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Vertigo Symptom Scale

Last Updated

Purpose

The VSS is a self-report questionnaire designed to assess and differentiate symptoms of balance disorder, and somatic anxiety and autonomic arousal in patients complaining of dizziness and vertigo.

Acronym VSS

Area of Assessment

Balance – Vestibular
General Health
Mental Health
Stress & Coping
Vestibular

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Brain Injury Recovery
  • Vestibular Disorders

Populations

Vestibular Disorders
Movement and Gait Disorders

Key Descriptions

  • The long version contains 36 items addressing frequency and severity of dizziness symptoms within the last 12 months. Frequency of symptoms is rated on a Likert scale: 0 points: “never”, 1 point: “a few times (1-3 times a year)”, 2 points: “several times (4-12 times a year)”, 3 points: “quite often (on average, more than once a month)” and 4 points: “very often (on average more than once a week)”. Total score aims to figure out the severity of dizziness.

    Two principle subscales distinguishing between items related to vertigo and imbalance (Vertigo symptom scale) and those suggestive of anxiety and arousal (Autonomic/Anxiety).

    Vertigo/balance sub scale score range: 0-76

    Autonomic/Anxiety subscale score range: 0-60

    Four subscales are derived from the questionnaire which measure:
    1) Acute Vertigo: dizziness or unsteadiness lasting more than one hour sometimes accompanied by falling, nausea and vomiting
    2) Vertigo of short duration: isolated sensations of disorientation or disequilibrium
    3) Autonomic symptoms: heart pounding, excessive sweating, feeling fiat or short of breath
    4) Somatization or over reporting of health problems manifested as a tendency to complain of a large number of diverse symptoms
    Each item scored on a 5 point scale (range 0-4) and measure of symptom severity is obtained by summing item scores.
    To obtain a measure of symptom severity, sum marked responses of the total and/or the respective sub-scales.
    Mean score: divide sum-score by respective number of scale items.
  • Frequency of symptoms is rated on a Likert scale:
    0 points: “never”
    1 point: “a few times (1-3 times a year)”
    2 points: “several times (4-12 times a year)”
    3 points: “quite often (on average, more than once a month)”
    4 points: “very often (on average more than once a week)”
  • Two principal subscales distinguish between items related to vertigo and imbalance (Vertigo symptom scale) as well as items suggestive of anxiety and arousal (Autonomic/Anxiety):
    1) Vertigo/balance sub scale score range: 0-76
    2) Autonomic/Anxiety subscale score range: 0-60
  • Scoring:
    1) Total score aims to figure out the severity of dizziness
    2) Maximum score: 136 (severe vertigo)
    3) Minimum score: 0 (no symptoms)
  • Four subscales are derived from the questionnaire which measure:
    1) Acute Vertigo: dizziness or unsteadiness lasting more than one hour sometimes accompanied by falling, nausea and vomiting
    2) Vertigo of short duration: isolated sensations of disorientation or disequilibrium
    3) Autonomic symptoms: heart pounding, excessive sweating, feeling fiat or short of breath
    4) Somatization or over reporting of health problems manifested as a tendency to complain of a large number of diverse symptoms
  • Scoring:
    1) Each item scored on a 5-point scale (range 0-4) and measure of symptom severity is obtained by summing item scores
    2) To obtain a measure of symptom severity, sum marked responses of the total and/or the respective sub-scales
    3) Mean score: divide sum-score by respective number of scale items
  • Short Form contains 15 items:
    1) Two sub-scales: 8 items relating to vertigo-balance (VSS-V score ranging from 0-32), and 7 items relating to autonomic anxiety symptoms (VSS-A, score ranging 0-28)
    2) Severe dizziness defined as ≥ 12 points on the total scale

Number of Items

Long Form: 36
Short Form: 15

Equipment Required

  • Pen
  • Scoring sheet

Time to Administer

15 minutes

Required Training

Reading an Article/Manual

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Jennifer Fay, PT, DPT, NCS and Tracy Rice, PT, MPH, NCS and the Vestibular EDGE task force of the Neurology section of the APTA.

