Exploring the role of attention towards balance in chronic dizziness: Development of the Balance Vigilance Questionnaire (Balance-VQ)

Background and ObjectivesVigilance towards balance has been proposed to underpin various chronic dizziness disorders, including Persistent Postural Perceptual Dizziness (PPPD). The objective of this study is to develop (through patient input) a validated balance-specific measure of vigilance that comprehensively assesses the varied ways in which this construct may manifest. MethodsWe developed the Balance Vigilance Questionnaire (Balance-VQ) through patient and clinician feedback, designed to assess vigilance towards balance. We then validated the questionnaire in 497 participants consisting of patients diagnosed with chronic dizziness disorders (including 97 individuals diagnosed with PPPD) and healthy controls. ResultsThe final 6-item Balance-VQ was shown to be a valid and reliable way to assess vigilance towards balance. Scores were significantly higher in individuals diagnosed with PPPD compared to controls. Although scores were also higher in the PPPD group compared to individuals with diagnosed vestibular disorders other than PPPD, Balance-VQ scores did not discriminate between the two groups when confounding factors were controlled for. ConclusionsOur findings confirm that the Balance-VQ is a valid and reliable instrument for assessing vigilance towards balance. As symptom vigilance has been identified as a key risk factor for developing chronic dizziness following an acute neuro-otological insult, we recommend using the Balance-VQ as a screening tool in people presenting with such symptoms. Key Messages- Vigilance towards balance has been proposed to underpin the development and maintenance of chronic dizziness disorders, such as Persistent Postural Perceptual Dizziness (PPPD). - Clinically assessing balance vigilance is difficult, as no validated assessment method exists. - Through feedback from patients and clinicians, we developed a new scale capable of assessing this construct: The Balance Vigilance Questionnaire (Balance-VQ). - Our findings confirm that the Balance-VQ is a valid and reliable instrument for assessing vigilance towards balance. - We recommend using the Balance-VQ as a screening tool in people at risk of developing, or currently presenting with, chronic dizziness.