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Yrsel ur patientens perspektiv: En klinisk och epidemiologisk studie på personer med öronrelaterad yrsel
Red Cross University College of Nursing. Karolinska Instiutet.
2007 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to characterize and improve assessment of self-rated health and quality of life in patients with peripheral vestibular disorder, with the ultimate goal of developing the care and rehabilitation of these patients. The aim of the first study was to investigate the prevalence of dizziness/balance disturbance and auditory symptoms, and relate this to self-rated general, psychosocial and mental health in a Swedish community sample (n=2547). The overall prevalence of dizziness was 21%, higher among women (27%) than men (14%). Significantly more women than men experienced dizziness as everything spinning. Of those with dizziness, 24 % of the men and 21% of the women simultaneously experienced loss of hearing and tinnitus. Unsteadiness was recorded in 44% of both men and women, but significantly more women experienced dizziness when they lay down. Both men and women with dizziness perceived significantly worse self-rated health than those without dizziness. In the explorative second study, ten patients were interviewed and asked to describe how dizziness affected their lives. Four areas of concern were identified, vulnerability, non-affirmation, daily living and the need for support. These areas constituted the basis for the choice of questionnaires in the third and fourth studies, where the aim was to evaluate self-rated quality of life and relate this to coping capacity (sense of coherence) and medical data. Ninety-nine patients answered five questionnaires concerning the presence and frequency of dizziness-specific symptoms (Vertigo Severity Scale), handicap (Vertigo Handicap Questionnaire), functional status (Sickness Impact Profile), emotional distress (Hospital Anxiety and Depression Scale) and sense of coherence (SOC Scale). The majority of patients reported the presence of all three characteristic symptoms of dizziness, experiencing that everything is spinning, being light-headed or giddy and feeling unsteady. The most common concurrent symptoms were headache, pressure in the ear and visual disturbance. The worst functional impairments occurred in the psychosocial area, such as a feeling of a restricting and demanding situation, which led to avoidance of a number of activities. Furthermore, 71 patients stated that they always had to stop whatever they were doing during an attack of dizziness. In comparison with a healthy reference group, patients´ ratings of their functional status in all areas (physical and psycho-social dimension, work, sleep/rest, home management, recreation/pastimes and eating) were both significantly statistically worse as well as clinically worse, and similar to those of patients with other serious illnesses. Thirty-nine patients rated a tendency to anxiety and 18 a tendency to depression. Few significant relationships were found between quality of life and demographic data or disease- specific symptoms. The results showed that patients with a high sense of coherence rated statistically lower levels of handicap, emotional distress, impact on working capacity and psychosocial dysfunction than those with low SOC scores. This thesis shows that dizziness is a common symptom and is related to a negative influence on self-rated health and quality of life. There are indications, that patients with peripheral vestibular disorders, especially those with a lower sense of coherence, suffer severe consequences in terms of quality of life, independently of the disease symptom pattern. It is suggested that patients´ perspectives on symptoms, functional and emotional status and sense of coherence should be assessed, in order to identify and evaluate the need for care and rehabilitation.

Place, publisher, year, edition, pages
Stockholm: Karolinska institutet , 2007. , 45, [7] p.
Keyword [sv]
yrsel
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:rkh:diva-598ISBN: 978-91-7357-368-9 (print)OAI: oai:DiVA.org:rkh-598DiVA: diva2:610314
Available from: 2014-07-08 Created: 2013-03-11 Last updated: 2014-07-08Bibliographically approved
List of papers
1. Dizziness: A common, troublesome symptom but often treatable
Open this publication in new window or tab >>Dizziness: A common, troublesome symptom but often treatable
2010 (English)In: Journal of Vestibular Research-Equilibrium & Orientation, ISSN 0957-4271, Vol. 20, no 5, 391-398 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the prevalence of self-rated dizziness/unsteadiness and health as well as to estimate the proportion of participants with peripheral vestibular disorders.

Methods: Altogether, 2547 participants (66%) participated in an epidemiological cross-sectional study, including self-rated questions about dizziness/unsteadiness, concomitant auditory symptoms and self-rated general, psychosocial and mental health.

Results: The overall prevalence of dizziness was 21% and higher among women (27%) than men (14%) (p< 0.001). Dizziness, provoked by the movement of lying-down (benign paroxysmal positional vertigo), was noted in 5% of the participants with the symptom occurring more often in women than in men (p< 0.001). Twenty-four percent of the men and 21% of the women with dizziness simultaneously experienced a sense of rotation and loss of hearing and tinnitus. Fifteen percent reported falls because of dizziness. Both men and women suffering from dizziness symptoms perceived worse self-rated health generally, psychosocially and mentally than those without symptoms of dizziness (p< 0.001).

