Alia A. Alghwiri

The Development and Validation of the Vestibular Activities and Participation Measure

OBJECTIVES To develop and validate a new self-report outcome measure named the Vestibular Activities and Participation (VAP) for people with vestibular disorders to examine their activities and participation according to the International Classification of Functioning Disability and Health. DESIGN Delphi iterative survey for the development of the VAP and validation study. SETTING Tertiary balance clinic. PARTICIPANTS A panel of worldwide experts (n=17) in vestibular dysfunction participated in the development of the VAP, and patients (N=58) with vestibular disorders were enrolled in the validation of the VAP. INTERVENTION Not applicable. MAIN OUTCOME MEASURES For the development of the VAP, an Internet-based survey of 55 activities and participation items was presented to the panel of experts and the percentage agreement per item was calculated. For the validation of the VAP, the VAP was completed twice to examine the test-retest reliability, the World Health Organization Disability Assessment Schedule II (WHODAS II) was used to examine the concurrent validity with the VAP, and the Dizziness Handicap Inventory (DHI) was used to examine the convergent validity of the VAP. RESULTS After 2 rounds of the Delphi technique, the VAP was developed. The VAP total score had excellent test-retest reliability (intraclass correlation coefficient=.95; confidence interval=.91-.97) and good to excellent agreement per item indicated by the unweighted kappa (.41-.80) and the weighted kappa (.58-.94). The minimum detectable change at 95% confidence level of the VAP score was .58. The VAP had strong correlation (ρ=.70; P<.05) with the WHODAS II and moderate to strong correlations (ρ=.54-.74) with the DHI subscale and total scores. After adjustment for age, we found sex and self-reported imbalance to be independent explanatory variables of the transformed VAP total score. CONCLUSIONS The VAP measure was developed to examine the disabling effect of vestibular disorders on peoples activities and participation based on a standardized framework (the International Classification of Functioning Disability and Health). The VAP demonstrated excellent reliability and was validated with external instruments in people with vestibular disorders.

Content Comparison of Self-Report Measures Used in Vestibular Rehabilitation Based on the International Classification of Functioning, Disability and Health

Background Physical therapists should understand the content included in self-report questionnaires in order to choose the appropriate questionnaire for examination and follow-up purposes. The International Classification of Functioning, Disability and Health (ICF) provides a universal and standard language for the description of health and health-related states and can be used for the content comparison of self-report questionnaires. Objective The purpose of this study was to describe and compare the contents covered by 8 self-report measures used in vestibular rehabilitation based on the linkage of their content to the ICF. Design This was a cross-sectional study. Method Eight vestibular questionnaires were identified and linked to the ICF by 2 health care professionals according to established linking rules. Based on the linking, the contents of the 8 questionnaires were compared and the interobserver agreement between 2 raters was estimated using kappa coefficients. Results A total of 312 meaningful concepts from the 164 items of the 8 vestibular questionnaires were identified and linked to the ICF. The meaningful concepts identified were linked to 51 different ICF components: 19 categories of the component “body functions,” 30 categories of the component “activities and participation,” and 2 categories of the component “environmental factors.” Forty-two concepts could not be linked to any of the ICF components. The estimated kappa coefficients for 2 raters at the component and first and second levels of the ICF ranged from 0.83 to 0.96. Limitations The method of identifying vestibular measures was not based on a systematic search; instead, the most widely used instruments in the field of vestibular rehabilitation were selected. Thus, the study results are limited to the examined vestibular instruments. Conclusion Using the ICF as a theoretical framework was found to be useful for comparing the content of health status questionnaires, as well as for exploring the focus of the measures currently in use in vestibular rehabilitation.

Subscales of the Vestibular Activities and Participation questionnaire could be applied across cultures

OBJECTIVES The objective of this study was to assess the objectivity, cross-cultural validity, and convergent validity of the Vestibular Activities and Participation (VAP) questionnaire among four countries, Germany, United States, Jordan, and Saudi Arabia. STUDY DESIGN AND SETTING This was a cross-sectional study conducted in four specialized outpatient dizziness clinics in Germany, United States, Jordan, and Saudi Arabia. RESULTS A total of 453 participants were included in the study. The Rasch analysis revealed two separate subscales. Subscale 1 items included focusing attention, lying down, standing, bending, lifting and carrying objects, and sports. Subscale 2 items included walking long distances, climbing, running, moving around within buildings other than home, using transportation, and driving. The Pearson product-moment correlation between the Dizziness Handicap Inventory and the summary score of the VAP subscale 1 was 0.66 and was 0.64 for subscale 2. CONCLUSION Owing to its shortness and intercultural adaptability, the new two-scale version of the VAP questionnaire lends itself to clinical practice and research across countries to estimate the effect of vertigo and dizziness on activity limitation and participation restrictions. Psychometrically sound summary scores can be calculated. More extended versions of the VAP can be used for comprehensive clinical assessment where summary scores are not needed or a more detailed documentation is warranted.

