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The social impact of dizziness in London and Siena

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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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References

  1. Bigal ME, Rapoport AM, Lipton RB, Tepper SJ, Sheftell FD (2003) Assessment of migraine disability using the migraine disability assessment (MIDAS) questionnaire: a comparison of chronic migraine with episodic migraine. Headache 43:336–342

    Article  PubMed  Google Scholar 

  2. Bingefors K, Isacson D (2004) Epidemiology, co-morbidity, and impact on health-related quality of life of self-reported headache and musculoskeletal pain–a gender perspective. Eur J Pain 8:435–450

    Article  PubMed  Google Scholar 

  3. Brontein AB, Lempert T (2007) Dizziness: a practical approach to diagnosis and management. Cambridge University Press

  4. Cohen HS, Kimball KT, Adams AS (2000) Application of the vestibular disorders activities of daily living scale. Laryngoscope 110:1204–1209

    Article  CAS  PubMed  Google Scholar 

  5. Fowler JH, Christakis NA (2008) Dynamic spread of happiness in a large social network: longitudinal analysis over 20 years in the Framingham Heart Study. BMJ 337:a2338

    Article  PubMed  Google Scholar 

  6. Hannaford PC, Simpson JA, Bisset AF, Davis A, McKerrow W, Mills R (2005) The prevalence of ear, nose and throat problems in the community: results from a national cross-sectional postal survey in Scotland. Fam Pract 22:227–233

    Article  PubMed  Google Scholar 

  7. Jacobson GP, Newman CW (1990) The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 116:424–427

    CAS  PubMed  Google Scholar 

  8. Kammerlind AS, Ledin TE, Skargren EI, Odkvist LM (2005) Long-term follow-up after acute unilateral vestibular loss and comparison between subjects with and without remaining symptoms. Acta Otolaryngol 125:946–953

    Article  PubMed  Google Scholar 

  9. Kroenke K, Price RK (1993) Symptoms in the community. Prevalence, classification, and psychiatric comorbidity. Arch Intern Med 153:2474–2480

    Article  CAS  PubMed  Google Scholar 

  10. Lopez-Escamez JA, Gamiz MJ, Fernandez-Perez A, Gomez-Fiñana M (2005) Long-term outcome and health-related quality of life in benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol 262:507–511

    Article  PubMed  Google Scholar 

  11. Magliulo G, Bertin S, Ruggieri M, Gagliardi M (2005) Benign paroxysmal positional vertigo and post-treatment quality of life. Eur Arch Otorhinolaryngol 262:627–630

    Article  PubMed  Google Scholar 

  12. Mendel B, Bergenius J, Langius A (1999) Dizziness symptom severity and impact on daily living as perceived by patients suffering from peripheral vestibular disorder. Clin Otolaryngol Allied Sci 24:286–293

    Article  CAS  PubMed  Google Scholar 

  13. Mennini FS, Gitto L, Martelletti P (2008) Improving care through health economics analyses: cost of illness and headache. J Headache Pain 9:199–206

    Article  PubMed  Google Scholar 

  14. Monzani D, Casolari L, Guidetti G, Rigatelli M (2001) Psychological distress and disability in patients with vertigo. J Psychosomat Res 50:319–323

    Article  CAS  Google Scholar 

  15. Nazareth I, Yardley L, Owen N, Luxon L (1999) Outcome of symptoms of dizziness in a general practice community sample. Fam Pract 16:616–618

    Article  CAS  PubMed  Google Scholar 

  16. Neuhauser HK (2007) Epidemiology of vertigo. Cur Opin Neurol 20:40–46

    Article  Google Scholar 

  17. Neuhauser HK, von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T (2005) Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology 65:898–904

    Article  CAS  PubMed  Google Scholar 

  18. Sloane PD, Coeytaux RR, Beck RS, Dallara J (2001) Dizziness: state of the science. Ann Intern Med 134:823–832

    CAS  PubMed  Google Scholar 

  19. Steptoe A, Roux AV (2008) Happiness, social networks, and health. BMJ 337:a2781

    Article  PubMed  Google Scholar 

  20. Stovner LJ, Zwart JA, Hagen K, Terwindt GM, Pascual J (2006) Epidemiology of headache in Europe. Eur J Neurol 13:333–345

    Article  CAS  PubMed  Google Scholar 

  21. van der Windt DA, Dunn KM, Spies-Dorgelo MN, Mallen CD, Blankenstein AH, Stalman WA (2008) Impact of physical symptoms on perceived health in the community. J Psychosom Res 64:265–274

    Article  PubMed  Google Scholar 

  22. von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T, Neuhauser H (2007) Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 78:710–715

    Article  Google Scholar 

  23. Yardley L, Putman J (1992) Quantitative analysis of factors contributing to handicap and distress in vertiginous patients: a questionnaire study. Clin Otolaryngol Allied Sci 17:231–236

    Article  CAS  PubMed  Google Scholar 

  24. Yardley L, Luxon LM, Haacke NP (1994) A longitudinal study of symptoms, anxiety and subjective well-being in patients with vertigo. Clin Otolaryngol Allied Sci 19:109–116

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Adolfo M. Bronstein.

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.

  1. 1)

    Please state your age in years. _______

  2. 2)

    Please state your gender. _______

  3. 3)

    Have you ever attended a postural balance or dizziness clinic?

    • YES

    • NO

    • If ‘YES’ how many times have you attended? ____________

  4. 4)

    Are you currently attending a clinic because you are off balance or dizzy or disoriented in some way?

    • YES

    • NO

  5. 5)

    If you are attending a clinic for Balance/ Dizziness problems: Approximately how long have you had these problems? _______________

  6. 6)

    If attending a clinic for Balance/ Dizziness problems: Have you seen any other specialists (apart from your GP) about your problems?

    • YES

    • NO

    • If ‘YES’ please list the types of specialists you have seen (neurologist, ENT doctor, other) __________________________________________________

  7. 7)

    What is your current pattern of employment?

    • Full time

    • Part time

    • Not working

    • If part time, how many hours per week do you work? _____________________

  8. 8)

    Have your hours or type of work changed because of balance/ dizziness problems?

    • YES

    • NO

    • If YES, please explain _____________________________________________

  9. 9)

    Have balance/ dizziness problems made you give up work completely?

    • YES

    • NO

    • IF YOU ARE NOT WORKING, PLEASE GO STRAIGHT TO QUESTION 13, Otherwise please continue with the next question.

  10. 10)

    Have balance/ dizziness problems caused you difficulty at work?

    • YES

    • NO

    • If YES, please describe _____________________________________________

  11. 11)

    Have balance/ dizziness problems caused you to have time off work?

    • YES

    • NO

    • 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 ______________________________

  12. 12)

    Do you think that your efficiency at work has suffered as a result of your dizzy symptoms?

    • YES

    • NO

    • - If ‘YES’ did your efficiency at work drop to : (please circle)

  13. Around three quarters (75%) of what it used to be.

  14. Around half (50%) of what it used to be.

  15. Around a quarter (25%) of what it used to be.

  16. 13)

    Have balance/ dizziness problems caused difficulties in your social life (e.g. restrictions on going out, planning holidays, etc)?

    • YES

    • NO

    • If ‘YES’, please describe ____________________________________________

  17. 14)

    Have balance/ dizziness problems caused difficulties in your family life?

    • YES

    • NO

    • If ‘YES’, please describe ____________________________________________

  18. 15)

    Have balance/ dizziness problems restricted your ability to travel (e.g. cannot ride bike, travel by car, plane)?

    • YES

    • NO

    • If ‘YES’, please describe_____________________________________________

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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