Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania.
JAMA Otolaryngol Head Neck Surg. 2021 Feb 1;147(2):144-150. doi: 10.1001/jamaoto.2020.4203.
Fear avoidance is a behavioral response to dizziness that can lead to chronic symptoms and maladaptation of the vestibular system, but there is no valid and reliable clinical measure of fear avoidance for persons with dizziness. Although the Vestibular Activities Avoidance Instrument (VAAI) was developed to identify fear avoidance beliefs in persons with dizziness, it was considered too long for clinical use.
To continue development of the VAAI for clinical use by reducing its length and by assessing the internal consistency and construct validity through associations with measures of disability, quality of life, and psychological well-being.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study conducted from February 2018 to December 2019 at a tertiary care balance disorders clinic and in outpatient physical therapy clinics in the United States included 404 adults with dizziness.
Participants completed the 81-item VAAI, the Vestibular Activities and Participation (VAP) measure, the 12-Item Short Form Health Survey (SF-12), and the Hospital Anxiety and Depression Scale (HADS) at baseline. Exploratory factor analysis of the VAAI was conducted to reduce the number of items. Internal consistency of the reduced VAAI was determined by calculating the Cronbach α. Convergent validity was assessed by examining the associations between the reduced VAAI and the VAP, the SF-12, and the HADS using Spearman correlation coefficients.
Data from 404 adults (mean [SD] age, 54.0 [17.0] years; 64.6% women) were included in the analyses. The exploratory factor analysis indicated that 2 factors explained the underlying constructs of the 81-Item VAAI. The first factor was retained and measured the construct of fear avoidance. The VAAI was reduced to 9 items (VAAI-9). The VAAI-9 showed excellent internal consistency (Cronbach α = 0.92) and was positively associated with the VAP (ρ = 0.81) and the HADS anxiety (ρ = 0.47) and depression (ρ = 0.64) subscales, and negatively associated with physical (ρ = -0.76) and mental (ρ = -0.47) health-related quality of life.
These findings indicate that the VAAI-9 is a short, internally consistent, valid measure of fear avoidance and is associated with quality of life, activity limitations and participation restrictions, and psychological well-being. The next steps in the development of the VAAI-9 will include validation in an external sample, assessment of test-retest validity, and prospective investigations of its association with future disability.
恐避行为是一种对头晕的行为反应，可能导致前庭系统的慢性症状和适应不良，但目前尚无针对头晕患者的有效且可靠的恐避行为临床测量方法。尽管前庭活动回避量表（VAAI）是为了识别头晕患者的恐避信念而开发的，但由于其长度过长，不适合临床使用。
通过减少 VAAI 的长度，并通过与残疾、生活质量和心理健康测量的关联来评估其内部一致性和结构有效性，继续开发用于临床使用的 VAAI。
设计、地点和参与者：这项前瞻性队列研究于 2018 年 2 月至 2019 年 12 月在美国一家三级护理平衡障碍诊所和门诊物理治疗诊所进行，纳入了 404 名有头晕的成年人。
参与者在基线时完成了 81 项 VAAI、前庭活动和参与量表（VAP）、12 项简短健康调查量表（SF-12）和医院焦虑和抑郁量表（HADS）。对 VAAI 进行探索性因素分析以减少项目数量。通过计算 Cronbach α 来确定简化后的 VAAI 的内部一致性。通过 Spearman 相关系数评估收敛效度，即考察简化后的 VAAI 与 VAP、SF-12 和 HADS 之间的关联。
共纳入 404 名成年人（平均[标准差]年龄 54.0[17.0]岁；64.6%为女性）的数据进行分析。探索性因素分析表明，81 项 VAAI 的两个因素可以解释其潜在结构。保留了第一个因素，并测量了恐避的结构。VAAI 简化为 9 项（VAAI-9）。VAAI-9 具有极好的内部一致性（Cronbach α=0.92），与 VAP（ρ=0.81）和 HADS 焦虑（ρ=0.47）和抑郁（ρ=0.64）分量表呈正相关，与身体（ρ=-0.76）和心理（ρ=-0.47）健康相关生活质量呈负相关。
这些发现表明，VAAI-9 是一种简短、内部一致、有效的恐避行为测量方法，与生活质量、活动受限和参与受限以及心理健康有关。VAAI-9 的下一步发展将包括在外部样本中的验证、测试-重测信度的评估以及对其与未来残疾关联的前瞻性研究。
