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The Effects of Fear Avoidance on Disability Among Persons with Vestibular Disorders

Dunlap, Pamela (2020) The Effects of Fear Avoidance on Disability Among Persons with Vestibular Disorders. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Purpose: The association between fear avoidance beliefs and disability among persons with vestibular disorders is unknown because there is no measure of fear avoidance in this population. The purpose of this study was to determine the psychometric properties of the Vestibular Activities Avoidance Instrument (VAAI) and to evaluate the effect of fear-avoidance beliefs on level of disability in persons with vestibular disorders at three months.

Methods: Subjects were recruited from a balance disorders clinic and physical therapy clinics and were between the ages of 18-100, English-speaking, and experiencing dizziness. Exploratory factor analysis of the 81-item VAAI was completed. The modified VAAI was assessed for internal consistency using Cronbach’s alpha and for construct validity using Spearman’s correlation coefficients and bootstrap resampling methods. The relationship between fear avoidance beliefs at baseline and disability at follow-up was determined using Spearman’s correlation coefficients. Other baseline characteristics were accounted for by constructing general linear models and then including significant predictors and VAAI score at baseline in a final multivariate linear regression model with 3-month Vestibular Activities and Participation Measure (VAP) score as the dependent variable.

Results: The sample included 404 subjects (mean age=54 years). One factor was retained because it measure the construct of activity avoidance. After item reduction, the resulting scale included 9 items (VAAI-9) and demonstrated excellent internal consistency and convergent validity with the Hospital Anxiety and Depression Scale (HADS), 12 Item Short-Form Health Survey, and the VAP at baseline. The VAAI-9 score at baseline was significantly related to all disability measures at 3 months. The multivariate linear regression model included the VAAI-9 score, the dizziness visual analogue scale, and the HADS Depression subscale score at baseline and predicted a significant proportion of the variance in VAP score at follow-up.

Conclusion: The VAAI-9 is a valid and reliable measure of fear avoidance beliefs in persons with vestibular disorders. Fear avoidance beliefs measured by the VAAI-9 at baseline were associated with activity and participation limitations at 3 months. The VAAI-9 may be a useful clinical tool to evaluate fear avoidance beliefs which is associated with disability in persons with vestibular disorders.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Dunlap, Pameladunlappm@pitt.edudunlappm0000-0001-9181-4533
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairWhitney,
Committee MemberDelitto,
Committee MemberFurman,
Committee MemberMarchetti,
Committee MemberSparto,
Committee MemberStaab,
Date: 31 July 2020
Date Type: Publication
Defense Date: 19 May 2020
Approval Date: 31 July 2020
Submission Date: 6 May 2020
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 153
Institution: University of Pittsburgh
Schools and Programs: School of Health and Rehabilitation Sciences > Rehabilitation Science
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: dizziness, vestibular rehabilitation, activity avoidance, physical therapy
Date Deposited: 13 Aug 2020 13:34
Last Modified: 31 Jul 2022 05:15


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