Cross-Cultural Adaptation, Translation, and Validation of the Victorian Institute of Sport Assessment-Achilles Questionnaire (VISA-A) for Use With Arabic-Speaking Patients With Achilles Tendinopathy.

Background: The Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire is a validated instrument for assessing symptoms of Achilles tendinopathy (AT). However, there is a need to validate the Arabic version of the VISA-A (VISA-A-AR) in Arabic-speaking patients with AT. Purpose: To validate the VISA-A-AR in Arabic patients with AT and evaluate its reliability and validity. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The translation and cultural adaptation of the VISA-A questionnaire into Arabic followed international guidelines. A total of 81 participants were recruited, including 45 patients diagnosed with AT and 36 healthy individuals. The AT group comprised male and female native Arabic speakers aged ≥18 years who were diagnosed with and had symptoms of AT. The inclusion criteria for the healthy group were the same, except that they must not have had AT at the time of the study or previously. The exclusion criteria were individuals with a partial or complete Achilles tendon rupture or prior Achilles tendon surgery. The internal consistency of the VISA-A-AR was assessed using the Cronbach α coefficient. Test-retest reliability was evaluated using the intraclass correlation coefficient (ICC[3,1]). Construct validity was assessed through correlation analysis between VISA-A-AR scores and the Arabic versions of the Short Form-36 Health Survey (SF-36-AR) and the Numeric Pain Rating Scale (ANPRS). Differences in VISA-A-AR scores between patients with AT and healthy controls were analyzed using appropriate statistical tests. Results: The VISA-A-AR demonstrated a high level of internal consistency (Cronbach α = 0.935) and excellent test-retest reliability (ICC[3,1] = 0.985). Significant positive correlations were observed between VISA-A-AR scores and SF-36-AR (r(43) = 0.838, P < .001), indicating good construct validity. In addition, VISA-A-AR scores showed a significant negative correlation with ANPRS (rS(43) = -0.835, P < .001). Furthermore, VISA-A-AR scores exhibited a significant difference between patients with AT (mean, 45.82 ± 16.65) and healthy controls (mean, 99.94 ± 0.33) (P < .001). Conclusion: The findings of this study validate the VISA-A-AR as a reliable and valid tool for assessing symptoms of AT in Arabic-speaking patients.

Relationship between severity of concussion's symptoms and functional performance in children.

INTRODUCTION: Concussion is a common brain injury that has significant effects on multiple functional domains in children. However, limited research exists on the relationship between concussion severity and functional performance in this population. This study aimed to examine the relationship between the severity of concussion symptoms and children's balance and functional performance. METHODS: This cross-sectional study recruited 23 children (9 males and 14 females; mean age 13.9 ± 2.2 years) with clinically diagnosed concussions from a tertiary balance center in 2016. Participants underwent clinical and functional evaluations by specialized physical therapists. Symptom severity was assessed using the Post-Concussion Symptom Scale (PCSS), while functional performance was measured using the Functional Gait Assessment (FGA). RESULTS: There was a trend suggesting a negative correlation between symptom severity (PCSS) and functional performance (FGA), indicating potentially better performance in individuals with milder symptoms. However, this trend was not significant (rs (21) = -.072, p = 0.744). Furthermore, no significant correlation was found between FGA scores and the severity of individual symptoms. CONCLUSION: The findings suggest that concussion symptom severity may not be directly related to functional performance in children. Therefore, it is crucial to incorporate functional performance measures alongside symptom assessment for comprehensive concussion management.

The relationship between chronic diseases and the intensity and duration of low back pain.

