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Biomedical subjects

L Yardley

Publications and source records attributed to L Yardley.

At least 37 records · Page 2Linked to original sources
PubMed1999

Attitudes of medical and nonmedical students toward orthodox and complementary therapies: is scientific evidence taken into account?

Medical and nonmedical students completed a questionnaire indicating how willing they would be to try various therapies for treatment. Both groups assessed more traditional complementary practices such as homeopathy and acupuncture as similar to more orthodox treatments such as physiotherapy or prescribed diets. Both groups appeared not to differentiate between established techniques (physiotherapy) and less tested techniques (yoga). Furthermore, neither group seemed particularly concerned about the scientific evaluations of treatments.

Attitude of Health Personnel↗
PubMed1999

Outcome of symptoms of dizziness in a general practice community sample.

BACKGROUND: Dizziness is commonly experienced in the community, but little is known about the long-term progression of the condition. OBJECTIVE: We aimed to assess over 18 months the outcome of symptoms of dizziness in a sample of patients identified from London general practices. METHOD: We followed up at 18 months a cohort of patients who reported symptoms of dizziness with or without anxiety, panic reactions or avoidance of situations that provoked the symptoms. The subjects completed a structured questionnaire both at baseline and at 18 months. RESULTS: At 18 months, 24% (95% CI = 23.5-34.8%) were more handicapped and 20% (95% CI = 15.2-25.2%) had recurrent dizziness, while 20% (95% CI = 14.9-24.8%) had improved. Patients with significant dizziness were more likely to consult their GP (OR = 14.4, 95% CI = 7.0-29.1) and were more likely to receive treatment (OR = 7.8, 95% CI = 3.2-22.4) or be referred to hospital (OR = 8.4, 95% CI = 3.2-22.4). The independent predictors of handicapping dizziness at 18 months were a history of fainting (OR = 2.4, 95% CI = 1.2-4.7), vertigo (OR = 2.6, 95% CI = 1.3-5.0) and avoidance of a situation that provoke dizziness (OR = 4.8, 95% CI = 2.5-9.0). CONCLUSION: Four per cent of all patients registered with a GP suffer persistent symptoms of dizziness and at least 3% are severely incapacitated by their symptoms. The presence of vertigo, fainting and avoidance in a person with dizziness is predictive of chronic handicapping dizziness. Further research is required on the progressions of symptoms of dizziness in a sample of GP attenders and those in the community.

Adolescent↗
PubMed1998

Relationship between postural control and motion sickness in healthy subjects.

This study examined the relationship between reported susceptibility to motion sickness, anxious personality and postural control. Postural stability was assessed in 34 healthy subjects standing with eyes open, eyes closed and viewing a disorienting virtual reality display. These measures were repeated with vibration of the calf muscles to distort the somatosensory feedback from the legs. Susceptibility to motion sickness and anxious personality were evaluated by questionnaire. Greater postural instability was correlated with susceptibility to motion sickness. Motion sickness susceptibility correlated most strongly with increased sway when the visual and somatosensory feedback was absent or distorted. Anxiety was correlated with reported susceptibility to motion sickness but not with postural stability. These findings suggest that deficient perceptual-motor responses to disorienting conditions may contribute to motion sickness susceptibility.

Adult↗
PubMed1998

Changes in heart rate and respiration rate in patients with vestibular dysfunction following head movements which provoke dizziness.

Patients with vestibular dysfunction often complain of additional symptoms typical of panic disorder and/or hyperventilation. This study investigated whether autonomic and respiratory symptoms reported by patients with vestibular disorders were associated with objective changes in heart and respiration rate following head movements provoking dizziness. Subjective ratings of symptoms and anxiety and objective measures of heart and respiration rate were obtained from 29 patients and 16 healthy controls immediately before and after the subjects performed three standardised sets of vigorous head movements. Within-group analyses revealed greater increases in respiration rate following head movement among patients who complained of more somatic symptoms, both during the previous 2 months and following head movement.

Adult↗
PubMed1998

Feasibility and effectiveness of providing vestibular rehabilitation for dizzy patients in the community.

Since the majority of people with dizziness in the community are never referred for specialist testing and treatment, the purpose of this study was to investigate whether it was desirable and feasible to provide vestibular rehabilitation for this patient population. Demand for therapy was assessed by a survey of 9198 working age people randomly sampled from six general practices. One in 10 respondents reported current, handicapping dizziness, but fewer than 2% of those with dizziness severe enough to merit treatment proved suitable and willing to attend hospital for testing and rehabilitation. Nevertheless, vestibular rehabilitation was clearly beneficial for the 16 patients who completed the therapy programme, as their scores on measures of symptoms, disability, handicap and postural stability improved significantly post-therapy to near-normal levels. We conclude that there is a need for provision of vestibular rehabilitation in primary care for patients with dizziness in the community.

