Table 2 Baseline assessment (BA) and re-assessment (RA) including outcome measures
Domain | Test and criterion for abnormal/impaired performance | BA | RA | O |
|---|---|---|---|---|
General | • Patients’ history and medications. | ✓ | ✓ | - |
• Frequency and duration of dizziness episodes. | ✓ | ✓a | P | |
• Dizziness Handicap Inventory [36]. | ✓ | ✓ | P | |
• Vertigo Symptom Scale [37]. | ✓ | ✓ | S | |
• EQ-5D: a generic measure of health status which will be used in the economic evaluation [38]. | ✓ | ✓ | S | |
• AQOL-6D (Assessment of Quality of Life): a utility measure of quality of life - will be used to conduct the economic evaluation [39]. | ✓ | ✓ | S | |
Vestibular | • Eye movement examination (nystagmus, pursuit, saccades, Vestibulo-Ocular Reflex (VOR) suppression) using Frenzel’s glasses [40] – abnormalities are indicative of peripheral and/or central vestibular disorder. | ✓ | ✓ | - |
• Dix-Hallpike positional manoeuvre : a positive test indicates Benign Paroxysmal Positional Vertigo [22]. | ✓ | ✓ | - | |
• Dynamic-Visual Acuity (DVA) Test – assessed during passive head impulses, score > 0.316 indicates impaired DVA [41] | ✓ | ✓ | - | |
• Video Head Impulse Test: a + test indicates impaired VOR, peripheral vestibular disorders [42–44]. | ✓ | ✓ | - | |
• Rotary chair testing: VOR gain < 0.75 (at 1 Hz) and time constant < 6 s indicates VOR hypofunction, time constant >12 s indicates cerebellum disorders [41] | ✓ | ✓ | - | |
Cardio-vascular | • Tilt Table test - a decrease in systolic blood pressure ≥20 mmHg or a decrease of systolic blood pressure to ≤90 mmHg after 3 min of upright standing, defines orthostatic hypotension whether or not symptoms occur [23, 45, 46]. | ✓ | ✓ | S |
• Electrocardiogram - arrhythmia defines possible arrhythmia-related syncope [23]. | ✓ | - | - | |
Balance, Gait and Fall Risk | • Physiological Profile Assessment of fall risk - performances 1 standard deviation below established norms for older people aged 65 years and over define impairments in vision, touch, peripheral sensation, reaction time, lower limb strength and balance [47, 48]. | ✓ | ✓ | S |
• Coordinated Stability - score ≥15 error points indicates impaired dynamic balance [7, 49]. | ✓ | ✓ | S | |
• Choice-Stepping Reaction Time - total reaction time > 1.4 s indicates impaired performance (composite measure of strength, balance and reaction time) [31]. | ✓ | ✓ | P | |
• Step timing variability at preferred walking speed > 0.03 s indicates impaired walking stability [32, 50]. | ✓ | ✓ | P | |
Psychological | • Falls Efficacy Scale –International - score > 22 indicates high levels of fear of falling [51, 52]. | ✓ | ✓ | S |
• Patient Health Questionnaire −9 - score > 9 indicates depressive symptoms [53–56]. | ✓ | ✓ | S | |
• Generalized Anxiety Disorder 7 items scale - score > 7 indicates anxiety disorders [57]. | ✓ | ✓ | S | |
• Neuroticism scale of the NEO-Five Factor Inventory– score ≥ 56 indicates a high level of neuroticism [58]. | ✓ | ✓ | S |