The correlation between depression, balance, and physical functioning post stroke

BACKGROUND AND OBJECTIVE Depression, imbalance, and physical disability are among the serious stroke sequels. The objective of this study was to examine the correlation between depression, balance, and self-reported physical performance in patients post stroke. METHODS The Arabic versions of the Beck Depression Inventory (BDI), Dynamic Gait Index (A-DGI), and physical Stroke Impact Scale-16 version 3 were administered to a convenience sample of patients post stroke. The correlation between the mentioned measures was calculated using the Pearson coefficient. Additionally, the Kruskal-Wallis test was used to find out if the distribution of measurement scores differs among BDI levels of depression intensity or among Orpington Prognostic Scale (OPS) levels of stroke severity. RESULTS Sixty-one patients with stroke (mean age [standard deviation] = 64 [12] years, 39 male) were recruited. Significant moderate correlations were found between BDI and A-DGI, BDI and Stroke Impact Scale (SIS), and A-DGI and physical SIS. Additionally, the distribution of the A-DGI and the physical SIS scores showed significant differences among BDI levels of depression intensity. Moreover, the distribution of the BDI, A-DGI, and physical SIS scores showed significant differences among OPS levels of stroke severity. CONCLUSIONS Depressive symptoms were found frequent among people post stroke and were associated with balance and self-reported physical performance.

Physical therapy for persons with vestibular disorders.

PURPOSE OF REVIEW Persons with vestibular disorders experience symptoms of dizziness and balance dysfunction, resulting in falls, as well as impairments of daily life. Various interventions provided by physical therapists have been shown to decrease dizziness and improve postural control. In the present review, we will focus on the role of physical therapy in the management of vestibular symptoms in patients with peripheral and central vestibular disorders. RECENT FINDINGS Persons with both acute and chronic central and peripheral vestibular disorders improve with vestibular rehabilitation. New interventions during the past 5 years have been designed to enhance recovery from problems with balance and dizziness. Examples include the use of virtual reality, vibrotactile feedback, optokinetic flow, YouTube videos, and innovative methods to change the gain of the vestibulo-ocular reflex (VOR). SUMMARY Patients with central and peripheral vestibular disorders benefit from physical therapy interventions. Advances in physical therapy interventions include new methods to stimulate adaptation of the VOR and the vestibulospinal systems.

Reliability and Validity of the Arabic Dynamic Gait Index in People Poststroke

Abstract Background and Objective: The Dynamic Gait Index (DGI) is a valid and reliable measure of gait, balance, and fall risk. The purpose of this study was to translate the DGI into Arabic and evaluate the reliability and validity of the Arabic version of the DGI (A-DGI) in patients with stroke. Methods: The DGI was translated into Arabic according to the World Health Organization forward/backward translation protocol for translating assessment tools. It was then administered to a convenience sample of patients with stroke. The inter-and intrarater reliability as well as convergent and discriminant validity of the A-DGI were examined. Results: Fifty-one patients with stroke (mean [SD] age, 64 [12] years; 33 male) were enrolled in the study. The A-DGI score reflected high agreement for both interrater (intraclass correlation coefficient [ICC]3,1 = .98; 95% confidence interval [CI], .97-.99) and intrarater (ICC1,1 = .97; 95% CI, .95-.98) reliability and correlated moderately but significantly with the Glasgow Coma Scale (rho = .39, P = .01), Beck Depression Inventory (rho = -.50, P < .01), and Stroke Impact Scale-16 version 3.0 domains. The A-DGI discriminated between subjects who were at risk of fall and those who were not (U = .00, P < .01), younger and older adults (U = 195, P = .03), side of hemiplegia (U = 218, P = .04), and mild and moderate (U = 105.5, P = .02) as well as mild and severe stroke severity (U = 30, P < .01). Conclusions: The A-DGI reflected high reliability and validity in the stroke population. The availability of a reliable and valid A-DGI facilitates its use among therapists from Arabic origins, which will enrich the rehabilitation process in their clinical practice.

