Yrsel ur patientens perspektiv : en klinisk och epidemiologisk studie på personer med öronrelaterad yrsel

Abstract

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.