BACKGROUND: Low back pain (LBP) is a worldwide problem that affects numerous people and limits their mobility. Several factors, including chronic diseases, increase the risk of developing LBP. To date, the information available about the relationship between chronic diseases and the intensity and duration of LBP is quite limited. AIM: The aim of the present study was to address the relationship between chronic diseases and both the intensity and duration of LBP. DESIGN: This is an observational cross-sectional study. SETTING: The study was conducted in the community of Saudi Arabia. POPULATION: 2181 adult participants (aged 18 years or more, mean age of 33 and standard deviation [SD] of ±11, 61% females) from Saudi Arabia with either recent or recurring LBP participated in the study. METHODS: The participants of this study were surveyed, and their demographic information was obtained. They were asked whether they had LBP during the past year, and if they had, they were asked about their LBP in terms of the pain intensity on a scale that runs from 0 to 10, where 0 indicates no pain and 10 indicates extreme pain. Further, the participants were asked how long their pain lasted (in days). They were also inquired whether they had any of the following chronic diseases: diabetes mellitus, high blood pressure, hypotension, arthritis, cardiopulmonary diseases, kidney diseases, and hypothyroidism. Logistic regression was used to analyze the relationships between both of LBP's intensity and duration, and the presence of chronic diseases, while adjusting for the potential effect of age and gender. RESULTS: A total of 2181 adults with either new onset of or recurrent LBP during the past 12 months participated in the present study. Of these, 356 (16%), who had LBP, suffered from one or more of the said chronic diseases. It was found that having one or more chronic diseases had statistically significant relationship with increased LBP's intensity (P=0.002), as well as prolonged duration (P=0.001). In particular, hypertension, arthritis, and hypothyroidism have statistically significant relationship with increased the intensity of the pain (P<0.05). Only, hypertension and arthritis have statistically significant relationship with increased the duration of pain (P≤0.001). CONCLUSIONS: The presence of chronic diseases was associated with a more intense and longer duration of LBP. CLINICAL REHABILITATION IMPACT: In view of the results of this study, we expect that those who have chronic diseases will have a longer duration of LBP and more intense pain.

Characteristics of the Functional Gait Assessment in adolescents with concussion.

OBJECTIVES: To assesse the characteristics and validity of the Functional Gait Assessment (FGA). Concussion is a frequent brain injury that affect cognition, balance, and mobility. Prediction of the course of recovery after concussion could be achieved using a multidimensional examination. The FGA has been used to assess balance of individuals with concussion. METHODS: A prospective cross-sectional study was commenced between 2015-2020 in Pittsburgh, PA, USA, including 27 high schoolers with current complaints of concussion and 86 healthy controls. Participants in both groups provided demographics and completed FGA, Gait Disorientation Test (GDT), and Gait Speed (GS) tests. RESULTS: The FGA test correlated significantly with the GS and GDT. The FGA score in adolescents with concussion was significantly lower than healthy controls (U=1574.5, p=0.004). An FGA score less than 27 indicated a positive concussion injury with a sensitivity of 0.33 and a specificity of 0.92. The FGA showed a diagnostic odds ratio of 5.64. The positive and the negative likelihood ratios were of 3.03 and 0.54, respectively. For adolescents with concussion, the FGA showed no floor effect; however, a small ceiling effect (11.1%) was observed. CONCLUSION: The FGA was valid and feasible to assess concussion injuries. It should be noted that a full score on the FGA should not be interpreted as full recovery from a concussion injury.

Arabic Translation and Cross-Cultural Adaptation of the Victorian Institute of Sport Assessment Questionnaire for Patellar Tendinopathy.

Background: The Victorian Institute of Sport Assessment questionnaire for patellar tendinopathy (VISA-P) is currently not available in the Arabic language. Purpose: To translate and culturally adapt the VISA-P questionnaire into Arabic and to evaluate its reliability and validity. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Translation of the VISA-P questionnaire was implemented in compliance with international guidelines. In total, 111 participants (53 with patellar tendinopathy and 58 healthy controls) were recruited to validate the Arabic-language version of the VISA-P (VISA-P-Ar). The patients with patellar tendinopathy completed the 36-item Short Form Health Survey (SF-36) and rated their knee pain using the numeric pain rating scale (NPRS). They completed the VISA-P-Ar twice (within a week) to assess test-retest reliability. Scores between the patients and controls were compared with the Mann-Whitney U test, construct validity was assessed with Spearman rank-order correlation, internal consistency was assessed with the Cronbach alpha, and test-retest reliability was assessed with the intraclass correlation coefficient (ICC). Results: There was a significant difference in VISA-P-Ar scores between the patellar tendinopathy group (mean, 41.35 ± 13.56) and the control group (mean, 95.22 ± 8.22) (P < .001). In addition, scores on the VISA-P-Ar were significantly positively correlated with the SF-36 (r = 0.630; P < .001) and significantly negatively correlated with the NPRS (r = -0.681; P < .001). The items in the VISA-P-Ar had good internal consistency (α = 0.709) and showed high test-retest reliability (ICC, 0.941; P < .001). Conclusion: The results of this study indicated that the VISA-P-Ar is a valid and reliable tool for assessing symptoms of patellar tendinopathy in the Saudi population and can be used in clinical and research settings.

