Pediatric Physical Therapy:
Clinical Bottom Line
University of Southern California Los Angeles, California
Los Angeles Children's Hospital Los Angeles, California
The authors declare no conflicts of interest.
“How could I apply this information?”
Clinicians can use the positive and negative likelihood ratios (LR+, LR−) provided in Table 5 to determine the likelihood that a specific child diagnosed with severe to profound sensorineural hearing loss (SNHL) has vestibular hypofunction (VH). We use the example of the 6-year-old child with SNHL in this study who did not undergo reference standard Vestibular Function Testing (VFT) yet had positive results on 4 clinical tests: (1) Head Thrust Test, (2) Dynamic Visual Acuity Test, (3) Modified Clinical Test of Sensory Interaction on Balance total score, and (4) Modified Emory Clinical Vestibular Chair Test with fixation removed. Her pretest probability for VH was 42%, on the basis of the fact that 8 of 19 children with SNHL in this study had VH as diagnosed by VFT. Using a nomogram1 and the LR+ from each clinical test (range, 2.84-5.87), her posttest probability of having VH as diagnosed by VFT would be approximately 65% to 82% (Figure 1). If each clinical test had been negative (LR− range, 0.14-0.38), her posttest probability of having VH as diagnosed by VFT would be approximately 8% to 20% (Figure 2). In this case, the use of a nomogram and the LR of each clinical test provided critical quantitative information that increased certainty that the child had VH to make appropriate referrals for reference standard VFT and determine the most appropriate intervention plan.
“What should I be mindful about when applying this information?”
Clinicians must be mindful that only 8 participants had VH as diagnosed by reference standard VFT and that the psychometric properties of the 5 clinical tests of vestibular function can only be generalized to 6- to 12-year-old children with severe to profound SNHL from chronic lesions. Furthermore, 13 of 20 participants with SNHL used cochlear implants, yet no mention was made as to whether these children had a higher incidence of VH or whether their implants were on or off during the clinical tests of vestibular function.
Barabara Sargent, PT, PhD, PCS
University of Southern California
Los Angeles, California
Jennifer Pate, PT, DPT
Los Angeles Children's Hospital
Los Angeles, California
1. Fagan T. Nomogram for Bayes's theorem. N Engl J Med. 1975;293:257.
© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy Association.