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RehabMeasures Instrument

Last Updated

Purpose

The VAS is designed to measure perceived level of dizziness while sitting quietly and then following one minute of horizontal head movement at 1Hz.

Acronym VAS

Area of Assessment

Balance – Vestibular
Functional Mobility
Gait
Vestibular
Vision & Perception

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Vestibular Disorders

Key Descriptions

  • Oscillopsia (oVAS) and Perceived Disequilibrium (dVAS) (Herdman et al., 2007)

    Oscillopsia/perception of visual blurring:
    1) One end of the scale was descriptive anchor “No difficulty seeing clearly at all (normal)” and other end anchored with “The worst it could be."
    2) Patients asked to rate their visual blurring first while sitting and then while walking.

    Disequilibrium:
    1) One end of the scale was anchored with “I feel perfectly steady,” and the other end was anchored with “The worst it could be.”
    2) Patients were asked to rate their perception first while they were sitting and then while they were walking.
  • The difference in symptom intensity between sitting and walking conditions is used as the oVAS or dVAS score.
  • Head Movement VAS (Hall & Herdman, 2006):
    1) Designed to measure perceived level of dizziness while sitting quietly and then following one minute of horizontal head movement at 1Hz.
    2) Anchors on one end include the phrase “no dizziness at all” and on the other end include the phrase “as bad as it can be”.
  • Difference in severity of dizziness before and after one minute of head turns calculated and reported as head movement VAS (HM VAS).
  • A positive value indicates an increase in symptoms following head movement; negative value indicates a decrease in symptoms following head movement.

Number of Items

2

Two items for each scale: sitting, and while walking.

Equipment Required

  • Paper
  • Pencil
  • Ruler with centimeter markings

Time to Administer

5 minutes

Required Training

Reading an Article/Manual

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Jennifer Fay, PT, DPT, NCS and Tracy Rice, PT, MPH, NCS and the Vestibular EDGE task force of the Neurology Section of the APTA.

Body Part

Head

ICF Domain

Activity

Measurement Domain

General Health
Motor
Sensory

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

MS EDGE

R

R

R

R

R

Recommendations based on EDSS Classification:

 

EDSS 0.0 – 3.5

EDSS 4.0 – 5.5

EDSS 6.0 – 7.5

EDSS 8.0 – 9.5

MS EDGE

R

R

R

R

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

MS EDGE

Yes

Yes

Yes

No

Considerations

There is very limited data regarding validity of this measure as compared to other measures used in the vestibular population. However, it does provide a scale for patients to rate how severe their symptoms are.

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Vestibular Disorders

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Standard Error of Measurement (SEM)

Head Movement VAS:

SEM calculated from Hall, Herdman 2006 

  • SEM = 1.65 

 

Perceived visual blurring/Degree of oscillopsia (oVAS): 

(Herdman et al, 2007): 

Not Established 

 

Disequilibrium (dVAS):

(Herdman et al, 2007) 

Not Established (unable to calculate) 

 

Visual Analog Scale (Vertigo), Visual Analog Scale (Dizziness):

(Toupet M, Ferrary E, Bozorg Grayeli A.) 

Not Established

Minimal Detectable Change (MDC)

Head Movement VAS (HM VAS):

(Hall and Herdman, 2006) 

  • MDC: 4.57 calculated 

 

Perceived visual blurring/Degree of oscillopsia (oVAS):

(Herdman et al, 2007): 

Not Established (unable to calculate) 

 

Disequilibrium (dVAS):

(Herdman et al 2007) 

Not Established (unable to calculate) 

 

Visual Analog Scale (Vertigo), Visual Analog Scale (Dizziness):

(Toupet M, Ferrary E, Bozorg Grayeli A.)

Test/Retest Reliability

Head Movement Visual Analog Scale: 

(Hall & Herdman, 2006) 

  • Adequate test-retest reliability (ICC = 0.48) 

 

Perceived visual blurring/Degree of oscillopsia (oVAS):

(Herdman et al., 2007) (Herdman et al., 2003)

 

Disequilibrium (dVAS): 

(Herdman et al., 2007) (Herdman et al., 2003) 

  • Adequate test-retest reliability (r = 0.65)(ICC 1,1) 

 

Visual Analog Scale (Vertigo), Visual Analog Scale (Dizziness):

(Toupet M, Ferrary E, Bozorg Grayeli A.)

Bibliography

Hall, C. D. and Herdman, S. J. (2006). "Reliability of clinical measures used to with peripheral vestibular disorders." Journal of Neurologic Physical Therapy 30(2): 74-81. 

Herdman, S. J., Hall, C. D., et al. (2007). "Recovery of dynamic visual acuity in bilateral vestibular hypofunction." Arch Otolaryngol Head Neck Surg 133(4): 383-389. Find it on PubMed

Herdman, S. J., Schubert, M. C., et al. (2003). "Recovery of dynamic visual acuity in unilateral vestibular hypofunction." Arch Otolaryngol Head Neck Surg 129(8): 819-824. Find it on PubMed

Toupet, M., Ferrary, E., et al. (2011). "Visual analog scale to assess vertigo and dizziness after repositioning maneuvers for benign paroxysmal positional vertigo." J Vestib Res 21(4): 235-241. Find it on PubMed