Introduction
Methods
Inclusion criteria
Vestibular testing
Qualitative research analysis: interviews
Quantitative research analysis: questionnaires
Mixed method: comparing qualitative and quantitative research results
Ethical considerations
Results
Patient characteristics
Qualitative results from the semi-structured interviews
Symptoms
Physical symptoms (Fig. 1 )
Cognitive symptoms (Fig. 2)
Emotions (Fig. 3)
Context: challenging situations and triggers
Consequences and behavior
Quantitative results from the DHI, HADS and EQ-5D-5L
Questionnaire | Mean (median, range) | |
---|---|---|
First 18 patients | Total group (n = 50) | |
DHI | ||
Physical | 18.33 (20, 0–26) | 18.20 (20, 0–28) |
Functional | 20.78 (22, 6–230) | 22.12 (22, 6–30) |
Emotional | 15.56 (16, 4–28) | 15.72 (16, 4–34) |
Total | 54.67 (58, 12–80) | 56.04 (57, 12–98) |
HADS | ||
Anxiety | 7.67 (7.0, 0–16) | 6.52 (6.0, 0–16) |
Depression | 6.22 (4.5, 1–15) | 6.36 (5.0, 0–15) |
EQ-5D-5L | ||
VAS | 67.11 (72.50, 0–85) | 65.78 (70, 0–100) |
Index value | 0.680 (0.715, 0.439–0.837) | 0.680 (0.704, 0.322–1.000) |
Triangulation
Quantitative | Qualitative | Interview quotations: discrepancies between quantitative and qualitative results | |||
---|---|---|---|---|---|
DHI T (P, F, E) HADS-NL EQ-5D-5L | Descriptions: physical | Descriptions: cognitive | Descriptions: emotions | ||
Patient 1 | DHI 62 (24, 20, 16) A = 7, D = 4 EQ-5D-5L = 0,743 | Imbalance, oscillopsia, visual vertigo, no fast head movements | Difficulties with dual tasking | Sadness (suffering, sadness, shame, neglect), fear (nervousness), anger (exasperation, rage) | “brought down”, “life is harder”, “intensely miserable”, “feeling down”, “sad”, “fear of falling”, “feeling unsafe”, “anger” |
Patient 2 | DHI 74 (20, 26, 28) A = 11, D = 15 EQ-5D-5L = 0.769 | Imbalance, oscillopsia, visual vertigo, reading difficulties, no fast head movements | Difficulties with dual tasking, problems with spatial orientation, concentration problems | Sadness (suffering, sadness, disappointment, neglect), fear (nervousness) | “major limitation”, “I no longer look forward to anything, as it is always disappointing”, “feeling down”, “dark thoughts”, very sad, disappointed in people, fear of falling (during cycling) |
Patient 3 | DHI 80 (26, 30, 24) A = 7, D = 7 EQ-5D-5L = 0.439 | Imbalance, neck pain | Difficulties with dual tasking, forgetfulness | Anger (irritation, rage) | “quickly irritated”, “aggressive” |
Patient 4 | DHI 40 (16, 20,4) A = 1, D = 2 EQ-5D-5L = 0.798 | Imbalance, oscillopsia, neck pain | Difficulties with dual tasking | Sadness (shame, neglect), joy (optimism) | “drunk man”, “no balance”, “toddling”, “I need to hold on”(need of support), cycling: “just as if you are being trapped”, moving horizon, “I’m the guilty one”, “vulnerable”, “I adjusted my life accordingly. It has not put me in a situation where I feel run down now or I think this is the beginning of the end” |
Patient 5 | DHI 46 (16, 20, 10) A = 6, D = 4 EQ-5D-5L = 0.622 | Imbalance, oscillopsia, visual vertigo, tiredness, nausea, headache | Difficulties with dual tasking, concentration problems | Sadness (sadness), fear (nervousness) | “difficult to walk in a straight line”, cycling: “I fall more easily”, swimming: “I don't like it, the water is moving and everything. Can't focus. And I also find it very scary when I go underwater I just don't know what is above and below”, “I just can't keep my head still”, problems with sun shining through trees and oncoming traffic: “missing a peace”, “sometimes tired of it”, |
Patient 6 | DHI 38 (10, 16, 12) A = 7, D = 3 EQ-5D-5L = 0.799 | Imbalance, oscillopsia, vertigo attacks, tiredness, tinnitus | Difficulties with dual tasking, problems with spatial orientation, concentration problems | Sadness (sadness, neglect), fear (nervousness), anger (irritation) | “wandering”, “drunk”,”I am a fanatic bird watcher … first I have to stop and by then the bird has often flown”(bird watching not possible anymore), “flickering image”, “visual trailing”, vertigo during concentrating for a long time, cycling and oncoming traffic: “I have no control over what comes towards me. if he swerves, then I'm lost because I don't know what to do”, “reacting more sensitively”, “more insecure”, “fear of your instability” (falling), “stress” |
Patient 7 | DHI 32 (12, 10, 10) A = 4, D = 3 EQ-5D-5L = 0.805 | Imbalance, oscillopsia, no fast head movements, tiredness, tinnitus, lightheadedness | Forgetfulness | Sadness (sadness, shame), fear (nervousness), joy (optimism) | “staggering”, “drunk”, “You’re not able to cycle in a straight line, than you will fall”, stairs and standing up: “need to hold on”, not able to recognize faces or signs during walking, moving horizon, “fast head movements are difficult”, “tiredness”, standing up quickly: “lightheaded”, “forgetfulness”, “moments of feeling down”, “It’s all my fault”, “fear”, fear of falling, fear of walking stairs, “hyperventilating”, “stress”, Wife: “that makes him very sad” |