Adolescent↗
PubMed1998

Neuro-otological and psychiatric abnormalities in a community sample of people with dizziness: a blind, controlled investigation.

OBJECTIVES: To determine neurootological and psychiatric abnormalities associated with complaints of dizziness in an epidemiological community sample of people of working age, and the extent of comorbidity between neuro-otological and psychiatric dysfunction. METHOD: A survey of 3884 people randomly selected from six general practice lists identified 262 people with significant dizziness, from which a subsample of 15 men and 22 women were recruited for testing. Dizzy subjects were evaluated by blind neuro-otological testing, computerised dynamic posturography, a computerised psychiatric assessment, neuro-otological and general medical examination, and diagnosis. An age matched control group of 18 men and 22 women underwent the same evaluation. RESULTS: Tests of auditory, vestibular, and oculo-motor function did not discriminate between dizzy subjects and controls, but dizzy subjects had significantly worse balance on posturographic testing, more diagnoses of medical disorder, and a higher prevalence of psychiatric morbidity. CONCLUSIONS: The findings suggest that dizziness in the community is typically characterised by mild physical disorder accompanied by some psychiatric disturbance. As the combination of minor physical and psychiatric disorder is known to be unusually persistent and handicapping, treatment programmes must be provided for this prevalent syndrome, perhaps by a partnership between primary care and neuro-otological and psychiatric hospital outpatient clinics with experience and expertise in the diagnosis and management of dizziness and psychiatric disturbance.

Adolescent↗
PubMed1998

Prevalence and presentation of dizziness in a general practice community sample of working age people.

BACKGROUND: Dizziness is known to be a common, handicapping condition in the elderly, and a strong association between dizziness and anxiety disorders has been observed in hospital samples. However, little is known about the prevalence of dizziness among people of working age in the community and its implications for psychosocial functioning and general practice consultation and treatment. AIM: To determine the prevalence of dizziness, giddiness, vertigo, and unsteadiness, and associations with disability and handicap, symptoms of panic and agoraphobia, and general practice consultation and treatment. METHOD: Postal questionnaires were completed by 2064 people aged 18-64 years randomly sampled from the patient lists of four London practices. Validated survey items were used to assess symptoms, panic and agoraphobia, levels of occupational disability and handicap, and general practice consultation and treatment. RESULTS: More than one in five responders (n = 480) had experienced dizziness during the past month; nearly half of these (n = 225) reported some degree of handicap and 30% had been dizzy for more than five years. Almost half (n = 221) of those with dizziness also reported anxiety and/or avoidance behaviour. Multiple physical and psychological symptoms were associated with higher levels of handicap. Only one in four of the 225 dizzy responders reporting some degree of handicap had received any form of treatment. CONCLUSION: Dizziness is a common, chronic, and often untreated symptom in people aged 18-65 years, associated with extensive handicap and psychological morbidity.

Adult↗
PubMed1998

A randomized controlled trial of exercise therapy for dizziness and vertigo in primary care.

BACKGROUND: 'Vestibular rehabilitation' (VR) is an increasingly popular treatment option for patients with persistent dizziness. Previous clinical trials have only evaluated the effects of specialist therapy programmes in small, selective, or uncontrolled patient samples. AIM: To determine the benefits of VR compared with standard medical care, using a brief intervention for dizzy patients in primary care. METHOD: Adults consulting their general practitioner (GP) with dizziness or vertigo were randomly assigned to treatment or control groups. Patients in both groups received the same evaluation at baseline, six-week follow-up, and six-month follow-up, comprising examination of nystagmus, postural control, and movement-provoked dizziness, and a questionnaire assessment of subjective status, symptoms, handicap, anxiety, and depression. At baseline and six weeks later, the treatment group also received an individualized 30-minute therapy session, in which they were taught head, eye, and body exercises designed to promote vestibular compensation and enhance skill and confidence in balance. RESULTS: The treatment group (n = 67) improved on all measures, whereas the control group (n = 76) showed no improvement, resulting in a significant difference between the two groups on physical indices of balance and subjective indices of symptoms and distress. Odds ratios for improvement in treated patients relative to untreated patients were 3.1:1 at six weeks (95% CI = 1.4-6.8) and 3.8:1 at six months (95% CI = 1.6-8.7). CONCLUSION: VR is a simple, inexpensive, and beneficial treatment, and may be an appropriate first stage of management for many dizzy patients in primary care.

