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Objective. The purpose of this study was to establish the psychometric properties of the 9-Item Vestibular Activities Avoidance Instrument (VAAI-9), a patient-reported outcome measure developed to identify fear avoidance beliefs in persons with vestibular disorders. Methods. This prospective cohort study included 100 participants 18 years and older seeking care at a balance disorders clinic for dizziness. Participants completed the VAAI-9, the Dizziness Handicap Inventory (DHI), and other patient-reported outcomes at the initial visit and the 3-month follow-up. To measure test-retest reliability, the VAAI-9 was completed again 5 days after the initial visit and was analyzed using a 2-way mixed ICC for absolute agreement. Internal consistency was determined using the Cronbach alpha. The Spearman correlation coefficient was used to assess convergent validity of the VAAI-9 with other outcomes. Receiver operating characteristic curves were used to identify baseline VAAI-9 cutoff scores for those who reported mild (DHI 30) perceived disability at the 3-month follow-up. Results. The mean age of the study cohort was 49 (SD=16) years; 73 (73%) were women. Seventy-one participants completed the 5-day follow-up, and 68 completed the 3-month follow-up. The VAAI-9 demonstrated excellent internal consistency ([alpha] = 0.91) and test-retest reliability (ICC = 0.90). Baseline VAAI-9 scores had moderate to strong associations with other outcome measures at baseline and 3 months. A baseline VAAI-9 score of 26 or higher had a sensitivity of 80.6% and a specificity of 78.4% for identifying a DHI score of >30 at 3 months (area under the curve = 0.86). Conclusions. The results provide evidence of excellent reliability and validity for the 9-item VAAI in persons with vestibular disorders. A baseline VAAI-9 score of [greater than or equal to]26 identified individuals at risk of persistent moderate to severe disability due to dizziness. Impact. Initial levels of fear avoidance beliefs measured using the VAAI-9 provided important prognostic information about outcomes for persons with vestibular symptoms. Keywords: Balance, Dizziness, Measurement: Applied, Outcome Assessment (Health Care), Predictive Value of Tests, ROC Curve, Sensitivity and Specificity, Vertigo, Vestibular Diseases, Introduction Fear-related beliefs and behaviors can impact rehabilitation outcomes and prognosis in populations with orthopedic, neurologic, and other disorders. (1-5) For example, fear of falling impacts quality of life and [...]

Objective. The purpose of this study was to determine the association between fear-avoidance beliefs and disability in 3 months in people with vestibular disorders while accounting for demographic and clinical characteristics. Methods. This prospective cohort study included people aged 18 to 100 years who reported dizziness. Participants were recruited from a balance disorders clinic and outpatient physical therapy clinics. All participants completed the Vestibular Activities Avoidance Instrument (VAAI) and the Hospital Anxiety and Depression Scale at baseline and the Vestibular Activities and Participation measure (VAP), dizziness Visual Analogue Scale (VAS), and 12-item Short Form Health Questionnaire at baseline and 3-month follow-up. A modified version of the VAAI included 9 items abstracted from the 81-item VAAI. The relationships between 9-item VAAI scores and follow-up measures of disability were assessed using Spearman correlation coefficients. Linear regression models were analyzed to determine the effect of fear-avoidance beliefs on follow-up VAP score while accounting for baseline outcome measures. Results. All participants (n = 404) completed the baseline assessment (mean age =54 years), and 286 (71%) completed the 3-month assessment. The mean 9-item VAAI score was 25 (SD = 14) at baseline and was significantly associated with VAP ([rho] =0.54), 12-item Short Form Health Questionnaire component scores ([rho] = -0.53; -0.44), and dizziness VAS at followup ([rho] = 0.37). Approximately 38% of the variation in VAP score at follow-up was predicted by age, number of medications, 9-item VAAI score, dizziness VAS, and Hospital Anxiety and Depression Scale-depression score when considered together ([R.sup.2] =0.38). Conclusion. Fear-avoidance beliefs are associated with measures of disability at 3 months and are predictive of activity limitations and participation restrictions at 3 months when controlling for age, medications, baseline dizziness, and depression symptom severity in people with vestibular disorders. Impact. Measurement of fear-avoidance beliefs may provide important prognostic information, suggesting that an assessment of fear-avoidance beliefs could be used by clinicians to identify individuals at greater risk of disability after a vestibular disorder. Lay Summary. Fear-avoidance beliefs in people who have vestibular disorders are associated with disability at 3 months and predict limitations in daily activities at 3 months. Keywords: Avoidance Behavior, Dizziness, Vertigo, Vestibular Rehabilitation, Introduction Fear avoidance is a behavioral response characterized by the avoidance of activities or movement due to fear. (1) Fear of bodily sensations has been associated with chronic dizziness among [...]

Background. Standardized instruments for measuring the intensity of balance exercises in clinical environments are lacking. Objective. The objective of this study was to develop a method for quantifying the perceived intensity of standing balance exercises. Design. A test-retest study design was used, with repeated evaluations within the same visit and between visits 1 week later. Methods. Sixty-two participants who were healthy and 18 to 85 years old (with a mean age of 55 years [SD = 20 years]; 50% women) were enrolled. On each of 2 visits, they performed 2 sets of 24 randomized static standing exercises consisting of combinations of the following factors: surface, vision, stance, and head movement. Postural sway was measured with an inertial measurement unit, and ratings of perceived difficulty (RPD) were recorded using numerical and qualitative scales. The RPD scales were validated against the quantitative sway measures using a general linear model approach. The test-retest reliability of the RPD scales was examined using a weighted kappa coefficient. Results. Both RPD scales were associated with postural sway measures with correlation coefficients > 0.6 for the whole sample. The test-retest reliability of the ratings varied considerably across the different balance exercises, and the highest weighted kappa values occurred for RPD scores on the numerical scale within the second visit, as moderate agreement was achieved in 18 of the 24 exercises. Limitations. The limitations are that the RPD scales need to be validated for other types of balance exercises and in individuals with balance disorders. Conclusions. The RPD scores correlated with the magnitude of postural sway, suggesting that they can be used as a proxy measure of perceived intensity of balance exercises., Targeted balance and vestibular rehabilitation exercises have been shown to improve balance in older adults and people with vestibular disorders. (1-4) Similarly, a number of studies that have investigated interventions [...]