The impact of vestibular dysfunction on children and young people: chronic symptoms and health-related quality of life

Abstract

Dizziness and balance difficulties are not uncommon in children, with prevalence estimates in the general population ranging from 5%-18%, although the precise prevalence of those caused by vestibular dysfunction is not known. Whilst healthcare professionals are aware that vestibular dysfunction may lead to poor balance and delayed gross motor development in young children, little is known generally about the longer-term consequences of vestibular dysfunction in this group. This thesis sought to identify the existing evidence in the literature regarding the impact of vestibular dysfunction in children and young people (CYP), to identify the evidence gaps, and to add to the existing knowledge base by reporting on the author’s own original research study regarding chronic symptoms and health-related quality of life in this group. The thesis includes a scoping review of the literature performed to identify and summarize evidence from studies investigating the impact of vestibular dysfunction in CYP (e.g. ongoing symptoms, balance function, motor development and health-related quality of life). Databases and other sources were searched methodically and 33 studies met the criteria for inclusion in the review. The review confirmed that there is some evidence about the physical effects of vestibular dysfunction in children, but that this evidence is limited by methodological and design quality issues and the heterogeneous nature of the studies. There is a paucity of evidence about the interaction between vestibular and cognitive function, and the impact on psychological wellbeing and quality of life in CYP with vestibular dysfunction, The empirical research paper, presented in a journal paper format, reports on the author’s own observational cohort study of CYP with vestibular dysfunction. For this study, 49 CYP with vestibular dysfunction and 44 of their parents/carers completed a survey which included the Paediatric Vestibular Symptom Questionnaire (pVSQ), the Paediatric Quality of Life Inventory (PedsQL) and an open question asking for comments about vestibular dysfunction affects their/ their child’s life. The findings indicate that chronic vestibular symptoms are ongoing in many CYP with vestibular dysfunction even years after the onset of vestibular dysfunction: the majority of CYP (76%) in this study and most of the parents and carers (81%) reported the presence of significant levels of vestibular symptoms (the mean duration since onset of was 7.9 years), with females reporting more severe symptoms than males. Vestibular dysfunction was associated with impaired health-related quality of life (HRQoL): 61% of the children and young people in this study, and 57% of their parent/carers reported significantly impaired HRQoL in all domains compared to healthy norms. Linear regression modelling confirmed that high levels of vestibular symptoms are the main predictor of poor HRQoL with congenital vestibular dysfunction, and bilateral or central vestibular dysfunction also being additional risk factors for reduced HRQoL. Thematic analysis of the qualitative data collected explored study participants’ perceptions of the consequences of vestibular dysfunction. Overarching themes identified were ongoing “Symptoms� and “Falls & Imbalance�, which affected activities such as “School�, “Exercise�, “Everyday activity�, and had an impact on “Emotions�. The final chapter of the thesis provides a critical review of the process and findings of the scoping review and research study, and the implications of the findings for clinical practice and future research. There is also a reflective account of the author’s experience conducting the research as part of the Higher Specialist Scientist Training programme (HSST), and how this has contributed to personal and professional development

Date of Award	1 Aug 2023
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Karolina Kluk-De Kort (Supervisor)