Predicting an Unfavorable Course of Dizziness in Older Patients

Stam, H.; Maarsingh, Otto R; Heymans, Martijn W.; Weert, Henk van; Wouden, Johannes C. van der; Horst, Henriëtte E. van der

doi:10.1370/afm.2289

Cited by 13 publications

(9 citation statements)

References 44 publications

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“…Stam and colleagues focuses on the derivation and validation of a clinical prediction rule (CPR) aiming to predict which older people presenting with dizziness to their primary care physician will be more likely to have a poor prognosis. 1 Dizziness is somewhat common in primary care and can be debilitating, diagnostically challenging, and difficult to treat. 2 This CPR has potential to aid clinical decision making by tailoring treatment to older people at high risk of experiencing a poor outcome.…”

Section: N This Issue Of Annals Of Family Medicine An Article Bymentioning

confidence: 99%

Clinical Prediction Rules: Challenges, Barriers, and Promise

Wallace

Johansen

2018

Ann Fam Med

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Section: N This Issue Of Annals Of Family Medicine An Article Bymentioning

confidence: 99%

Clinical Prediction Rules: Challenges, Barriers, and Promise

Wallace

Johansen

2018

Ann Fam Med

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“…By including more potential predictors, the discriminative ability of the predictive models might be increased. The use of vestibular-suppressant medication, 10 comorbidities, 34 44 the severity and type of vestibular symptoms, 33 overall self-rated quality of life, 34 previous falls 45 and level of self-efficacy 46 47 are all factors that may influence treatment success of stand-alone and blended VR. Unlike the predictors used in our study, collecting information on these personal characteristics will take more time because patients will have to fill out extra questionnaires.…”

Section: Discussionmentioning

confidence: 99%

Treatment success of internet-based vestibular rehabilitation in general practice: development and internal validation of a prediction model

et al. 2020

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ObjectivesTo develop and internally validate prediction models to assess treatment success of both stand-alone and blended online vestibular rehabilitation (VR) in patients with chronic vestibular syndrome.DesignSecondary analysis of a randomised controlled trial.Setting59 general practices in The Netherlands.Participants202 adults, aged 50 years and older with a chronic vestibular syndrome who received either stand-alone VR (98) or blended VR (104). Stand-alone VR consisted of a 6-week, internet-based intervention with weekly online sessions and daily exercises. In blended VR, the same intervention was supplemented with physiotherapy support.Main outcome measuresSuccessful treatment was defined as: clinically relevant improvement of (1) vestibular symptoms (≥3 points improvement Vertigo Symptom Scale—Short Form); (2) vestibular-related disability (>11 points improvement Dizziness Handicap Inventory); and (3) both vestibular symptoms and vestibular-related disability. We assessed performance of the predictive models by applying calibration plots, Hosmer-Lemeshow statistics, area under the receiver operating characteristic curves (AUC) and applied internal validation.ResultsImprovement of vestibular symptoms, vestibular-related disability or both was seen in 121, 81 and 64 participants, respectively. We generated predictive models for each outcome, resulting in different predictors in the final models. Calibration for all models was adequate with non-significant Hosmer-Lemeshow statistics, but the discriminative ability of the final predictive models was poor (AUC 0.54 to 0.61). None of the identified models are therefore suitable for use in daily general practice to predict treatment success of online VR.ConclusionIt is difficult to predict treatment success of internet-based VR and it remains unclear who should be treated with stand-alone VR or blended VR. Because we were unable to develop a useful prediction model, the decision to offer stand-alone or blended VR should for now be based on availability, cost effectiveness and patient preference.Trial registration numberThe Netherlands Trial Register NTR5712.

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“…A total DHI score of 30 or higher is generally believed to indicate substantial dizziness-related impairment. 25,28,29 Participants were asked to fill out a DHI questionnaire at baseline, after 6 months, 30 and after 10 years. Participants who were mentally or physically unable to complete a questionnaire were excluded.…”

Section: Follow-upmentioning

confidence: 99%

“…General practitioners will continue to have to assess the primary cause of dizziness and identify patients at risk for persistent impairment due to dizziness. 28 Second, we adjusted our analyses for 10 potential confounders.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Prognosis and Survival of Older Patients With Dizziness in Primary Care: A 10-Year Prospective Cohort Study

et al. 2020

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PURPOSE The prognosis of older patients with dizziness in primary care is unknown. Our objective was to determine the prognosis and survival of patients with different subtypes and causes of dizziness. METHODS In a primary care prospective cohort study, 417 older adults with dizziness (mean age 79 years) received a full diagnostic workup in 2006-2008. A panel of physicians classified the subtype and primary cause of dizziness. Main outcome measures were mortality and dizziness-related impairment assessed at 10-year follow-up. RESULTS At 10-year follow-up 169 patients (40.5%) had died. Presyncope was the most common dizziness subtype (69.1%), followed by vertigo (41.0%), disequilibrium (39.8%), and other dizziness (1.7%). The most common primary causes of dizziness were cardiovascular disease (56.8%) and peripheral vestibular disease (14.4%). Multivariable adjusted Cox models showed a lower mortality rate for patients with the subtype vertigo compared with other subtypes (hazard ratio [HR] = 0.62; 95% CI, 0.40-0.96), and for peripheral vestibular disease vs cardiovascular disease as primary cause of dizziness (HR = 0.46; 95% CI, 0.25-0.84). After 10 years, 47.7% of patients who filled out the follow-up measurement experienced substantial dizziness-related impairment. No significant difference in substantial impairment was seen between different subtypes and primary causes of dizziness. CONCLUSIONS The 10-year mortality rate was lower for the dizziness subtype vertigo compared with other subtypes. Patients with dizziness primarily caused by peripheral vestibular disease had a lower mortality rate than patients with cardiovascular disease. Substantial dizziness-related impairment in older patients with dizziness 10 years later is high, and indicates that current treatment strategies by family physicians may be suboptimal.

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Predicting an Unfavorable Course of Dizziness in Older Patients

Abstract: We developed an easy-to-use risk score for dizziness-related impairment in primary care. The risk score, consisting of only 4 predictors, will help primary care physicians identify patients at high risk for an unfavorable course of dizziness.

Cited by 13 publications

References 44 publications

Clinical Prediction Rules: Challenges, Barriers, and Promise

Clinical Prediction Rules: Challenges, Barriers, and Promise

Treatment success of internet-based vestibular rehabilitation in general practice: development and internal validation of a prediction model

Prognosis and Survival of Older Patients With Dizziness in Primary Care: A 10-Year Prospective Cohort Study

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