Body Part

Head

ICF Domain

Body Structure
Body Function

Measurement Domain

Emotion
General Health
Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post) 

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

(Vestibular > 6 weeks post)

Vestibular EDGE

LS

 

LS

Recommendations based on vestibular diagnosis

 

Peripheral

Central

Benign Paroxysmal Positional Vertigo (BPPV)

Other

Vestibular EDGE

LS

LS

LS

LS

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

Vestibular EDGE

No

Yes

Yes

Yes

Considerations

  • German Version (Gloor-Juzi et al., 2012) Turkish version (Yanik et al., 2008)

  • Norwegian Version (Wilhelmsen et al., 2008)

  • Afrikaans Version (Rogers et al., 2011) 

  • Spanish Version (Yardley et al., 1999)

Do you see an error or have a suggestion for this instrument summary? Please e-mail us! 

Vestibular Disorders

back to Populations

Cut-Off Scores

Ranges from 0 (no symptoms) to 136 points (severe vertigo)

Test/Retest Reliability

Vestibular Dysfunction:

(Yardley et al 1992) 

  • Excellent test-retest reliability for vertigo symptom scale score (r = 0.94) 
    • Acute attack of vertigo scale (r = 0.98) 
    • Vertigo of short duration scale: (r = 0.89) 
  • Excellent test-retest reliability for Autonomic/Anxiety symptom scale (r = 0.95) 
    • Somatisation scale: (r = 0.95) 
    • Autonomic symptom scale (r = 0.95)

 

Vestibular Dysfunction:

(Gloor-Juzi et al 2012) 

  • Excellent test-retest reliability for the German version of Vertigo Symptom Scale total score (VSS-G) (ICC = 0.926 (0.826/0.965) 
    • Excellent test-retest reliability for the German version of Vertigo Symptom Scale Vertigo subscale (VSS-VER)(ICC = 0.920 (0.854/0.957) 

Excellent test-retest reliability for the German version of Vertigo Symptom Scale Anxiety/Autonomic subscale (ICC = 0.913 (0.737/0.963) 

Spanish version: 

  • Excellent internal consistency for both scales (VER = 0.82; AA = 0.90)

Movement and Gait Disorders

back to Populations

Test/Retest Reliability

Benign Paroxysmal Positional Vertigo:

(Yanik et al., 2008)

    • Excellent test-retest reliability for the Turkish version of Vertigo Symptom Scale (ICC = 0.90)

Internal Consistency

Vertiginous Patients:

(Yardley et al., 1992) 

  • Vertigo symptom scale score Excellent (n = 127) Cronbach’s α = 0.88, Adequate sample 2 (n = 44) Cronbach’s α = 0.76
    • Acute attack of vertigo subscale Excellent internal consistency Sample 1 (n = 127) Cronbach’s α = 0.83, Adequate internal consistency sample 2 (n = 44) Cronbach’s α = 0.80
    • Vertigo of short duration subscale: Excellent internal consistency sample 1(n = 127) Cronbach’s α = 0.87, Adequate internal consistency sample 2 (n = 44) Cronbach’s α = 0.70
  • Autonomic/Anxiety symptom scale: Excellent internal consistency (n = 127) Cronbach’s α = 0.83, Adequate internal consistency sample 2 (n = 44) Cronbach’s α = 0.83
    • Somatisation subscale : Excellent internal consistency (n = 127) Cronbach’s α = 0.78, Adequate internal consistency sample 2 (n = 44) Cronbach’s α = 0.69
    • Autonomic symptom subscale Excellent internal consistency (n = 127) Cronbach’s α = 0.75, Adequate internal consistency sample 2 ( n = 44) Cronbach’s α = 0.76

 

 

Vertiginous Patients:

(Yardley, Medina et al., 1999) 

  • Vertigo Symptom Scale Score Excellent internal consistencyCronbach’s α = 0.82
  • Autonomic/Anxiety Excellent internal consistency Cronbach’s α = 0.90

 

 

Benign Paroxysmal Positional Vertigo:

(Yanik et al 2008) 

  • Turkish version of Vertigo Symptom Scale Excellent internal consistency Cronbach’s α = 0.91

 

Vertiginous Patients:

(Rogers, et al 2011) 

  • Afrikaans version of Vertigo Symptom Subscale Excellent internal consistency Cronbach’s α = 0.88
  • Excellent Internal Consistency Anxiety/Autonomic symptom subscale Cronbach’s α = 0.92

