VESTIBULAR EDGE

PROCESS

The Vestibular Evidence Database to Guide Effectiveness (VEDGE) for task force was organized in 2012 and met for the first time at CSM 2013. The team included a balance of clinicians, academicians and scientists reflecting geographical, practice and research experience.

At the 2013 organization meeting, task force members developed vestibular specific criteria to evaluate measures and to assess their utility in clinical, academic and research practice settings.

After refining a candidate list of 76 measures, the VEDGE task force selected 46 tests and measures commonly used for the assessment of persons with vestibular dysfunction for further research and consideration.

The task force divided outcome measures into categories based on the clinical presentation of patients with suspected vestibular pathology reflecting measures to assess postural stability, dynamic stability, gaze stability, VOR function, symptom severity, and activity and participation restrictions.

The task force divided into four, two-person teams and performed a comprehensive literature review on all candidate measures. These so called “Buddy” teams compiled descriptive and psychometric data on each measure from which a fact sheet were developed.  Fact sheets developed by individual team members were initially cross-checked by the “secondary” author on that sheet.  Using evaluation criteria developed by the task force, the 2 person teams rated their assigned measures according to test psychometric and utility standards. Following rating consensus within the 2 person review teams, measures were more broadly considered and rated by the full task force of 8 members using an on-line Delphi process. Ratings for individual measures were deliberated by the task force until 80% agreement was reached for each of the rated categories.

The VEDEGE task force worked in close collaboration with project managers at Rehab Measures.org to facilitate the on-line dissemination of task force findings.  Findings for Vestibular tests and measures reviewed were presented at CSM 2014. Findings are available both on the Academy of Neurologic Physical Therapy page and at RehabilitationMeasures.org.

TRANSLATION

Ongoing translation efforts for the VEDGE task force recommendations include: 1) Clinical Translation: Select Outcome measures for use in the vestibular patient population will be published in the Archives of Physical Medicine and Rehabilitation to maximize visibility of measures with outstanding clinical utility and test psychometrics; 2) Academic Translation: Members of the VEDGE team are currently working with the Vestibular practice pattern task force within the Vestibular SIG to consolidate and organize the extensive list of measure recommendations for use by academicians in entry level PT programs; 3) Research Translation: Members of the VEDGE task force are proposing a coordinated research agenda to the Vestibular SIG to facilitate the targeted filling of psychometric property gaps identified by the VEDGE task force.  This proposed effort aims to strengthen the most promising vestibular outcome measures through clinical research to systematically enhance psychometric properties improving clinical management and research suitability for select measures used to assess vestibular dysfunction. 

RECOMMENDATION CATEGORIES

4= Highly Recommended

            This outcome measure has excellent psychometric properties and clinical utility,

            AND this measure is free or reasonably accessible to the broad community of providers.

3= Recommended

            This outcome measure has good psychometric properties and good clinical utility,

            OR this measure has excellent psychometric properties and clinical utility; however, it is not free and may require access to specialized testing equipment that is beyond the means of many clinicians or clinics.

2= Reasonable to Recommend at this time

            This measure has adequate to good psychometric properties and clinical utility; however, it is not free and may require access to specialized testing equipment that is beyond the means of many clinicians or clinics,

            OR this measure has been validated in other patient populations but not in persons with vestibular deficits

            OR this measure has only adequate clinical utility.

1= Not Recommended

            This outcome measure has poor psychometric properties,

            OR this measure has poor clinical utility.

RECOMMENDATIONS

•Recommendations for use of each outcome measure reviewed were categorized according to four criteria:

• Acuity (< 6 weeks of symptoms/ > 6 weeks of symptoms);

• Diagnostic Category (Peripheral vestibular dysfunction, Central vestibular dysfunction, BPPV, Other (e.g. cervicogenic dizziness);

• Academic: Recommendations for each outcome measure to entry level PT education were also included. Measures were characterized as those that students should learn to administer, should be exposed to, or are not recommended.

• Research: Measures were categorized as being recommended or not recommended for use in research and whether there was a need for additional research in a given outcome measure.

 Click HERE for the completed EDGE document of all the outcome measures reviewed.  The completed document contains detailed information on the psychometric properties of the outcome measures and references.

Click HERE to search for completed Rehab Measures templates of for vestibular outcome measures reviewed. Rehab Measures templates provide additional detail characterizing comprehensive psychometric test properties, comments on clinical utility, and for a full reference list. Rehab Measures.org will periodically update these measures in concert with ongoing efforts from the VEDGE task force and other members of the vestibular practice community.

Documents summarizing recommendations are available by clicking on the following links:

• Clinical
• Academic
• Research

Vestibular EDGE Task Force Members

• Matthew R. Scherer, PT, PhD*, Chair
  • Andrew Radar U.S. Army Health Clinic, Joint Base Fort-Myer Henderson Hall, Physical Therapy, Arlington, VA
• Linda B. Horn, PT, DScPT, MHS*, Co-Chair
  • University of Maryland School of Medicine, Physical Therapy and Rehabilitation Science,  Baltimore, MD
• Elizabeth Dannenbaum, MScPT
  • Jewish Rehabilitation Hospital, Laval, Canada
• Jennifer L. Fay, PT
  • NYU Langone Medical Center, Rusk Institute for Rehabilitation Medicine, Vestibular Rehabilitation Department, New York, NY
• Karen H. Lambert, PT, MPT*
  • Bodies in Balance Physical Therapy, Wilmington, NC
• Teresa A. Rice, PT, MPH*
  • West Virginia University, Division of Physical Therapy, Department of Human Performance,  Morgantown, WV
• Jennifer L. Stoskus, PT
  • Kessler Institute for Rehabilitation, Outpatient Physical Therapy Department, Chester, NJ
• Diane M. Wrisley, PhD, PT*
  • Wingate University, Department of Physical Therapy Wingate, NC

*All the Physical Therapists above are Board Certified Neurologic Clinical Specialists.