title: The development of the ICF vestibular environmental scale.
abstract: People with vestibular disorders report changes in symptoms based on their environment with many situations increasing their symptoms. The purpose of this paper was to utilize the International Classification of Functioning Disability and Health (ICF) from the World Health Organization (WHO) to describe common environmental triggers for dizziness in persons living with balance and vestibular disorders. A multi-centre cross-sectional study was conducted with four different centres on three different continents, including patients from the United States (Pittsburgh), Germany (Munich), Jordan (Amman) and Saudi Arabia (Riyadh).
  
  
  
  Three hundred eighty one persons with vestibular disorders participated.
  
  
  
  A 9-item questionnaire (the Vestibular Environmental Scale) was developed from existing ICF items, which were compared to Dizziness Handicap Inventory (DHI) scores. Sixty-five percent of participants reported that "quick movements in the vicinity" increased symptoms, "crowds" at 45%, and "design of buildings, e.g. narrow hallways, stairs, elevators" at 42%. The "crowds" item was a good positive predictor of psychogenic vertigo (OR 1.8, 95% Confidence Interval 1.03-3.16), while "food" (OR 0.47, 95% Confidence Interval 0.17-1.29) and "light" (OR 0.41 95% Confidence Interval 0.23-0.75) were negative predictors of psychogenic vertigo. There also was a positive correlation between the number of triggers and DHI score (Spearman correlation coefficient 0.47, p < 0.0001). Sixty-eight percent of the subjects reported an increase in symptoms with between 1 and 4 environmental triggers. In our cross cultural sample, environmental triggers affect dizziness in persons living with balance and vestibular disorders. The use of items from the ICF of the WHO may help to promote cross cultural sharing of information in persons with dizziness.
authors.affiliation: Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.|Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Whitney
authors.affiliation: Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Alghadir
authors.affiliation: Faculty of Rehabilitation Sciences, Department of Physical Therapy, The University of Jordan, Amman, Jordan.
authors.forename: Alia
authors.initials: A
authors.lastname: Alghwiri
authors.affiliation: Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Kefah M
authors.initials: KM
authors.lastname: Alshebber
authors.affiliation: Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Alshehri
authors.affiliation: Department of Otolaryngology and Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Furman
authors.affiliation: Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. Munich, Germany and the German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Marchioninistr. Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Mueller
authors.affiliation: Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. Munich, Germany and the German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Marchioninistr. Munich, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Grill
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D004244:Dizziness / Q000175:diagnosis; D004777:Environment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012931:Social Environment; D011795:Surveys and Questionnaires; D014717:Vertigo / Q000175:diagnosis / Q000209:etiology; D015837:Vestibular Diseases / Q000150:complications / Q000175:diagnosis* / Q000534:rehabilitation
keywords: ICF; Vestibular; dizziness; environment; rehabilitation; vestibular rehabilitation