The role of pre-diagnosis audio-vestibular dysfunction versus distress, illness-related cognitions and behaviors in predicted ongoing dizziness handicap.

OBJECTIVE People with chronic vestibular diseases experience variable degrees of self-perceived disability. However, longitudinal data examining predictive validity of relevant clinical variables alongside psychological variables is limited. The present study examined whether these factors predict self-reported dizziness handicap three months following assessment and diagnosis. METHODS Patients were recruited from a waiting list of a tertiary neuro-otology clinic and completed standardised mood, cognitive, behavioural and dizziness handicap questionnaires before and three months after their initial consultation and diagnosis. All patients were clinically assessed and underwent comprehensive audio-vestibular investigations. RESULTS Seventy three percent of participants responded at follow up (n=135, 73% female, M age 54.23 [SD 17.53]) of whom 88% were diagnosed with a neurotological condition. There were significant improvements in handicap, depression and anxiety at 3 months. 30/135 (22%) showed clinically meaningful improvement in handicap. The percentage of case level depression and anxiety remained the same. Negative illness perceptions and symptom responses reduced, although participants still tended to view their condition negatively. Vestibular tests and type of diagnosis were not associated with self-reported handicap. Most baseline psychological variables significantly correlated with handicap at 3 months. When adjusting for baseline handicap and demographics, the baseline psychological variables only explained a significant ~3% of the variance in dizziness handicap at follow-up with baseline handicap explaining most of the variance. All-or-nothing behaviour was the most significant predicter. CONCLUSIONS Tertiary patients with vertigo and dizziness report negative illness perceptions and cognitive and behavioural responses to symptoms which are associated with self-reported handicap over time. Future studies are needed to investigate whether targeting these factors alongside traditional treatment approaches improves handicap in patients with chronic dizziness.