Abstract
Although dizziness is a common presenting symptom in general and hospital practice, its social cost is not known. We assessed the social and work life impact of dizziness on patients in two contrasting European cities, Siena and London. First, we developed the ‘Social life & Work Impact of Dizziness questionnaire’ (SWID), which was validated by administering it to 43 patients with dizziness and 45 normal controls and by correlating the results with the EQ-5D (Europe quality of life) questionnaire. The SWID and EQ-5D scores were worse in patients than controls (p < 0.001) and the two correlated significantly (r = 0.50 p < 0.001). Then two hundred consecutive patients per city attending tertiary specialised ‘dizzy patient’ clinics, one in London led by a neurologist, one in Siena led by an ear, nose and throat specialist (ENT), were investigated with SWID. Amongst the 400 patients, 27% reported changing their jobs and 21% giving up work as a result of the dizziness. Over 50% of patients felt that their efficiency at work had dropped considerably. The mean number of days off work attributed to the dizziness in the previous 6 months was 7.15 days. Social life was disrupted in 57% of all 400 patients. Factor analysis identified that detrimental effects on work, travel, social and family life combine to create a single factor accounting for much of the overall impact of their dizziness. Significant differences in some measures of handicap between London and Siena emerged, with London patients often faring worse. Reasons for these location differences include, as expected, a higher proportion of neurological patients in London than in Siena. However, factors related to city demographics and social cohesion may also modulate the impact on quality of life and working practice. Regardless of inter-city differences, these findings highlight the high social and economic impact of dizziness.
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Appendices
Appendix 1. The SWID (Social life & Work Impact of Dizziness) questionnaire
Balance and dizziness survey
All the following questions concern any problems you may have in Postural Balance and/or Dizziness. The survey assesses the impact of such symptoms on your working and social life. All replies are in strict confidence.
PLEASE CIRCLE THE CORRECT ‘YES’ AND ‘NO’ ANSWERS AND PLEASE WRITE THE ADDITIONAL INFORMATION REQUESTED.
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1)
Please state your age in years. _______
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2)
Please state your gender. _______
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3)
Have you ever attended a postural balance or dizziness clinic?
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YES
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NO
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If ‘YES’ how many times have you attended? ____________
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4)
Are you currently attending a clinic because you are off balance or dizzy or disoriented in some way?
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YES
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NO
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5)
If you are attending a clinic for Balance/ Dizziness problems: Approximately how long have you had these problems? _______________
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6)
If attending a clinic for Balance/ Dizziness problems: Have you seen any other specialists (apart from your GP) about your problems?
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YES
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NO
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If ‘YES’ please list the types of specialists you have seen (neurologist, ENT doctor, other) __________________________________________________
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7)
What is your current pattern of employment?
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Full time
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Part time
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Not working
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If part time, how many hours per week do you work? _____________________
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8)
Have your hours or type of work changed because of balance/ dizziness problems?
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YES
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NO
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If YES, please explain _____________________________________________
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9)
Have balance/ dizziness problems made you give up work completely?
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YES
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NO
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IF YOU ARE NOT WORKING, PLEASE GO STRAIGHT TO QUESTION 13, Otherwise please continue with the next question.
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10)
Have balance/ dizziness problems caused you difficulty at work?
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YES
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NO
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If YES, please describe _____________________________________________
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11)
Have balance/ dizziness problems caused you to have time off work?
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YES
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NO
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If ‘YES’ please estimate how many days off work you had in the last 6 months as a result of your dizzy or balance symptoms ______________________________
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12)
Do you think that your efficiency at work has suffered as a result of your dizzy symptoms?
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YES
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NO
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- If ‘YES’ did your efficiency at work drop to : (please circle)
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Around three quarters (75%) of what it used to be.
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Around half (50%) of what it used to be.
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Around a quarter (25%) of what it used to be.
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13)
Have balance/ dizziness problems caused difficulties in your social life (e.g. restrictions on going out, planning holidays, etc)?
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YES
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NO
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If ‘YES’, please describe ____________________________________________
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14)
Have balance/ dizziness problems caused difficulties in your family life?
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YES
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NO
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If ‘YES’, please describe ____________________________________________
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15)
Have balance/ dizziness problems restricted your ability to travel (e.g. cannot ride bike, travel by car, plane)?
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YES
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NO
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If ‘YES’, please describe_____________________________________________
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Many thanks for your participation.
Appendix 2
Validation of the social life & work impact of dizziness questionnaire (SWID)
In this appendix we provide validation data for the new ‘Social life & Work Impact of Dizziness questionnaire’ (SWID).
Methods
The SWID questionnaire and a standardised quality of life questionnaire EuroQOL (http://www.euroqol.org) [8] were given to a sample (n = 43) patients attending ‘dizzy patient clinics’ (neuro-otology) and to an opportunistic sample of normal controls (n = 45) of equivalent age distribution and gender ratio. Locations were London and Siena on an equal split. Scale scores computed were the SWID4 (work, social, family, travel difficulties due to dizziness), and the EuroQOL five item scale EQ-5D. The EuroQOL current Health State visual analogue scale (HS) was analysed separately. Parametric and non-parametric statistical analyses were used as appropriate.
Results
There were no significant differences on any variable between London and Siena and the samples were combined. The SWID4 scale had good reliability with a Cronbach’s alpha = 0.85. Age [Mean (SD) years] was equivalent for patients [56.6 (18.0)] and controls [52.2 (18.0)] (p = ns). Gender ratios were equivalent for patients (17 M 26 F) and controls (15 M 30 F) (p = ns). Slightly over half of patients vs one third of controls were unemployed or retired (Chi square; p < 0.05). Four patients and no controls had given up work completely due to dizziness (Fisher exact p < 0.05). Social (p < 0.001), Family (p < 0.001) and Travel (p < 0.001) difficulties due to dizziness were higher in patients vs controls (Chi square). Similarly the SWID4 (p < 0.001), EQ-5D (p < 0.001) and HS (p < 0.001) scores were worse in patients vs controls. The SWID4 correlated with EQ-5D (r = 0.50 p < 0.001), with HS (r = 0.31 p < 0.01). Retired participants somewhat ‘diluted’ the work difficulty item. If this was dropped then the correlations rose to r = 0.6 and r = 0.5 respectively.
Conclusions
We expected that the patient group would score significantly worse in terms of work and social life functioning on the SWID. The significant differences in the expected direction between patients versus controls for the SWID provide validity evidence for this questionnaire. Similarly, the patients score worse on the well standardised questionnaire EuroQOL. In addition the significant associations of the SWID with the EuroQOL provide further support for the validity of the SWID questionnaire.
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Bronstein, A.M., Golding, J.F., Gresty, M.A. et al. The social impact of dizziness in London and Siena. J Neurol 257, 183–190 (2010). https://doi.org/10.1007/s00415-009-5287-z
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DOI: https://doi.org/10.1007/s00415-009-5287-z