The minimal clinically important difference for gait speed in significant unilateral vestibular hypofunction after vestibular rehabilitation

Isaac B Thorman; Brian J Loyd; Richard A Clendaniel; Leland E Dibble; Michael C Schubert

doi:10.1016/j.joto.2022.11.001

The minimal clinically important difference for gait speed in significant unilateral vestibular hypofunction after vestibular rehabilitation

J Otol. 2023 Jan;18(1):15-20. doi: 10.1016/j.joto.2022.11.001. Epub 2022 Nov 10.

Authors

Isaac B Thorman^{1

2}, Brian J Loyd³, Richard A Clendaniel⁴, Leland E Dibble⁵, Michael C Schubert^{2

6}

Affiliations

¹ School of Public Health, Department of Epidemiology, Johns Hopkins University, United States.
² Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, United States.
³ School of Physical Therapy and Rehabilitation Science, University of Montana, United States.
⁴ Department of Orthopedic Surgery, Doctor of Physical Therapy Division, And Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, United States.
⁵ Department of Physical Therapy & Athletic Training, University of Utah, United States.
⁶ Department of Physical Medicine and Rehabilitation, Johns Hopkins University, United States.

Abstract

Gait speed is a valid measure of both physical function and vestibular health. Vestibular rehabilitation is useful to improve gait speed for patients with vestibular hypofunction, yet there is little data to indicate how changes in gait speed reflect changes in patient-reported health outcomes. We determined the minimal clinically important difference in the gait speed of patients with unilateral vestibular hypofunction, mostly due to deafferentation surgery, as anchored to the Dizziness Handicap Index and the Activities Balance Confidence scale, validated using regression analysis, change difference, receiver-operator characteristic curve, and average change methods. After six weeks of vestibular rehabilitation, a change in gait speed from 0.20 to 0.34 m/s with 95% confidence was required for the patients to perceive a significant reduction in perception of dizziness and improved balance confidence.

Keywords: Gait speed; Minimal clinically important difference; Vestibular hypofunction.

Grants and funding

UL1 TR002538/TR/NCATS NIH HHS/United States