Patient 8 | DHI 52 (20, 20, 12) A = 10, D = 5 EQ-5D-5L = 0.580 | Imbalance, oscillopsia, visual vertigo, reading difficulties, no fast head movements, tiredness, lightheadedness | Problems with spatial orientation, concentration problems | Sadness (sadness, shame, neglect), fear (nervousness) | “burnout”, “emotional”, “sadness”, “shame”, “sometimes, I just find it bothersome to be reliant on others” (stopped using antidepressant one week ago) |
Patient 9 | DHI 64 (22, 26, 16) A = 16, D = 13 EQ-5D-5L = 0.490 | Imbalance, oscillopsia, visual vertigo, reading difficulties, no fast head movements, vertigo attacks, tiredness, tinnitus, neck pain, nausea, lightheadedness, headache | Difficulties with dual tasking, problems with spatial orientation, forgetfulness | Sadness (sadness, shame, neglect), fear (horror), anger (irritation, exasperation, rage) | |
Patient 10 | DHI 76 (24, 28, 24) A = 12, D = 12 EQ-5D-5L = 0.625 | Imbalance, oscillopsia, visual vertigo, reading difficulties, no fast head movements, tiredness, tinnitus, lightheadedness | Difficulties with dual tasking, concentration problems, forgetfulness | Sadness (suffering, sadness, neglect), fear (horror, nervousness), anger (irritation), joy (optimism) | |
Patient 11 | DHI 58 (20, 22, 16) A = 7, D = 9 EQ-5D-5L = 0.498 | Imbalance, oscillopsia, visual vertigo, no fast head movements, vertigo attacks, tiredness, nausea, headache, sleeping problems | Difficulties with dual tasking, problems with spatial orientation, concentration problems, forgetfulness | Sadness (suffering, sadness, neglect), fear (horror, nervousness), anger (irritation, exasperation), joy (hope, optimism) | |
Patient 12 | DHI 56 (20, 24, 12) A = 9, D = 1 EQ-5D-5L = 0.700 | Imbalance, oscillopsia, visual vertigo, reading difficulties, no fast head movements, vertigo attacks, tiredness, tinnitus, nausea, headache | Difficulties with dual tasking, problems with spatial orientation | Sadness (neglect), anger (exasperation), joy (optimism) | “loss of freedom”, “dependent”, “powerlessness up to annoyance”, “insecure”, “incomprehension of others” |
Patient 13 | DHI 42 (16, 14, 12) A = 4, D = 3 EQ-5D-5L = 0.837 | Imbalance, oscillopsia, visual vertigo | Fear (nervousness), anger (irritation) | “anxiety”, “irritation” | |
Patient 14 | DHI 68 (24, 24, 20) A = 2, D = 1 EQ-5D-5L = 0.730 | Imbalance, oscillopsia, visual vertigo, reading difficulties, no fast head movements, tiredness, tinnitus, restless mind, sleeping problems | Difficulties with dual tasking | Sadness (suffering, disappointment, neglect), fear (nervousness) | “it controls my whole life”, “often, I find it such a pity”, “displeasure”, “If I go away, I won’t go by myself”, “fear of falling” |
Patient 15 | DHI 62 (20, 22, 20) A = 14, D = 8 EQ-5D-5L = 0.776 | Imbalance, oscillopsia, visual vertigo, reading difficulties, vertigo attacks, tiredness, headache | Difficulties with dual tasking, problems with spatial orientation, forgetfulness | Sadness (neglect), fear (nervousness), anger (irritation) | “dependent”, “more anxious”, “annoying” |
Patient 16 | DHI 64 (20, 22, 22) A = 15, D = 14 EQ-5D-5L = 0.589 | Imbalance, oscillopsia, visual vertigo, no fast head movements, vertigo attacks, tiredness, tinnitus, neck pain, light-headedness, headache, restless mind | Difficulties with dual tasking, problems with spatial orientation | Sadness (sadness, disappointment, shame, neglect), fear (nervousness) | |
Patient 17 | DHI 58 (20, 22, 16) A = 6, D = 7 EQ-5D-5L = 0.608 | Imbalance, oscillopsia, visual vertigo, reading difficulties, no fast head movements, tiredness, headache, restless mind | Difficulties with dual tasking, problems with spatial orientation, concentration problems | Sadness (sadness, shame, neglect, sympathy), fear (nervousness), anger (irritation), joy (hope, optimism) | “it spoils everything”, “I feel really guilty”, “you don't want everyone to see it”(embarrassed), “I have to hand it over”, “feeling left out”, “I don't want to appear pathetic”, cycling: “stressful”, “annoying”, “short fuse”, “I try to get everything out of it” |
Patient 18 | DHI 12 (0, 6, 6) A = 0, D = 1 EQ-5D-5L = 0.824 | Imbalance, oscillopsia, visual vertigo, no fast head movements | Difficulties with dual tasking | Fear (nervousness), love (affection) | “I sway”, “staggering”, “drunk”, “falling”, “fell with the bicycle”, horizon: “moves during walking”, not able to recognize faces or read signs or boxes in the supermarket during walking, “not able to focus”, “hard to look back” (literally: turning head), “fear of losing balance”, “more anxious”, “It takes more effort and more concentration” |