Abstract
BackgroundDizziness or vertigo is associated with both vestibular-balance and psychological factors. A common assessment tool is the Vertigo Symptom Scale (VSS) -short form, which has two subscales: vestibular-balance and autonomic-anxiety. Despite frequent use, the factor structure of the VSS-short form has yet to be confirmed. Here, we clarified the factor structure of the VSS-short form, and assessed the validity and reliability of the Japanese version of this tool.MethodsWe conducted a cross-sectional, multicenter, psychometric evaluation of patients with non-central dizziness or vertigo persisting for longer than 1 month. Participants completed the VSS-short form, the Dizziness Handicap Inventory, and the Hospital Anxiety and Depression Scale. They also completed the VSS-short form a second time 1–3 days later. The questionnaire was translated into Japanese and cross-culturally adapted. We conducted a confirmatory factor analysis followed by an exploratory factor analysis. Convergent and discriminant validity, internal consistency, and test-retest reliability were evaluated.ResultsThe total sample and retest sample consisted of 159 and 79 participants, respectively. Model-fitting for a two-subscale structure in a confirmatory factor analysis was poor. An exploratory factor analysis produced a three-factor structure: long-duration vestibular-balance symptoms, short-duration vestibular-balance symptoms, and autonomic-anxiety symptoms. Regarding convergent and discriminant validity, all hypotheses were clearly supported. We obtained high Cronbach’s α coefficients for the total score and subscales, ranging from 0.758 to 0.866. Total score and subscale interclass correlation coefficients for test-retest reliability were acceptable, ranging from 0.867 to 0.897.ConclusionsThe VSS-short form has a three-factor structure that was cross-culturally well-matched with previous data from the VSS-long version. Thus, it was suggested that vestibular-balance symptoms can be analyzed separately according to symptom duration, which may reflect pathophysiological factors. The VSS-short form can be used to evaluate vestibular-balance symptoms and autonomic-anxiety symptoms, as well as the duration of vestibular-balance symptoms. Further research using the VSS-short form should be required in other languages and populations.
Highlights
Dizziness or vertigo is associated with both vestibular-balance and psychological factors
Neurootology experts excluded patients with vertigo or dizziness caused by the central nervous system, and diagnosed all patients according to the Diagnostic Guideline of Equilibrium Disorders by Japan Society for Equilibrium Research
With respect to test-retest reliability in the current study population, we considered 1–3 days to be an appropriate interval for completion because 1) vertigo- or dizziness-related symptoms can vary widely on the scale of several days, and 2) because 24- or 48-hour intervals have been adopted in previous studies for similar populations [17,22]
Summary
Dizziness or vertigo is associated with both vestibular-balance and psychological factors. A common assessment tool is the Vertigo Symptom Scale (VSS) -short form, which has two subscales: vestibular-balance and autonomic-anxiety. Patient-reported scales assessing both vestibularbalance and psycho-physiological factors are absolutely necessary to evaluate severity of symptoms or effectiveness of treatment, such as vestibular rehabilitation [9] and cognitive behavioral therapy [10]. Two patient-reported scales have been widely used to comprehensively evaluate patients with vestibular-balance symptoms: the Dizziness Handicap Inventory (DHI) [7] and the Vertigo Symptom Scale (VSS) [8]. The VSS, which assesses patient-reported symptoms, has an advantage over the DHI in that it is not just used to evaluate the frequency of vestibular-balance symptoms, and the severity of autonomic-anxiety symptoms, which have a great impact on quality of life. For consistency between research groups, the two-factor solution has been employed continuously, the optimal number of factors was not examined or determined to be ‘three factors’ [12,13,14]
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