 

Vertiginous Patients: 

(Gloor-Juzi, et al 2012) 

  • German version of Vertigo Symptom Scale total score(VSS-G) Excellent internal consistency Cronbach’s α = 0.904
  • German version of Vertigo Symptom Scale subscale (VSS-VER) Excellent internal consistency Cronbach’s α = 0.859
  • German version of Vertigo Symptom Scale Anxiety/Autonomic symptom subscale Excellent internal consistency Cronbach’s α = 0.864

Criterion Validity (Predictive/Concurrent)

Benign Paroxysmal Positional Vertigo: 

(Yanik et al 2008) 

  • Adequate concurrent validity between the Vertigo Symptom Scale and Becks Depression Inventory (r = 0.55 p < 0.001) 
  • Poor concurrent validity between the Vertigo Symptom Scale and SF-36 (r = -0.21, p < 0.005) 

 

Autonomic/Anxiety Symptom Scale significantly correlated with trait anxiety (r = 0.44, P < 0.001) and state anxiety (r = 0.55, p < 0.001). 

 

Combined Vertigo Symptom scale correlated with neither trait anxiety (r = -0.01) and state anxiety (r = 0.06). 

 

Autonomic/Anxiety Symptom Scale and Combined Vertigo Scale associated to handicap (r = 0.33 and r = -0.37 respectively; p < 0.001) 

 

Intercorrelations between Symptoms, Anxiety and Depression 

 

Acute Vertigo: 

  • With short duration vertigo r = 0.42 p < 0.001 
  • With somatization r = 0.09 
  • With autonomic symptoms r = -0.28 p < 0.01 
  • With Spielberger’s Trait Anxiety Inventory (STAI-T) r = 0.07 
  • Hospital Anxiety and Depression Scale Anxiety (HAD-A) r = 0.06, Depression (HAD-D) r = -0.04 
  • Vertigo Handicap Questionnaire (VHQ) r = 0.41 p < 0.001 

 

Vertigo of Short Duration: 

  • With Somatization subscale 0.17 
  • With Autonomic symptoms subscale 0.24 p < 0.01 
  • STAI-T -0.07 
  • HAD-A r = 0.02, HAD-D r = 0.02 
  • VHQ r = 0.19

Construct Validity

Vertiginous Patients:

(Gloor-Juzi et al 2012)

Areas under the ROC-Curve calculated to show difference between median scores of the VSS-German (total score), VSS-Vertigo, and VSS-Autonomic/Anxiety Scale. 

 

Excellent Discriminant Validity

VSS-G = 0.95 (0.92, 0.97) 

VSS-VER = 0.99 (98, 1.00) 

VSS-AA = 0.84 (0.78, 0.89) 

Moderate correlation of the VSS total score with the Vestibular Rehabilitation Benefit Questionnaire (VRBQ) total score (r = 0.45) 

Moderate correlation between VSS scales and VHQ: r = 0.19-0.41

Bibliography

Gloor-Juzi, T., Kurre, A., et al. (2012). "Translation and validation of the vertigo symptom scale into German: A cultural adaption to a wider German-speaking population." BMC Ear Nose Throat Disord 12: 7. 

Rogers, C., de Wet, J., et al. (2011). "The translation of the Vertigo Symptom Scale into Afrikaans: a pilot study." S Afr J Commun Disord 58: 6-12. 

Wilhelmsen, K., Strand, L. I., et al. (2008). "Psychometric properties of the Vertigo symptom scale - Short form." BMC Ear Nose Throat Disord 8(1): 2. 

Yanik, B., Kulcu, D. G., et al. (2008). "The reliability and validity of the Vertigo Symptom Scale and the Vertigo Dizziness Imbalance Questionnaires in a Turkish patient population with benign paroxysmal positional vertigo." J Vestib Res 18(2-3): 159-170. 

Yardley, L., Masson, E., et al. (1992). "Symptoms, anxiety and handicap in dizzy patients: development of the vertigo symptom scale." J Psychosom Res 36(8): 731-741. 

Yardley, L., Medina, S., et al. (1999). "Relationship between physical and psychosocial dysfunction in Mexican patients with vertigo: a cross-cultural validation of the vertigo symptom scale." Journal of Psychosomatic Research 46(1): 63-74.

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