Department of Physical Therapy Student Theses, Dissertations and Capstones

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

Department

College of Health Care Sciences - Physical Therapy Department

First Advisor

Mary Blackinton

Second Advisor

Joann Gallichio

Third Advisor

Anne Galgon

Publication Date / Copyright Date

2020

Publisher

Nova Southeastern University

Abstract

Background. Dizziness, a common complaint among older adults, is associated with multiple falls, loss of function and independence, and reduced balance confidence. The Clinical Practice Guideline for Peripheral Vestibular Hypofunction recommends walking for endurance as a component of vestibular rehabilitation (VR). However, studies on VR in the olderadults do not include walking in the intervention.

Research Design: 1) A pragmatic, randomized, experimental design to evaluate the impact of walking on vestibular outcomes, length of stay, and number of visits, and to examine whether pedometers increase the adherence of older adults with vestibular issues to a walking program; 2) a descriptive design to determine test-retest reliability of the TUG in older adults withvestibular issues; and 3) a correlational, retrospective design to determine if TUG, DGI, and MCTSIB are significant predictors of DHI.

Results: A total of 17 participants met the inclusion and exclusion criteria and elected to participate. The walking group (mean age 80.40 years) had 11 participants while the control (mean age 76.20 years) had 6 participants. Five participants used pedometer-based walking (VRWP) and six participants used time-based walking (VRW) in the walking group. A significant between-group difference was found on the DHI (mean difference walking group 20.60, control group 3.2, P=0.04). The walkinggroup significantly improved on MCTSIB (P=0.03), TUG (P=0.05), DGI (P=0.01) and DHI (P=0.01) while the control group improved on TUG (P=0.04) only. The length of stay and number of visits were not significantly different between both groups. No between and within group difference was found on IPAQ-Walk and IPAQ-Total.

The TUG had excellent test-retest reliability (ICC 0.98), with SEM of 0.33seconds and 95% MDC of 0.92seconds, while the DHI had a moderate inverse correlation with mCTSIB (-.381) and DGI (-.322), and a fair correlation with TUG (0.396). The MCTSIB, TUG and DGI accounted for 10% of the variance in the DHI, however, this relationship was not found to be significant (P=0.25).

Conclusions. A prescribed walking program in vestibular rehabilitation significantly improved outcomes on the DGI, DHI and MCTSIB when compared to VR alone in this pilot study. The TUG significantly improved in both groups. It did not impact thelength of PT interventions and number of visits. Giving pedometers and instruction for daily walking to patients with vestibular problems increased overall walking and physical activity compared to those patients who only received instructions to walk without a pedometer. The test-retest reliability of the TUG for older adults with dizziness is equivalent to that of older adultswithout dizziness. The TUG test, DGI and mCTSIB test are not strong predictors of scores on the DHI for older adults withvestibular dysfunction. This study should be replicated as a large, multi-site trial to overcome the limitations of a small sample size.

Disciplines

Physical Therapy

Keywords

Dizziness, Older Adults, Older adults with Dizziness, Prescribed Walking Program, Walking

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