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Rehab Measures: Disability Rating Scale/ Disability Scale (Vestibular Disorders)

Link to instrument

 

Title of Assessment

Disability Rating Scale/ Disability Scale (Vestibular Disorders) 

Acronym

Instrument Reviewer(s)

Initially reviewed by Jennifer Fay, PT, DPT, NCS and Tracy Rice, PT, MPH, NCS and the Vestibular EDGE task force of the Neurology section of the APTA

Summary Date

3/29/2013 

Purpose

A self report scale in which the individual is asked to rate their level of disability based on descriptions of symptoms and limited activities.

Description

Six point scale from 0 to 5 with 0 indicating no disability and 5 indicating long term severe disability.  Patients asked to check one statement that best described how they felt about their symptoms.

Area of Assessment

Activities of Daily Living; Balance Vestibular; Functional Mobility; General Health; Occupational Performance 

Body Part

Head 

ICF Domain

Activity; Participation 

Domain

ADL; General Health 

Assessment Type

Patient Reported Outcomes 

Length of Test

05 Minutes or Less 

Time to Administer

5 minutes

Number of Items

6 items 

Equipment Required

Score sheet and pen

Training Required

None

Type of training required

No Training; Reading an Article/Manual 

Cost

Free 

Actual Cost

 

Age Range

Adult: 18-64 years; Elderly adult: 65+ 

Administration Mode

Paper/Pencil 

Diagnosis

Vestibular Disorders 

Populations Tested

  • Individuals with unilateral peripheral disease, bilateral peripheral disease, central disease and mixed central/ peripheral disease (n = 94; Shepard et al., 1990)
  • Unilateral or bilateral vestibular hypofunction due to a variety of peripheral vestibular disorders. (Hall and Herdman, 2006)

Standard Error of Measurement (SEM)

(Hall and Herdman, 2006)
  • Calculated SEM = 0.82

Minimal Detectable Change (MDC)

(Hall and Herdman, 2006)
  • Calculated MDC = 2.27

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

(Shepard et al., 1990; 1993)
  • Scores of 5 correlated with poor outcome

Normative Data

Not Established

Test-retest Reliability

Vestibular Dysfunction:

(Hall and Herdman, 2006; n =16, mean age = 51.8 years ± 13.4 years)

  • Excellent test-retest reliability for Disability score (ICC = 0.96)

Interrater/Intrarater Reliability

Not Established

Internal Consistency

Not Established

Criterion Validity (Predictive/Concurrent)

Not Established

Construct Validity (Convergent/Discriminant)

Not Established

Content Validity

Not Established

Face Validity

Not Established

Floor/Ceiling Effects

Not Established

Responsiveness

Not Established

Professional Association Recommendations

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (VEDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

 

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

(Vestibular > 6 weeks post)

VEDGE

LS

LS

LS

 

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

TBI EDGE

LS

R

LS

R

LS

 

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

N/A

N/A

N/A

N/A

 

Recommendations based on vestibular diagnosis

 

Peripheral

Central

Benign Paroxysmal Positional Vertigo (BPPV)

Other

VEDGE

LS

LS

LS

LS

 

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

TBI EDGE

No

Yes

Yes

Not reported

VEDGE

No

yes

No

Yes

Considerations

There is limited evidence for reliability, validity, sensitivity/specificity for this measure.  Although predictive validity not formally studied, the pre-therapy disability score can indicate prognosis for post-therapy disability score.  Patients that had a pretherapy disability score of 5 showed the most resistance to change after therapy.  Level of disability, as measured by the disability rating scale, decreases with vestibular rehabilitation (from 3.0 pretherapy to 1.4 posttherapy) and 80% of patients had a decrease in their disability score of at least 1 level with therapy.   (Shepard et al., 1990; Shephard et al., 1993). 

 

The mean pretherapy disability score as compared to the post-therapy score were significantly different at the p < 0.001 level (n = 94; Shepard et al., 1990)

Bibliography

Clendaniel, R. A. (2000). "Outcome measures for assessment of treatment of the dizzy and balance disorder patient." Otolaryngologic Clinics of North America 33(3): 519-533.

Hall, C. D. and Herdman, S. J. (2006). "Reliability of clinical measures used to with peripheral vestibular disorders." Journal of Neurologic Physical Therapy 30(2): 74-81.

Shepard, N., Telian, S., et al. (1993). "Vestibular and balance rehabilitation therapy." The Annals of otology, rhinology, and laryngology 102(3 Pt 1): 198-205.

Shepard, N. T., Telian, S. A., et al. (1990). "Habituation and balance retraining therapy: a retrospective review." Neurologic Clinics.

Year published

1990 

Instrument in PDF Format

 
Approval Status Approved 
 
Attachments
Created at 1/29/2014 5:17 PM  by Jason Raad 
Last modified at 9/3/2014 10:12 AM  by Jason Raad