The vestibular activities and participation measure and vestibular disorders

Vestibular disorders are commonly reported health conditions that lead to debilitating consequences. Activity limitations and participation restrictions are the main disabling consequences of vestibular disorders. Measuring activities and participation in people with vestibular disorders has been a challenge due to the absence of specialized outcome measures that quantify activities and participation based on a standardized framework such as the International Classification of Functioning, Disability and Health (ICF). The Vestibular Activities and Participation (VAP) questionnaire was developed to quantify activity limitations and participation restrictions in people with balance and vestibular disorders. Of the 34 items included in the VAP, 29 (85%) of the items had at least 25% or more of the respondents report that they had moderate to severe difficulty and 10 items had 40% or more of the participants report that they had difficulty with the activity or participation item. The psychometric properties of the VAP were examined and demonstrated very good reliability and validity in persons with balance and vestibular dysfunction and may be helpful in identifying activity and participation limitations.

An overview of vestibular rehabilitation.

Data related to the efficacy of vestibular rehabilitation and its evolution as an intervention are provided. Concepts and various treatment strategies are described, with explanations of why people with uncompensated peripheral and central vestibular disorders might improve with rehabilitation. Various tests and measures are described that are commonly used to examine patients and determine their level of ability to participate in their environment. Factors that affect recovery, both positively and negatively, are described in order to better prognosticate recovery. A case utilizing many of the principles discussed is included to provide insight into how to utilize vestibular rehabilitation with a person with an uncompensated peripheral vestibular loss.

The activities-specific balance confidence scale and berg balance scale: Reliability and validity in Arabic-speaking vestibular patients.

Persons with vestibular disorders are susceptible to imbalance. The Activities-specific Balance Confidence (ABC) scale and Berg Balance Scale (BBS) have been validated in persons with vestibular disorders. The purpose of this study was to examine the reliability and validity of the Arabic versions of ABC and BBS among Arabic-speaking persons with vestibular disorders in Jordan and Saudi Arabia. Therefore, the A-ABC and A-BBS were administered to a convenience sample of 82 persons with vestibular disorders (age = 43 ± 14), (56% female). The test-retest reliability of the A-ABC item and total score as well as the inter-rater and intra-rater reliability of the A-BBS total score reflected high agreement. Significant and large correlations were found between the A-ABC and the A-BBS (r= 0.54, P< 0.05), the A-ABC and the Arabic Dizziness Handicap Inventory (A-DHI) (r= -0.76, P< 0.05), and the A-BBS and the A-DHI (r= -0.56, P< 0.05). The A-ABC and the A-BBS demonstrated good reliability and validity and can be utilized with Arabic-speaking persons with vestibular disorders.

Ten-year Diabetes Risk Forecast in the Capital of Jordan: Arab Diabetes Risk Assessment Questionnaire Perspective-A Strobe-Complaint Article.

AbstractThe prevalence of diabetes in Jordan has been increasing. The early diagnosis of diabetes is vital to slow its progression. The Arab Risk (ARABRISK) screening tool is a self-administered questionnaire used to determine people who are at high risk for developing diabetes. This study aimed to identify people at high risk for developing type 2 diabetes by using the ARABRISK in the capital of Jordan.A cross-sectional study was conducted with a convenience sample of people in the capital of Jordan. The ARABRISK screening tool was administered to identify the participants’ risk for developing diabetes. In addition to descriptive statistics, percentages of the ARABRISK categories were represented, and an independent samples t test was used to explore the differences between men and women. A total of 513 participants with a mean age of 51.94 (SD = 10.33) were recruited; 64.9% of the participants were men (n = 333).The total ARABRISK score ranged from 0 to 25 with a mean score of 12.30 (SD = 4.76). Using the independent samples t test, women (mean = 13.25, SE = 0.10) had significantly higher ARABRISK total scores than men did (mean = 12.95, SE = 0.09), t(141) = −2.23, P = 0.03 in the “moderate risk” category. All of the items in the ARABRISK questionnaire were found to be good predictors of the ARABRISK total scores. Among them, age, body mass index (BMI), and high blood glucose (HBG) were the best predictors as indicated by the standardized regression coefficient (&bgr;). Older age, obesity, elevated weight circumference, absence of daily physical activity, daily consumption of fruits/vegetables, presence of high blood pressure (HBP), and HBG were significantly associated with increased odds of high ARABRISK total scores. Neither a history of gestational diabetes nor a positive family history was associated with an increased odds of high ARABRISK total scores.By identifying risk factors in these participants, interventions and lifestyle changes can be suggested and implemented to reduce the risk and incidence of diabetes.