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. 2023 Dec 6;103(12):pzad094.
doi: 10.1093/ptj/pzad094.

The Psychometric Properties of the 9-Item Vestibular Activities Avoidance Instrument

Pamela M Dunlap  1 , Fai A Alradady  1 , Claudia M Costa  2 , Anthony Delitto  1 , Lauren Terhorst  3 , Patrick J Sparto  1 , Joseph M Furman  4 , Gregory F Marchetti  5 , Jeffrey P Staab  6 , Jasmine Chueh  7 , Susan L Whitney  1
Affiliations

The Psychometric Properties of the 9-Item Vestibular Activities Avoidance Instrument

Pamela M Dunlap et al. Phys Ther. .

Abstract

Objective: The purpose of this study was to establish the psychometric properties of the 9-Item Vestibular Activities Avoidance Instrument (VAAI-9), a patient-reported outcome measure developed to identify fear avoidance beliefs in persons with vestibular disorders.

Methods: This prospective cohort study included 100 participants 18 years and older seeking care at a balance disorders clinic for dizziness. Participants completed the VAAI-9, the Dizziness Handicap Inventory (DHI), and other patient-reported outcomes at the initial visit and the 3-month follow-up. To measure test-retest reliability, the VAAI-9 was completed again 5 days after the initial visit and was analyzed using a 2-way mixed ICC for absolute agreement. Internal consistency was determined using the Cronbach alpha. The Spearman correlation coefficient was used to assess convergent validity of the VAAI-9 with other outcomes. Receiver operating characteristic curves were used to identify baseline VAAI-9 cutoff scores for those who reported mild (DHI ≤ 30) or moderate or severe (DHI > 30) perceived disability at the 3-month follow-up.

Results: The mean age of the study cohort was 49 (SD = 16) years; 73 (73%) were women. Seventy-one participants completed the 5-day follow-up, and 68 completed the 3-month follow-up. The VAAI-9 demonstrated excellent internal consistency (α = 0.91) and test-retest reliability (ICC = 0.90). Baseline VAAI-9 scores had moderate to strong associations with other outcome measures at baseline and 3 months. A baseline VAAI-9 score of 26 or higher had a sensitivity of 80.6% and a specificity of 78.4% for identifying a DHI score of >30 at 3 months (area under the curve = 0.86).

Conclusions: The results provide evidence of excellent reliability and validity for the 9-item VAAI in persons with vestibular disorders. A baseline VAAI-9 score of ≥26 identified individuals at risk of persistent moderate to severe disability due to dizziness.

Impact: Initial levels of fear avoidance beliefs measured using the VAAI-9 provided important prognostic information about outcomes for persons with vestibular symptoms.

Keywords: Balance; Dizziness; Measurement: Applied; Outcome Assessment (Health Care); Predictive Value of Tests; ROC Curve; Sensitivity and Specificity; Vertigo; Vestibular Diseases.

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