Assessment of fall risk in patients with vestibular hypofunction

Abstract

Introduction: Individuals with vestibular hypofunction may report symptoms such as dizziness and postural instability, which consequently increases the risk of falling, causing a negative impact on their quality of life. However, there is still a gap associating specific vestibular tests with fall risk. Objective: To identify possible association relationships between Video Head Impulse Test (vHIT) results with the risk of falling in patients with unilateral and bilateral vestibular deficit. Methods: This is a cross-sectional and correlational observational study. Twenty-two participants were included in the study. Initially, participants completed a self-reported questionnaire regarding personal (gender, age) and clinical (symptoms, duration of symptoms, BMI, history of falls) characteristics. Afterwards, their vestibuloculomotor function was evaluated using the video head impulse test (vHit), and then they were submitted to some specific tests and filled out questionnaires: DHI, FES-I, DGI, BESTest, EVA Dizziness and Mini state exam mental (MMSE). Data were analyzed to identify possible correlations or odds ratios between variables. Results: The mean age of the population was 63.7 (±15.9) years, and 15 participants (68.2%) were women. Considering the intensity of dizziness, a correlation was identified between the scores of the EVA and FES-I instruments (r= 0.42; p=0.04). There was also a correlation between the EVA and the total DHI value (r=0.45; p=0.03). A correlation was identified between the FES-I value and the DHI value (r=0.75;p=0.01). A
negative correlation was found between the DHI and Bestest results (r= -0.48; p=0.02). Specifically in relation to VHit, a negative correlation was identified between gait cadence and VHit value both to the right (r=-0.57, 95%CI 0.46-0.59;p=0.01); as to the left (r=-0.56, 95%CI 0.43-0.62; p=0.01). An odds ratio (OR= 2.01; 95%CI 1.03 - 6.03) was identified between individuals with bilateral hypofunction (Score VHit) and individuals at risk of falls (Score DGI). Conclusion: Individuals with bilateral vestibular hypofunction are twice as likely to fall as individuals with unilateral hypofunction. A correlation was also found between dizziness intensity scores and fear of falling scores and the impact of dizziness on daily activities.