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Which primary care patients with dizziness will develop persistent impairment?
K E Bailey1, P D Sloane, M Mitchell
1Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill.
Objective:
To determine which factors identifiable during an office visit for dizziness predict chronic impairment from dizziness 3 months later.
Design:
A prospective cohort study with 3-month telephone follow-up.
Setting:
Nine primary care office practices in North Carolina.
Subjects:
117 adults who presented to primary care practices because of dizziness.
Outcome Measures:
Our outcome of interest, restriction of daily activities due to dizziness 3 months after the enrollment visit, was characterized using three different but correlated self-reported measures. Independent analytic models tested the relationship between demographic variables, health status, psychological state, and dizziness characteristics at baseline and our three measures of activity restriction due to dizziness.
Results:
A two-stage logistic regression analysis identified the following baseline characteristics to be independent predictors in one or more models of activity-limiting dizziness at 3 months: dependency in instrumental activities of daily living (odds ratio [OR] = 11.1, P = .002); a high anxiety score (OR = 5.7, P = .003); self-rating of health as fair or poor (OR = 3.2, P = .042); the presence of three or more chronic conditions (OR = 1.9, P = .022); interference from chronic conditions (OR = 1.7, P = .012); dizziness duration of greater than 1 year (OR = 20.9, P < .001); frequent dizziness (OR = 4.3, P = .016); subjective imbalance (OR = 4.7, P = .012); and activity limitation due to dizziness (OR = 11.7, P < .001).
Conclusion:
To estimate the prognosis and clinical significance of dizziness complaints, primary care physicians should take into account not only the characteristics of the patient's dizziness but also the patient's baseline health status and psychological state.