Validation of the Gait Disorientation Test in children with concussion.

Background: Mild traumatic brain injury (mTBI) or concussion is a complex injury that is difficult to diagnose and assess. There are negative impacts on cognition, balance, and mobility after a concussion. The Gait Disorientation Test (GDT) is an objective measure that assesses a person's balance ability by comparing the walking time with eyes open and the walking time with eyes closed in a standardized walking task. The purpose of this study was to assess the validity and the diagnostic properties of the GDT in children with concussions. Methods: Thirty-six children with concussions, and 91 controls aged between 9 and 18 years old participated in the study. Participants completed demographics, the GDT, the Functional Gait Assessment (FGA), the Pediatric Vestibular Symptom Questionnaire (PVSQ), and the Pediatric Visually Induced Dizziness Questionnaire (PVID). Results: Children with concussions showed higher (worse) GDT scores (M = 2.18 ± 1.93 s) than healthy controls (M = 1.13 ± 0.95 s), which was statistically significant (P = 0.014). Conclusion: The GDT was able to distinguish between children with concussions and healthy controls. Given the simplicity of the GDT, it can be used to assist in discriminating between children with and without concussion.

A Systematic Review of Psychometric Properties of Knee-Related Outcome Measures Translated, Cross-Culturally Adapted, and Validated in Arabic Language.

During the previous two decades, patient-reported outcome measures (PROMs) have been well tested, and the tools were validated in different languages across the globe. This systematic review aimed to identify the knee disease-specific outcome tools in Arabic and evaluate their methodological quality of psychometric properties of the most promising tools based on the COSMIN checklist and PRISMA guidelines. Articles published in English, from the inception of databases until the date of search (10 August 2022), were included. Articles without at least one psychometric property (reliability, validity, and responsiveness) evaluation, and articles other than in the English language, were excluded from the study. The key terms ["Arabic" AND "Knee" AND ("Questionnaire" OR "Scale")] were used in three databases, i.e., PubMed, Scopus, and Web of Science (WoS) in the advanced search strategy. Key terms were either in the title or abstract for PubMed. Key words were in the topic (TS) for WoS. COSMIN (COnsensus-based Standards for the selection of health Measurement Instruments) risk of bias checklist was used to evaluate the methodological quality of psychometric properties of the Arabic knee-related outcome measures. A total of 99 articles were identified in PubMed, SCOPUS, and WoS. After passing inclusion and exclusion criteria, 20 articles describing 22 scales from five countries were included in this review. The instruments validated in the Arabic language are Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee injury and osteoarthritis outcome score (KOOS), knee outcome survey- activities of daily living scale (KOS-ADLS), Oxford knee score (OKS), anterior knee pain scale, osteoarthritis of knee and hip health-related quality of life (OAKHQoL) scale, Lysholm knee score (LKS), international documentation committee subjective knee form (IKDC), intermittent and constant osteoarthritis pain (ICOAP) questionnaire, Kujala patellofemoral pain scoring system (PFPSS), anterior knee pain scale (AKPS) and osteoarthritis quality of life questionnaire (OAQoL),. All were found to have good test-retest reliability (Intra Correlation Coefficient), internal consistency (Cronbach's alpha), and construct validity (Visual Analog Scale, Short Form-12, RAND-36, etc.). Of 20 instruments available to assess self-reported knee symptoms and function, 12 were validated in the Saudi Arabian population. Among them, KOS-ADLS is the best PROM to be used in various knee conditions, followed by KOOS and WOMAC. The assessed methodological quality of evidence says that the knee Arabic PROMs are reliable instruments to evaluate knee symptoms/function.

