Prediction of fall risk reduction as measured by dynamic gait index in individuals with unilateral vestibular hypofunction

Objective: To determine the effect of vestibular rehabilitation on reduction of fall risk in individuals with unilateral vestibular hypofunction and to identify those factors that predict fall risk reduction. Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: Forty-seven patients with unilateral vestibular hypofunction, aged 28 to 86 years, who were at risk for falls on initial assessment. Intervention: All patients underwent vestibular rehabilitation including adaptation exercises, designed to improve gaze stability, and gait and balance exercises. Main Outcome Measures: Fall risk (Dynamic Gait Index), visual acuity during head movements (Dynamic Visual Acuity), and subjective complaints were measured initially, at 2-week intervals, and at completion of physical therapy. Results: As a group, the patients had significantly reduced risk for falls (p < 0.001) after rehabilitation. Time from onset of symptoms did not affect the efficacy of vestibular rehabilitation. Both older (greater than or equal to 65 yr) and younger (< 65 yr) adults showed significant reductions in fall risk with vestibular rehabilitation (p < 0.001). However, a significantly greater proportion (chi(2) = 0.016) of older adults remained at risk for falls at discharge compared with young adults (45% versus 11%). Initial Dynamic Gait Index and Dynamic Visual Acuity scores predicted fall risk reduction in patients with unilateral vestibular hypofunction. A model was developed using initial Dynamic Gait Index and Dynamic Visual Acuity scores to predict fall risk reduction. Conclusions: Vestibular rehabilitation is effective in significantly reducing fall risk in individuals with unilateral vestibular deficit. The model predicts fall risk reduction with good sensitivity (77%) and specificity (90%).