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The five times sit to stand test: Responsiveness to change and concurrent validity in adults undergoing vestibular rehabilitation
pp. 233 - 243
Bridget M. Meretta, Susan L. Whitney, Gregory F. Marchetti, Patrick J. Sparto, Robb J. Muirhead

Objective: The purpose of this study was to determine if patients with balance and vestibular disorders would demonstrate clinically meaningful improvement in the Five Times Sit to Stand Test (FTSST) score as a result of vestibular rehabilitation and to determine the concurrent validity of the FTSST. Design: Retrospective chart review of 351 people who underwent individualized outpatient vestibular rehabilitation programs. Setting: Outpatient tertiary balance and vestibular clinic. Subjects: One hundred and seventeen patients (45 men, 72 women), mean age 62.7 years, with peripheral, central or mixed vestibular dysfunction. Main Outcome Measures: FTSST, gait speed, Timed Up and Go Test (TUG), Dynamic Gait Index (DGI), Dizziness Handicap Inventory (DHI), and Activities-Specific Balance Confidence Scale (ABC). Results: The mean change in FTSST score was 2.7 seconds. Subjects demonstrated statistically significant improvements in the FTSST, gait speed, ABC, DHI, DGI and TUG after vestibular rehabilitation (p < 0.01). The responsiveness-treatment coefficient (RT) was calculated as 0.58 for the FTSST indicating moderate responsiveness. Logistic regression showed that an improvement in the FTSST of greater than 2.3 seconds resulted in an odds ratio of 4.67 for demonstrating clinical improvement in DHI, compared with a change less than 2.3 seconds. The univariate linear regression model for baseline FTSST predicting FTSST change was significant (p < 0.01) and predicted 49% of the change variance. The FTSST scores demonstrated a moderate correlation with gait speed and the TUG (p< 0.01). FTSST improvement subsequent to vestibular rehabilitation was moderately correlated with improvements in the DGI and the TUG scores (p< 0.01). Conclusions: The FTSST was moderately responsive to change over time and was moderately related to measures of gait and dynamic balance.Patients with chronic vestibular dysfunction often experience visually-induced aggravation of dizzy symptoms (visual vertigo; VV). The Situational Characteristics Questionnaire (SCQ), Computerized Dynamic Posturography or Rod and Frame Test (RFT) are used to assess VV symptoms. This study evaluates whether correlations exist between these three tests, their ability to identify patients with VV and whether emotional state correlates with VV symptoms. Tests were completed by 20 normal controls (Group NC), 20 patients with vestibular dysfunction plus VV (Group VV) and 13 without VV (Group NVV). Additionally, the Vertigo Symptom Scale (VSS-V) was applied to quantify general, non-visually induced vertigo (dizziness, lightheadedness and/or spinning) and imbalance. Autonomic (VSS-A) and psychological symptoms (Hospital Anxiety and Depression questionnaire; HAD) were also assessed. With the SCQ 100% of Group VV scored outside normal ranges and scores differed significantly between Group VV and both Groups NC and NVV. RFT values were not significantly different between groups; only 15% of patients scored outside normal ranges. Posturography scores were abnormal for 50% of patients; significant differences were noted between Groups NC and VV for composite scores and ratios 3/1, 4/1, 5/1 and 6/1 (indicative of abnormal sensory re-weighting). There were no correlations between the three data sets in patients. Anxiety and depression scores significantly differed between Groups NC and VV but not between patient groups; this indicates that psychological symptoms may be present in either patient group. The SCQ can be used to corroborate an initial clinical diagnosis of VV and quantify its severity in patients with vestibular dysfunction. Posturography data suggested patients with VV have a sensory re-weighting abnormality. The rod and frame test results and posturography findings agree less with the clinical diagnosis of VV. Psychological symptoms may need to be addressed.