Utility of a Postural Stability/Perceptual Inhibition Dual Task for Identifying Concussion in Adolescents.

CONTEXT: Research in the area of dual-task paradigms to assess sport-related concussion (SRC) status is growing, but additional assessment of this paradigm in adolescents is warranted. DESIGN: This case-control study compared 49 adolescent athletes aged 12-20 years with diagnosed SRC to 49 age- and sex-matched controls on visual-spatial discrimination and perceptual inhibition (PIT) reaction time tasks performed while balancing on floor/foam pad conditions. METHODS: The SRC group completed measures at a single time point between 1 and 10 days postinjury. Primary outcomes were dual-task reaction time, accuracy, and sway. General linear models evaluated differences between groups (P < .05). Logistic regression identified predictors of concussion from outcomes. Area under the curve evaluated discriminative ability of identifying SRC. RESULTS: Results supported significantly higher anterior-posterior (AP) sway values in concussed participants for visual-spatial discrimination and PIT when balancing on the floor (P = .03) and foam pad (P = .03), as well as mediolateral sway values on the floor during visual-spatial discrimination (P = .01). Logistic regression analysis (R2 = .15; P = .001) of all dual-task outcomes identified AP postural sway during the PIT foam dual task as the only significant predictor of concussed status (ß = -2.4; P = .004). Total symptoms (area under the curve = 0.87; P < .001) and AP postural sway on foam (area under the curve = 0.70; P = .001) differentiated concussed from controls. CONCLUSION: The AP postural sway on foam during a postural stability/PIT dual task can identify concussion in adolescents between 1 and 10 days from injury.

Short-Term Psychological and Hormonal Effects of Virtual Reality Training on Chronic Low Back Pain in Soccer Players.

OBJECTIVE: To find the short-term psychological and hormonal effects of virtual reality training on chronic low back pain in American soccer players. DESIGN, SETTING, PARTICIPANTS: The 3-block random sampling method was used on 54 university American soccer players with chronic low back pain, and they were allocated into 3 groups: virtual reality training (VRT; n = 18), combined physical rehabilitation (n = 18), and control (n = 18) groups at University Hospital. They underwent different balance training exercises for 4 weeks. The participants and the therapist who is assessing the outcomes were blinded. Psychological (pain intensity and kinesiophobia) and hormonal (glucose, insulin, Homeostatic Model Assessment of Insulin Resistance, growth hormone, prolactin, adrenocorticotropic hormone, and cortisol) values were measured at baseline, after 4 weeks, and after 6 months. RESULTS: The baseline demographic, psychological, and hormonal data between the VRT, combined physical rehabilitation, and control groups show no statistical difference (P ≥ .05). Four weeks following training, the VRT group shows more significant changes in pain intensity and kinesiophobia than the combined physical rehabilitation and control groups (P < .001), and the improvement was noted in the 6-month follow-up. All the hormonal variables (glucose, insulin, growth hormone, prolactin, adrenocorticotropic hormone, and cortisol) show significant changes at 4-week training (P < .001), except for the Homeostatic Model Assessment of Insulin Resistance (P = .075) between the 3 groups. At 6-month follow-up glucose, prolactin, adrenocorticotropic hormone, and cortisol show more significant difference in the VRT group than the other 2 groups (P < .001). At the same time, insulin (P = .694), Homeostatic Model Assessment of Insulin Resistance (P = .272), and growth hormone (P = .145) failed to show significant changes between the groups. CONCLUSION: Training through virtual reality is an effective treatment program when compared with conventional exercise training programs from a psychological and hormonal analysis perspective in American soccer players with chronic low back pain.

Anterior cruciate ligament injury patterns and their relationship to fatigue and physical fitness levels - a cross-sectional study.