Conclusion: Dizziness-related symptoms are common in all age groups and may manifest worse self-rated health. About 50% of the participants had symptoms indicating origin of peripheral vestibular disorders. Self-rated questions seem capable of identifying patients for referral to clinical examinations and subsequently those who can be successfully treated.

Place, publisher, year, edition, pages
IOS Press, 2010
Keyword
balance disturbance, dizziness, epidemiology, quality of life, self-rated health
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-600 (URN)10.3233/VES-2010-0370 (DOI)20826938 (PubMedID)
Note

Som manuskript i avhandling. As manuscript in dissertation.

Available from: 2013-03-11 Created: 2013-03-11 Last updated: 2014-11-07Bibliographically approved
2. Living with dizziness: an explorative study
Open this publication in new window or tab >>Living with dizziness: an explorative study
1997 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 26, no 6, 1134-1141 p.Article in journal (Refereed) Published
Abstract [en]

A qualitative study was conducted for the purpose of exploring how patients with dizziness manage their daily living. Ten patients with history of dizziness were recruited from the out-patient clinic, Department of Audiology, in a hospital in Stockholm. Collection and analysis of data were inspired by the method of grounded theory. Four themes were developed that described the experience-of living with dizziness: vulnerable reactions, affirmation and non-affirmation, finding ways to carry on daily living, and expressing the need for health care support. These themes seem to conceptualize these patients' difficulties and needs in relationship to living with dizziness and, given the small sample, have implications for nursing practice and provide a framework for a broader study.

Keyword
dizziness, daily living, patient's perceptions, qualitative study
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-894 (URN)10.1111/j.1365-2648.1997.tb00805.x (DOI)9429963 (PubMedID)
Available from: 2014-07-08 Created: 2014-07-08 Last updated: 2014-11-07Bibliographically approved
3. Dizziness symptom severity and impact on daily living as perceived by patients suffering from peripheral vestibular disorder
Open this publication in new window or tab >>Dizziness symptom severity and impact on daily living as perceived by patients suffering from peripheral vestibular disorder
1999 (English)In: Clinical Otolaryngology & Allied Sciences, ISSN 0307-7772, Vol. 24, no 4, 286-293 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to describe quality-of-life aspects in a group of patients (n = 99) suffering from peripheral vestibular disorder, using three different self-rated instruments, the Vertigo Symptom Scale (VSS), the Vertigo Handicap Questionnaire (VHQ) and the Sickness Impact Profile (SIP). The results showed that the type of dizziness that most influenced the quality-of-life aspects were: frequent short- or long-term dizziness, nausea, and the feeling that the ground was distant or as though the patient were walking on clouds. However, several of the impairments in daily life were neither related to the disease itself nor the demographic data. This verifies the necessity of investigating other factors such as personality and coping capacity. The results of this study also demonstrate the patients' need of psychosocial support. A comprehensive assessment and evaluation is important in order to identify each patient's needs.

Keyword
dizziness, peripheral vestibular disorder, quality-of-life, functional status, symptoms
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:rkh:diva-893 (URN)10.1046/j.1365-2273.1999.00261.x (DOI)10472462 (PubMedID)
Available from: 2014-07-08 Created: 2014-07-08 Last updated: 2014-11-07Bibliographically approved
4. The sense of coherence: a tool for evaluating patients with peripheral vestibular disorders
Open this publication in new window or tab >>The sense of coherence: a tool for evaluating patients with peripheral vestibular disorders
2001 (English)In: Clinical Otolaryngology & Allied Sciences, ISSN 0307-7772, Vol. 26, no 1, 19-24 p.Article in journal (Refereed) Published
Abstract [en]

Peripheral vestibular disorders may result. in physical as well as psychosocial dysfunction. Such a situation demands a capacity to cope which lately has been discussed as an important factor in the health outcome. Antonovsky has described the concept of sense of coherence (SOC) as such a trait and has developed a questionnaire (the SOC Scale) to measure it. The aim of this study was to describe the patients' self-rated degree of SOC and to set this in relation to their perception of the self-rated quality of life. The results showed that patients with a strong SOC scored statistically less self-rated handicap, less emotional distress, less impact on working capacity and sleep and rest and less psychosocial dysfunction than those with weak SOC scores. It is suggested that the SOC Scale may serve as a tool to identify patients who are at risk of poorer quality of life and in need of supportive care.

Keyword
peripheral vestibular disorders, coping, Sense of Coherence, quality of life
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:rkh:diva-892 (URN)10.1046/j.1365-2273.2001.00398.x (DOI)11298161 (PubMedID)
Available from: 2014-07-08 Created: 2014-07-08 Last updated: 2014-11-07Bibliographically approved

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