Vestibular dysfunction in people who fall: A systematic review and meta-analysis of prevalence and associated factors.

OBJECTIVES: To evaluate the prevalence and factors associated with vestibular dysfunction in people who fall. DATA SOURCES: All electronic records from MEDLINE, CINAHL, Embase and psycINFO databases were searched to 9 December 2022. REVIEW METHODS: Participants were adults with at least one fall within the previous year who were exposed to at least one vestibular function test. Any published peer reviewed trial designs were accepted. Included studies were assessed for risk of bias using a modified Epidemiological Appraisal Instrument. The quality of each meta-analysis was assessed using modified Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: Ten trials (468 participants) were identified, six of which had high methodological quality. Vestibular dysfunction was found in 61% (48.01-72.32) I2 = 78% of participants. The most prevalent type of dysfunction was from tests of vestibulo-ocular reflex at 61% (49.79 to 70.49) I2 = 68%, followed by benign paroxysmal positional vertigo at 22% (10.30-40.32) I2 = 87% and central dysfunction at 11% (2.24-37.76) I2 = 50%. People who fall with vestibular dysfunction had reduced walking function compared to those without dysfunction -0.51 (-0.85 to -0.16) I2 = 11%. Dizziness was not related to vestibular dysfunction in people who fall 0.25 (-0.10 to 0.60), I2 = 0%. The quality of the body of evidence ranged from very low to high. CONCLUSION: More than one in two people who fall have vestibular dysfunction. Clinicians cannot rely on dizziness report to indicate need for vestibular screening in those who fall. A vestibular screen should be incorporated into a comprehensive falls assessment.

Balance self-efficacy in older adults following inpatient rehabilitation.

Older adults discharging from inpatient rehabilitation were investigated to determine change in self-efficacy at 1 month after discharge, the relationship with discharge balance performance and physical function, and the influence of diagnosis. A prospective cohort of 101 adults older than 50 years of age, 43% men, average age 75.84 (SD 9.8) years, were recruited at discharge from inpatient rehabilitation. Balance self-efficacy was assessed using Activities-specific Balance Confidence (ABC) scale at discharge and 1 month following discharge. Balance and physical function were measured at discharge using the Functional Independence Measure, Balance Outcome Measure for Elder Rehabilitation, Modified Elderly Mobility Scale and gait speed. At discharge, balance self-efficacy was moderate (ABC score 62, SD 23) and did not change at follow-up. When grouped by discharge self-efficacy (ABC scores: low<50; moderate 51-80; high>80), significant between-group differences were found for balance (P=0.005) and physical function (P=0.035). At the 1-month follow-up, those with low discharge balance self-efficacy showed improvement (mean-change ABC score 12, 95% confidence interval 2-22) and those with high discharge balance self-efficacy had lower scores (mean-change ABC score 18, 95% confidence interval -8 to -28). Differences in ABC change scores were also found between diagnostic groups (F=3.740, P=0.03), with the orthopaedic group improving (ABC mean change=8) and the general frailty group showing a decrease in confidence (ABC mean change=10). The differences in balance self-efficacy change at 1 month following discharge were related to self-efficacy level at discharge and clinical group requiring rehabilitation. Clinicians need to be aware of these changes as patients are prepared for discharge.