ABSTRACT: Anterior cruciate ligament (ACL) injury is one of the most common knee injuries that leads to many consequences such as early osteoarthritis and knee joint instability.To explore the association of the types of ACL tear (complete and partial) and side of injury (dominant vs nondominate) with types of playing surfaces, sports, shoes, and mechanism of injuries as well as to determine whether higher levels of fatigue and physical fitness are risk factors for complete ACL tear.This cross-sectional study used a questionnaire to collect information from young male adults with a confirmed ACL injury who were attending rehabilitation programs. The outcomes of interest were patterns of ACL injury, levels of fatigue before the injury on a 0 to 10 scale, and levels of physical fitness (hours per week). Mann-Whitney U and Kruskal Wallis tests were used to assess the differences between groups, while the odds ratios were calculated to evaluate risk factors for complete ACL tear.One hundred thirteen young male adults with a confirmed ACL injury were enrolled. Most of the reported ACL injuries in this study were complete tear (80.5%) and occurred more frequently in the dominant leg (74.6%) due to noncontact mechanism (63.6%). More ACL injuries happened while playing soccer (97.2%) on artificial turf (53.3%). The level of fatigue before ACL injury was significantly higher in partial ACL tear injuries compared to complete ACL tear injuries (P = .014). For every 1-point increase in the level of fatigue on a 0-10 scale, there was a 25% reduction in complete ACL injury risk (P = .023).The pattern of ACL types of tear and side of injury varies in different playing surfaces and mechanisms of injuries. Higher levels of fatigue seem to be associated with a partial tear of the ACL and reduction of a complete ACL tear risk factor.

The Physical Activity Type Most Related to Cognitive Function and Quality of Life.

BACKGROUND: Physical activity has been found to maintain and improve cognitive function and consequently improve health-related quality of life (HRQoL). The relationships between different types of physical activities, cognitive function, and HRQoL have not been studied sufficiently and compared in different age and gender groups. This study is aimed at examining the relationship between different types of physical activity (high-intensity, moderate-intensity, and walking exercise), cognitive function, and HRQoL. In addition, this study is aimed at examining these relationships in different age and gender groups. METHODS: This cross-sectional study included 150 adults with a mean age of 50 ± 8.8 years. Participants completed the International Physical Activity Questionnaire (IPAQ) to assess the level of the physical activity types and the Short-Form Health Survey (SF-36) questionnaire to assess HRQoL. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA) screening instrument. Spearman correlation analysis was used to explore the relationships between the different variables of the study. RESULTS: There were significant positive relationships between all types of physical activities, cognitive ability, and HRQoL. The relationships between moderate-intensity physical activities and cognitive function (r = 0.38) and HRQoL (r = 0.33) were higher than the relationships with walking exercise and high-intensity physical activity. The middle-aged group had a significantly higher cognitive function compared to the senior adults (p < 0.001), while there was no significant difference between the age groups in HRQoL (p = 0.18). CONCLUSION: The cognitive function and HRQoL were more related to moderate-intensity physical activities compared to walking exercise or high-intensity physical activities. These relationships were more pronounced in the senior adult population compared to the middle-aged group.

Sleep Efficiency and Total Sleep Time in Individuals with Type 2 Diabetes with and without Insomnia Symptoms.

There is increasing awareness of the high prevalence of insomnia symptoms in individuals with type 2 diabetes (T2D). Past studies have established the importance of measuring sleep parameters using measures of central tendency and variability. Additionally, subjective and objective methods involve different constructs due to the discrepancies between the two approaches. Therefore, this study is aimed at comparing the averages of sleep parameters in individuals with T2D with and without insomnia symptoms and comparing the variability of sleep parameters in these individuals. This study assessed the between-group differences in the averages and variability of sleep efficiency (SE) and total sleep time (TST) of 59 participants with T2D with and without insomnia symptoms. Actigraph measurements and sleep diaries were used to assess sleep parameter averages and variabilities calculated by the coefficient of variation across 7 nights. Mann-Whitney U tests were utilized to compare group differences in the outcomes. Validated instruments were used to assess the symptoms of depression, anxiety, and pain as covariates. Objective SE was found to be statistically lower on average (85.98 ± 4.29) and highly variable (5.88 ± 2.57) for patients with T2D and insomnia symptoms than in those with T2D only (90.23 ± 6.44 and 3.82 ± 2.05, respectively). The subjective average and variability of SE were also worse in patients with T2D and insomnia symptoms, with symptoms of depression, anxiety, and pain potentially playing a role in this difference. TST did not significantly differ between the groups on averages or in variability even after controlling for age and symptoms of depression, anxiety, and pain. Future studies are needed to investigate the underlying mechanisms of worse averages and variability of SE in individuals with T2D and insomnia symptoms. Additionally, prompting the associated risk factors of insomnia symptoms in individuals with T2D might be warranted.

