Patient-Reported Outcomes Measurement Information System (PROMIS) outcomes: Higher odds of adverse mental health when physical function is impaired

Abstract

Purpose

Balance and vestibular disorders have a profound impact on quality of life. Anxiety (ANX) and depression (DEP) are common with dizziness, vertigo, or imbalance. It is unclear whether self-reported anxiety or depression depends on perceived physical function for individuals participating in vestibular rehabilitation (VPT). We hypothesized that individuals with worse physical function would be more likely to report abnormally high anxiety and/or depression levels.

Participants

170 individuals referred for vestibular rehabilitation (113 female, 57 males, and age 63.7 (21)).

Methods

A retrospective chart review extracted age, Patient-Reported Outcome Measurement Information System (PROMIS) scores (ANX, DEP, physical function) and primary diagnoses [benign paroxysmal positional vertigo (n = 42), unilateral vestibular hypofunction (n = 39), bilateral vestibular hypofunction (n = 14), concussion/head injury (n = 7), dizziness/vertigo (n = 37), and imbalance (n = 31)]. Average PROMIS scores and percentage of abnormal scores were calculated for physical function, ANX, and DEP scores and reported using descriptive statistics. Logistic regression was performed to separately examine the odds of abnormal ANX and DEP based on abnormal physical function while controlling for age and sex, on the entire dataset and on diagnosis subgroups.

Results

Individuals referred to vestibular physical therapy with self-reported abnormal physical function were more likely to have abnormal ANX (OR 5.1, p < 0.001) or DEP (OR 3.10, p = 0.002). Older adults were less likely to have abnormal ANX (OR = 0.96, p = 0.002). For individuals experiencing BPPV (n = 42), those with abnormal physical function are more likely to report ANX (OR 9.9, p = 0.009). For individuals with UVH (n = 39), those with abnormal physical function were more likely to report ANX (OR 10.1, p = 0.008) or DEP (OR 9.9, p = 0.010).

Conclusion

Self-reported abnormal physical function corresponds to a higher incidence of abnormal ANX and DEP for individuals referred to VPT. Individuals with benign proximal positional vertigo and unilateral vestibular hypofunction were approximately 10 times more likely to experience abnormally high ANX or DEP compared to all other primary diagnosis. Clinicians seeing patients in VPT should be screening for anxiety and depression especially for those with self-reports of impaired physical function.