual symptoms (“visual symptoms that result from vestibular pathology or visual-vestibular interaction”) postural symptoms (“balance symptoms related to maintenance of postural stability, occurring only while upright-seated, standing, or walking”) ( 13). The Bárány society, the leading international organization for clinicians and researchers involved in vestibular medicine, previously realized such a nomenclature: the International Classification of Vestibular Disorders (ICVD) ( 11, 12). Therefore, it is time to leave the Drachman-Hart typology and to adopt a more accurate and uniform way to describe vestibular symptoms. However, both doctors and patients use the term “vertigo” differently ( 6– 8), patients are inconsistent when describing their symptoms ( 7), the identified subtype does not reliably match the suggested etiology ( 5, 9), and regularly patients have more than one dizziness subtype ( 10). The Drachman-Hart typology is primarily based on how patients describe the nature of their symptoms, assuming that this will provide etiological insight, and therefore, diagnostic guidance ( 4, 5). This typology distinguishes four dizziness subtypes, i.e., vertigo (rotational dizziness), presyncope (lightheadedness), disequilibrium (unsteadiness when walking), and non-specific dizziness. To date, most primary care guidelines use the typology of Drachman and Hart ( 3). Moreover, we recommend using the DHI total score only and also to consider adding an instrument with more favorable measurement properties when assessing self-perceived handicap in patients with dizziness.Ĭopyright © 2022, Otology & Neurotology, Inc.When approaching a potentially complex problem, the use of a uniform nomenclature is crucial. Because of its widespread use and the current lack of a better alternative, researchers can use the DHI when assessing handicapping effects imposed by dizziness, but they should be aware of its limitations. ![]() The current evidence for a number of measurement properties of the DHI is suboptimal. No evidence synthesis could be done for the DHI's internal consistency due to multidimensionality (i.e., lack of support of the original subscales) and for its measurement error due to a lack of published information on the minimal important change. Based on the studies included, low evidence was found for sufficient reliability of the DHI total score. Moderate evidence was found for inconsistent structural validity, sufficient construct validity and borderline sufficient responsiveness. Overall, evidence on the DHI's content validity was either lacking or limited and of low quality. The search strategy resulted in 768 eligible publications, 42 of which were included in the review. From the included studies, relevant data were extracted, their methodological quality was assessed, the results were synthesized and the evidence was graded and summarized according the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. The selected literature databases were systematically searched to identify studies investigating one or more measurement properties of the DHI. To critically appraise and summarize the quality of the measurement properties of the Dizziness Handicap Inventory's (DHI) in adult patients with complaints of dizziness. ![]()
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