Vestibulo-Ocular Reflex Function in Adolescents With Sport-Related Concussion: Preliminary Results.

BACKGROUND: Oculomotor impairments, dizziness, and imbalance are common after sports-related concussion (SRC) in adolescents and suggest a relationship between SRC and vestibular system dysfunction. However, it is not clear whether the source of these problems is attributable to the peripheral or central vestibular system. HYPOTHESIS: The video Head Impulse Test (vHIT), which assesses peripheral vestibular function, will show differences in gain between adolescents with and without SRC. Furthermore, there will be an association between vHIT and clinical balance and vestibular/oculomotor testing. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 2. METHODS: Twenty-five symptomatic adolescents aged between 12 and 19 years with a recent (within 10 days) SRC and 22 healthy controls aged 13 to 20 years were assessed using the vHIT, Balance Error Scoring System (BESS), and Vestibular Ocular Motor Screening (VOMS) tools. The vestibulo-ocular reflex (VOR) gain was calculated independently for right and left head impulses. Independent-samples t tests or Mann-Whitney U tests for nonnormal distributions were used to compare concussed patients and controls on the measures. Spearman rank-order correlations were used to assess the association of vHIT with BESS and VOMS. RESULTS: VOR gain in all adolescents with SRC was greater than 0.8, which is considered within normal limits. VOR gain and BESS scores were not significantly different between groups. Adolescents with SRC had significantly worse VOMS item scores than adolescents without SRC (P < 0.001). There were no significant correlations among vHIT gain and VOMS or BESS. CONCLUSION: There was no evidence for dysfunction in the peripheral horizontal semicircular canal function at high rotation speeds (ie, vHIT) after SRC, and vHIT was unrelated to balance and vestibular/oculomotor symptoms and dysfunction. However, adolescents with SRC scored worse on vestibular and oculomotor testing than those without SRC. Vestibular dysfunction and symptoms after SRC may be centrally derived. CLINICAL RELEVANCE: We do not recommend the assessment of head impulse function in adolescents with SRC unless more definitive signs of peripheral vestibular injury are present. We recommend using the VOMS to assess symptoms of suspected SRC injury in adolescents.

Using Accelerometers to Record Postural Sway in Adolescents With Concussion: A Cross-Sectional Study.

OBJECTIVE: To investigate the magnitude of postural sway induced by different balance tasks in adolescents with concussion and to examine the associations of postural sway with concussion symptoms. DESIGN: Cross-sectional study. PATIENTS OR OTHER PARTICIPANTS: Fifty-six adolescents (20 girls, 36 boys) between 13 and 17 years of age who sustained a concussion within the past 44 days and were still symptomatic. MAIN OUTCOME MEASURE(S): Anterior-posterior postural sway was measured using an accelerometer attached to the participant's lower back while he or she performed 6 static-balance tasks that varied the visual input, type of surface, and foot stance. Participants self-reported symptoms that occurred at the time of the concussion (eg, dizziness, confusion, amnesia) as well as at the time of balance testing (eg, eye and head movement-induced dizziness). RESULTS: The normalized path length of postural sway during the different balance tasks was greater with the eyes closed (mean = 19.3 mG/s) compared with the eyes open (mean = 12.4 mG/s; P < .001). Furthermore, sway while standing with the feet together on a foam surface (mean = 17.9 mG/s) or while tandem standing on a firm surface (mean = 19.4 mG/s) was greater than sway while standing with the feet together on a firm surface (mean = 10.3 mG/s; P < .001). Greater sway was associated with dizziness and confusion reported at the time of injury ( P < .05). Dizziness and headache symptoms at rest were positively correlated with sway ( P < .05). CONCLUSIONS: Using accelerometers to measure postural sway during different challenging balance conditions in adolescents with concussion may provide an objective means of quantifying balance impairments in clinical environments. Furthermore, the association of these measurements with symptoms suggests a need to account for symptom severity at the time of testing.

