Psychological Aspects of Vestibular Disorders: A National Survey of Clinical Practice

Abstract

ObjectivePeople with vestibular disorders frequently experience psychological distress which can impede daily activities and clinical recovery. Although the need for psychological input is widely acknowledged, there are no clinical guidelines, leading to variation in care received. This study examines how psychological aspects of vestibular disorders are currently addressed highlighting any national variation.MethodAn online survey was completed by 101 UK healthcare professionals who treat vestibular disorders. The survey included open and close-ended questions covering service configurations, respondent characteristics, attitudes towards psychological aspects, and clinical practice for cognitive and mental health problems. Results96% of respondents thought there was a psychological component to vestibular disorders. There was a discrepancy between perceived importance of addressing psychological aspects and confidence to undertake this. Those with more years of experience felt more confident addressing psychological aspects. Mental health problems were addressed more frequently than cognitive problems. History taking and questionnaires containing one or two items about psychological distress were the most common assessment approaches. Discussing symptoms and signposting were the most frequent management approaches. Referrals for psychological support were typically to professionals within another service, via the patient’s GP. Qualitative responses highlighted the interdependence of psychological and vestibular disorders which require identification and timely intervention. Barriers to implementation included limited referral pathways and interdisciplinary expertise.ConclusionClinical practice varies and relates to the confidence, experience and expertise of individual health professionals, resources, and appropriate referral pathways. Although psychological distress is frequently identified, suitable psychological treatment is not routinely offered in the UK.

Impact and experiences of vestibular disorders and psychological distress: Qualitative findings from patients, family members and healthcare professionals

“…Our study and others show that vestibular disorders contribute to restrictions in participation and autonomy, with the general functional status of people with vestibular disorders rated similarly to that of patients with other chronic illnesses including kidney disease and rheumatic disorders 50 . However, unlike other chronic illnesses, vestibular disorders are poorly understood, underrecognized, and patients do not typically receive support for psychosocial aspects within routine care 32,39 . Accurate information provision resources could help validate patients' experiences and improve public awareness of the impacts of vestibular disorders if shared with workplaces, family members, and friends.…”

“…People with vestibular disorders and their families were recruited through our patient and public involvement (PPI) networks, vestibular charities (Ménière's Society, Vestibular Disorder Association), peer support groups, and by word of mouth. Healthcare professionals had previously participated in a survey on psychological aspects of vestibular disorders 39 and consented to a follow‐up interview.…”

“…50 However, unlike other chronic illnesses, vestibular disorders are poorly understood, underrecognized, and patients do not typically receive support for psychosocial aspects within routine care. 32,39 Accurate information provision resources could help validate patients' experiences and improve public awareness of the impacts of vestibular disorders if shared with workplaces, family members, and friends. Sharing resources with other healthcare professionals could also be a first step towards facilitating their understanding and involvement in vestibular disorders (e.g., workplace occupational health, occupational therapists, social prescribers).…”

Cognition in vestibular disorders: state of the field, challenges, and priorities for the future

“…Hence cognitive assessment and monitoring are not routinely offered to people with vestibular disorders within the clinical care setting ( 159 ). This practice is not only borne by pressing time constraints, but also the lack of consensus guidelines surrounding appropriate assessment tools ( 160 ). There is usually no joint working across the disciplines of psychiatry, psychology, and neuro-otology when it comes to managing the care of patients with vestibular disorders.…”

“…Where provided, cognitive assessment in the United Kingdom typically involves completing a questionnaire with only one or two items capturing cognitive functioning ( 160 ) such as the DHI ( 161 ) or Vertigo Symptom Scale [VSS, ( 162 )]. This provides a starting point for discussions about cognitive problems, however there is a lack of consensus around the assessments that should be administered to those patients who require further screening and, in some cases, comprehensive evaluation.…”