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1. Citation: Fong, E., Li, C., Aslakson, R., & Agrawal, Y. (2015). A systematic review of patient-reported outcome measures in clinical vestibular research. Archives of Physical Medicine and Rehabilitation, 96(2), 357-365. doi:10.1016/j.apmr.2014.09.017
Keywords: vertigo, vestibular rehabilitation, outcome research, outcome measures, systematic review


To identify the most commonly-used patient-reported outcome (PRO) measures in clinical vestibular research, and assess their test characteristics and applicability to study age-related vestibular loss (ARVL) in clinical trials.

Data Sources

We performed a systematic review of the PubMed, CINAHL, and PsycINFO databases from 1950 to August 13, 2013.

Study Selection

PRO measures were defined as outcomes that capture the subjective experience of the patient, such as symptoms, functional status, health perceptions, and quality of life. Two independent reviewers selected studies that used PRO measures in clinical vestibular research. Disparities were resolved with consensus between the reviewers. Of 2260 articles initially found on literature search, 255 full-text articles were retrieved for assessment. One-hundred and four studies met inclusion criteria for data collection.

Data Extraction

PRO measures were identified by two independent reviewers. The four most commonly used PROs were evaluated for their applicability to the condition of ARVL. Specifically, for these four PROs, data were collected pertaining to instrument test-retest reliability, item domains, and target population of the instrument.

Data Synthesis

A total of 50 PRO instruments were identified. The four most frequently utilized PROs were the Dizziness Handicap Inventory (DHI), the Activities-specific Balance Confidence (ABC) scale, the Vertigo Symptom Scale (VSS), and the Visual Analogue Scale (VAS). Of these four PROs, three were validated for use in patients with vestibular disease, and one was validated in community-dwelling older individuals with balance impairments. Items across the four PROs were categorized into three domains based on the International Classification of Functioning, Disability and Health: Activity, Participation, and Body Functions and Structures.


None of the most commonly-used PRO instruments were validated for use in community-dwelling older adults specifically with ARVL. Nevertheless, the three common domains of items identified across these four PRO instruments may be generalizable to older adults and provide a basis for developing a PRO instrument designed to evaluate the effectiveness of interventions targeted to ARVL.

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Record Updated:2017-02-15

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