The impact of episodic and chronic vestibular disorders and their specific vs. unspecific diagnosis on Health-related quality of life

Harajli, Saly (2023): The impact of episodic and chronic vestibular disorders and their specific vs. unspecific diagnosis on Health-related quality of life. Dissertation, LMU München: Medizinische Fakultät

Abstract

Vertigo and dizziness are relatively frequent complaints at primary, secondary and tertiary health-care settings. They tend to occur more often with increasing age and to negatively influence Health-related-quality of life (HRQoL) and functioning. Vestibular disorders are of episodic or chronic nature with a broad range of possible underlying causes. Episodic vestibular syndromes (EVS) present with unpredictable short attacks of vertigo and dizziness while chronic vestibular syndromes (CVS) present with long lasting episodes of vertigo and dizziness. Although they are manageable, vertigo and dizziness are often under- and misdiagnosed especially in primary care. It is not yet fully understood how EVS and CVS affect HRQoL and functioning. This far, little is known how an unspecific versus specific diagnosis of vertigo and dizziness is associated with HRQoL and its trajectories. Therefore, this doctoral thesis aims to study how EVS and CVS affect HRQoL and functioning. in addition to how an unspecific versus specific diagnosis of vertigo and dizziness is associated with HRQoL and its trajectories. The first analysis compares the effect of episodic and chronic vestibular diseases on HRQoL and functioning in a tertiary care setting, and the impact of lifestyle and sociodemographic factors. The second anal-ysis assesses the different effects of specific and unspecific diagnoses of vertigo and dizziness on HRQoL in a primary care setting. The change in HRQoL over one year is also assessed among specific and unspecific diagnoses. Data of study one originates from the “DizzyReg” database. The latter is an ongoing prospective registry for vertigo and dizziness patients. Patients showing up at the inter-disciplinary outpatient clinic of the German Center for Vertigo and Balance (DSGZ) at the Ludwig Maximilian University Hospital (LMU Klinikum) were included between De-cember 2015 and July 2019. The main outcomes are HRQoL and functioning scores which were measured by self-report using the 3-level version of the Euro-Qol five-dimensional (EQ5D3L) and the dizziness handicap inventory (DHI) questionnaires re-spectively. CVS and EVS classifications were based on a comprehensive thorough neu-ro-otological examination by the clinical experts at the DSGZ following diagnostic guide-lines of the international classification of vestibular disorders. The impact of CVS and EVS on HRQoL and functioning was assessed using multivariable linear regression models adjusting for possible confounders. Data of study two derives from the longitudinal MobilE-TRA which was collected be-tween 2017 and 2019. The latter is a multicenter observational practice-based prospec-tive cohort study among general practitioners (GPs) who have recruited patients with acute episode of vertigo and dizziness in the last quarter. Diagnosis was given by the GP at baseline and was classified as “Specific” if a clear underlying mechanism of verti-go and dizziness could be given, or “unspecific” otherwise. The main outcome was HRQoL score that had been measured also through EQ5D3L at 3- time points over one year (baseline, follow-up after 6 months and follow-up after 12 months). The association between the diagnosis and HRQoL over time was examined through mixed-effects re-gression models adjusting for possible confounders. The first analysis involved 548 participants with a mean age at the date of admission 51.35 years, among which 57% were women. Seventy-four percent had EVS while 26% had CVS. Compared to CVS, EVS patients had a female predominance (60% > 49%), younger age (48.5 < 59.6 years), and significantly higher HRQoL (63.87 > 58.08) and functioning (42.1 < 47.8) even after adjusting for confounders. The second analysis included 158 vestibular patients with a mean age at baseline 77.1 years (69% female, 42% had a specific diagnosis, 40% unspecific diagnosis and 18% left undecided). Compared to specific diagnosis, patients with unspecific diagnosis re-ported significantly lower HRQoL. No differential change in HRQoL over time could be shown, while being one year older was inversely associated with HRQoL. This thesis is leading in reporting: 1- lower HRQoL among CVS patients in compari-son to EVS and 2- worse HRQoL among patients with unspecific diagnosis of vertigo and dizziness compared to specific. The findings enhance the knowledge on the impact of both the nature of vestibular syndrome and the specificity of diagnosis on HRQoL of the patients. This knowledge might help to maintain better HRQoL among vestibular patients as they age. This could be done by shedding the light on mobility and balance in CVS patients on one hand, and referring patients with unspecific diagnosis for a more solid diagnosis (when possible) and better management of symptoms on the other hand. The findings of this thesis form a start for future research aiming to illuminate the above relationships and fill in the gaps to help preserve HRQoL of patients with vestibular dis-orders as they age.

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften ; 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Fakultäten: Medizinische Fakultät
• Sprache der Hochschulschrift: Englisch
• Datum der mündlichen Prüfung: 24. Oktober 2023
• 1. Bericht­erstatter:in: Grill, Eva