Fear avoidance beliefs are associated with perceived disability in persons with vestibular disorders

Pamela M. Dunlap, Patrick J. Sparto, Gregory F. Marchetti, Joseph M. Furman, Jeffrey P. Staab, Anthony Delitto, Brooke N. Klatt, Susan L. Whitney

Research output: Contribution to journalArticlepeer-review


Objective. The purpose of this study was to determine the association between fear-avoidance beliefs and disability in 3 months in people with vestibular disorders while accounting for demographic and clinical characteristics. Methods. This prospective cohort study included people aged 18 to 100 years who reported dizziness. Participants were recruited from a balance disorders clinic and outpatient physical therapy clinics. All participants completed the Vestibular Activities Avoidance Instrument (VAAI) and the Hospital Anxiety and Depression Scale at baseline and the Vestibular Activities and Participation measure (VAP), dizziness Visual Analogue Scale (VAS), and 12-item Short Form Health Questionnaire at baseline and 3-month follow-up. A modified version of the VAAI included 9 items abstracted from the 81-item VAAI. The relationships between 9-item VAAI scores and follow-up measures of disability were assessed using Spearman correlation coefficients. Linear regression models were analyzed to determine the effect of fear-avoidance beliefs on follow-up VAP score while accounting for baseline outcome measures. Results. All participants (n = 404) completed the baseline assessment (mean age=54 years), and 286 (71%) completed the 3-month assessment. The mean 9-item VAAI score was 25 (SD=14) at baseline and was significantly associated with VAP (ρ =0.54), 12-item Short Form Health Questionnaire component scores (ρ=-0.53; -0.44), and dizziness VAS at followup (ρ =0.37). Approximately 38% of the variation in VAP score at follow-up was predicted by age, number of medications, 9-item VAAI score, dizziness VAS, and Hospital Anxiety and Depression Scale-depression score when considered together (R2 =0.38). Conclusion. Fear-avoidance beliefs are associated with measures of disability at 3 months and are predictive of activity limitations and participation restrictions at 3months when controlling for age, medications, baseline dizziness, and depression symptom severity in people with vestibular disorders. Impact. Measurement of fear-avoidance beliefs may provide important prognostic information, suggesting that an assessment of fear-avoidance beliefs could be used by clinicians to identify individuals at greater risk of disability after a vestibular disorder. Lay Summary. Fear-avoidance beliefs in people who have vestibular disorders are associated with disability at 3 months and predict limitations in daily activities at 3 months.

Original languageEnglish (US)
Article numberpzab147
JournalPhysical Therapy
Issue number9
StatePublished - Sep 1 2021


  • Avoidance Behavior
  • Dizziness
  • Vertigo
  • Vestibular Rehabilitation

ASJC Scopus subject areas

  • General Medicine


Dive into the research topics of 'Fear avoidance beliefs are associated with perceived disability in persons with vestibular disorders'. Together they form a unique fingerprint.

Cite this