The authors developed a Visual Analog Independence Scale (VAS), which is a quick overall rating tool of the participants’ perception regarding their activities of daily living performance and how much the attacks affect their quality of life. This study aims to create an Arabic version of the VADL and to assess its validity and reliability and, in addition, to compare the relationship between the measured VADL scores during the attacks and between the attacks and to correlate the VADL scores with the Independency Visual Analog Scores. In this study, we found that the performance of ADLs for patients with BPPV, vestibular migraine, and Meniere’s disease is markedly affected during the attacks of vertigo. Higher scores in VADL indicate that those patients have difficulty and need help in performing activities of daily living. Moreover, higher scores of independence VAS means that patients are less satisfied with their functional daily performance and overall quality of life. Patients reported higher scores during attacks of vertigo, which means they have marked difficulty and inability to independently perform activities of daily living. On the other hand, patients reported lower scores in between the attacks, which means they do much better in the daily activities with more independence level. However, there was positive correlation between their scores during the attacks and in between the attacks which indicates that their performance in between the attacks is affected by the residual vestibular dysfunction or the negative psychological sequel of the attacks; the three episodic vestibular disorders included in the study have been reported to have residual symptoms in between the attacks [14,15,16].

Patients with vestibular migraine got lower scores during and in between the attacks, according to this study; the disease has the least effect on patients’ quality of life. Patients with vestibular migraine perform their activities independently either during or in between the attacks. This could be explained by the variability of the duration and severity of the attacks, or the effect of the small size of the sample or due to the higher frequency of attacks, so patients get habituated [14]. BPPV comes second; it has a more negative impact on daily performance and quality of life than VM. Patients with BPPV usually avoid carrying out their ADLs during the attacks. Also, in between the attacks, BPPV negatively affect patients more than VM. This could be explained by the intense vertigo attacks and their psychological sequel or due to the otolith dysfunction which sometimes accompany BPPV [16].

MD has the most significant negative impact on execution of the ADLs; patients with this disease have the highest scores in the VADL during and in between the attacks compared to the other two disorders. It impairs patient’s quality of life and restricts their independence. Patients with Ménière’s disease are unable to perform their ADLs without assistance during the attacks. Also, in between the attack, patients have difficulty in their daily activities with compromised quality of life [15]; this could be explained by the negative psychological sequel of the severe attacks, the associated vestibular end organ dysfunction, or the associated tinnitus and hearing loss [15].

Using the VAS, the authors assessed the patient’s perception of their ADLs performance. Their scores in independence VAS were highly correlated to their VADL scores during and in-between the attacks. Most of the patients reported poor performance during the vertigo attacks. Variable scores were obtained in between the attacks but significantly less than their scores during the attacks. Few studies have addressed quality of life in people with vestibular disorders by using Vestibular Activity of Daily Living Scale (VADL). The results indicated that people with MD were the most affected compared to patients with BPPV or vestibular migraine. Generally, people with vestibular disorders have difficulties in performing daily activities. Moreover, according to different studies, there was a significant association between vestibular dysfunction and ADLs impairment [18]. A study conducted by Cohen indicated that no differences were found on the total VADL score or any sub scores between male and female patients [18].

When comparing this study with other studies, there were similarities and differences. The results of this study are in agreement with results reported by Cohen; MD was the worst in limiting functional performance [18]. A Brazilian study reported difficulties in understanding some phrases of the Portuguese version of VDAL scale. On the contrary, the Arabic version was well understood and comprehendible to the degree that most of the patients filled out the scale independently [8]. This study is the first one that addressed ADL performance during and in-between the attacks of BPPV, VM, and MD and compared between them. None of the previous studies used independence VAS to rate the patient’s perception of their performance.

Strength and limitation of present study

The strength of this work is that it is the first study that tested the validity and reliability of the Arabic version of VADL scale to assess the impact of vestibular disorders on ADLs performance. Another point of strength is that an independence VAS scale was used. Remarkably high correlation between VADL scale and independence VAS was found. One of the limitations of this study is the small sample size, besides imbalance between the group numbers of the three vestibular disorders. It should also be mentioned that some patients were elderly and illiterate, so they refused to participate in the study; another limitation is that either the VADL scale during the attack or VADL scale in between the attacks was filled from the memory recall, as both filled in the same session.

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