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Validity and Responsiveness of the Visual Vertigo Analogue Scale

Dannenbaum, Elizabeth, MScPT; Chilingarian, Gevorg, MPH†; Fung, Joyce, PhD

Journal of Neurologic Physical Therapy: April 2019 - Volume 43 - Issue 2 - p 117–121
doi: 10.1097/NPT.0000000000000261
Research Articles

Background and Purpose: People with visual vertigo have dizziness provoked by visual stimulation. We have developed a Visual Vertigo Analogue Scale (VVAS) to evaluate their symptoms and response to rehabilitation. Our goal was to validate the VVAS against the Situation Characteristics Questionnaire (SITQ) score and determine its responsiveness to treatment.

Methods: Participants (n = 115) completed 3 questionnaires: Dizziness Handicap Inventory (DHI), VVAS, and the SITQ at their initial and final sessions of vestibular rehabilitation. The SITQ was analyzed using the Space Motion Discomfort (SMD1) outcome measure and by calculating the average score of all the items (SMDavg). The results were stratified into those who had a significant clinical change in their DHI score posttreatment and those who did not. Associations of the VVAS with SMD scores and change scores were determined by Pearson and Spearman correlations. Nonparametric t tests were used to compare the 2 DHI groups on the clinical outcomes.

Results: There were significant associations between VVAS scores (P < 0.0001) and both SMD1VVAS = 0.02) and SMDavg scores (βVVAS = 0.03). Significant differences existed between the 2 DHI groups for all scores: VVAS (P = 0.0002), SMD1 (P = 0.02), and SMDavg (P = 0.0001).

Discussion and Conclusions: VVAS scores correlated well with SMD1 and SMDavg scores. Changes in VVAS pre- and posttreatment scores corresponded to the changes seen in SMD1 and SMDavg scores. The VVAS shows validity and responsiveness to change. The VVAS can be used to detect clients with visual vertigo and to verify the progression of the client's symptoms.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1,

Feil/Oberfeld/CRIR Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval, Laval, Quebec, Canada; and School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.

Correspondence: Elizabeth Dannenbaum, MScPT, Feil/Oberfeld/CRIR Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval, 1755 Blvd René-Laennec, Laval, QC H7M 3L9, Canada (

†Deceased August 12, 2018.

This project was funded by the Jewish Rehabilitation Hospital Foundation.

There is no conflict of interest between any of the authors to any financial, consultant, or institutional organization.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

© 2019 Academy of Neurologic Physical Therapy, APTA