Visually Induced Dizziness in Children and Validation of the Pediatric Visually Induced Dizziness Questionnaire.

AIMS: To develop and validate the Pediatric Visually Induced Dizziness Questionnaire (PVID) and quantify the presence and severity of visually induced dizziness (ViD), i.e., symptoms induced by visual motion stimuli including crowds and scrolling computer screens in children. METHODS: 169 healthy (female n = 89; recruited from mainstream schools, London, UK) and 114 children with a primary migraine, concussion, or vestibular disorder diagnosis (female n = 62), aged 6-17 years, were included. Children with primary migraine were recruited from mainstream schools while children with concussion or vestibular disorder were recruited from tertiary balance centers in London, UK, and Pittsburgh, PA, USA. Children completed the PVID, which assesses the frequency of dizziness and unsteadiness experienced in specific environmental situations, and Strength and Difficulties Questionnaire (SDQ), a brief behavioral screening instrument. RESULTS: The PVID showed high internal consistency (11 items; α = 0.90). A significant between-group difference was noted with higher (i.e., worse) PVID scores for patients vs. healthy participants (U = 2,436.5, z = -10.719, p < 0.001); a significant difference was noted between individual patient groups [χ2(2) = 11.014, p = 0.004] but post hoc analysis showed no significant pairwise comparisons. The optimal cut-off score for discriminating between individuals with and without abnormal ViD levels was 0.45 out of 3 (sensitivity 83%, specificity 75%). Self-rated emotional (U = 2,730.0, z = -6.169) and hyperactivity (U = 3,445.0, z = -4.506) SDQ subscale as well as informant (U = 188.5, z = -3.916) and self-rated (U = 3,178.5, z = -5.083) total scores were significantly worse for patients compared to healthy participants (p < 0.001). CONCLUSION: ViD is common in children with a primary concussion, migraine, or vestibular diagnosis. The PVID is a valid measure for identifying the presence of ViD in children and should be used to identify and quantify these symptoms, which require specific management incorporating exposure to optokinetic stimuli.

The Pediatric Vestibular Symptom Questionnaire: A Validation Study.

OBJECTIVE: To develop and validate the Pediatric Vestibular Symptom Questionnaire (PVSQ) and quantify subjective vestibular symptom (ie, dizziness, unsteadiness) severity in children. STUDY DESIGN: One hundred sixty-eight healthy children (female, n = 91) and 56 children with postconcussion dizziness or a vestibular disorder (female, n = 32), between ages 6 and 17 years, were included. The PVSQ contains questions regarding vestibular symptom frequency during the previous month. The Strengths and Difficulties Questionnaire (SDQ), a brief behavioral screening instrument, was also completed. RESULTS: The PVSQ showed high internal consistency (10 items; Cronbach α = 0.88). A significant between-group difference was noted with higher (ie, worse) PVSQ scores for children with vestibular symptoms (P < .001); no significant differences were noted between patient groups. The optimal cut-off score for discriminating between individuals with and without abnormal levels of vestibular symptoms was 0.68 out of 3 (sensitivity 95%, specificity 85%). Emotional and hyperactivity SDQ subscale scores were significantly worse for patients compared with healthy participants (P ≤ .01). A significant relationship was noted between mean PVSQ and SDQ (parent-rated version) hyperactivity and total scores for patients (P ≤ .01) and the SDQ (self-rated) emotional, hyperactivity, and total score (P ≤ .01) in healthy controls. However, mean SDQ subscale and total scores were within normal ranges for both groups. CONCLUSIONS: Self-reported vestibular symptoms, measured by the PVSQ, discriminated between children presenting with vestibular symptoms and healthy controls and should be used to identify and quantify vestibular symptoms that require additional assessment and management.