Adult↗
PubMed1998

A dual-task study of interference between mental activity and control of balance.

OBJECTIVE: This study aimed to examine interference between mental activity and control of balance. STUDY DESIGN: In a mixed design, dual-task study, the performance of patients and healthy control subjects was compared on computerized dynamic posturography, on a visuospatial mental task, and when performing the mental task while balancing. SETTING: The study was performed at a tertiary referral outpatient neuro-otology clinic. PATIENTS AND SUBJECTS: The patient group comprised 24 patients seen consecutively at the clinic because of vertigo and dizziness. The control group consisted of 24 subjects with no complaint or medical history of dizziness or balance disorder, matched with the patients for age and gender. MAIN OUTCOME MEASURES: Performance on a visuospatial mental task and on the computerized dynamic posturography test (conditions 4 and 5) was measured. RESULTS: Balancing on the posturography test resulted in a deterioration in performance on the mental task for both patients and control subjects. The effect was more marked when subjects had their eyes closed. Results on the balance test showed that normal subjects and patients with normal balance also swayed more when performing the mental task, whereas patients who had failed the posturography test swayed less when performing the mental task. CONCLUSIONS: These results show that mental performance deteriorates when performing a demanding balance task. In addition, in both normal subjects and patients, balance also may be affected by mental activity in complex and varied ways that merit further investigation.

Adult↗
PubMed1997

Stress and symptoms of Menière's disease: a time-series analysis.

Meniere's disease is an inner ear disease in which the symptom cluster of hearing loss, tinnitus, and dizziness is found along with attacks of vertigo and nausea. In this study, 20 subjects diagnosed with Meniere's disease completed daily measures of stress and symptoms during periods ranging between 45 and 351 days (M = 193.5). Data were analyzed by means of time-series analysis (ARIMA), and the temporal associations were investigated by lagged correlations. The results showed concurrent (same day) associations between stress and symptoms, but individual differences were found regarding which symptoms were associated with stress. Although stress is linked with symptom perception, this study does not support the role of stress as a precursor of symptoms in Meniere's disease.

Adult↗
PubMed1996

Visually and posturally mediated tilt illusion in Parkinson's disease and in labyrinthine defective subjects.

We tested 24 normal subjects, 24 patients with idiopathic Parkinson's disease (PD), and eight patients with bilateral absence of vestibular function (labyrinthine defective [LD] subjects) in their ability to set a straight line to the perceived gravitational vertical (visual vertical). Measurements were taken in static conditions, sitting upright, and lying down on the right side, and during visual background motion at constant angular velocities around the line of sight (roll-motion) in both sitting upright and sideways position. Aims of the study were to determine if the reported increased "visual dependence" in PD was present in a psychophysical task that is independent of motor performance, and to examine the interaction between visual motion and proprioceptive cues in the perception of verticality, in the absence of vestibular function. LD patients showed abnormally large deviations of the visual vertical induced both by lateral body tilt and by visual roll-motion. This suggests that vestibular cues play a significant part in counterbalancing visually and proprioceptive mediated biases on the perception of verticality. In contrast, PD patients were normal in all these tasks indicating that visual dependence in PD is not present at an afferent/perceptual level.

Adult↗
PubMed1995

Relationship between balance system function and agoraphobic avoidance.

There is a striking similarity between the situations avoided by people with agoraphobia and the environments which provoke disorientation in people with organic balance disorders. This study investigated the possibility that agoraphobia might be linked to balance system dysfunction by comparing the results of balance system tests in 36 people with symptoms of panic and agoraphobia and 20 normal controls. A traditional battery of audiovestibular tests was supplemented with moving platform posturography, which assesses the postural instability induced by disorienting perceptual conditions. Subjects also completed questionnaire measures of somatic symptoms of dizziness and anxiety, agoraphobic cognitions, avoidance behaviour and state anxiety. Over 60% of the Ss with symptoms of panic and agoraphobia were destabilised by the disorienting perceptual conditions, compared with just 10% of the normal controls. Postural instability was strongly related to reported agoraphobic avoidance (r = 0.63, P < 0.01), even after controlling for symptoms, anxiety and agoraphobic cognitions. In our discussion we consider alternative interpretations of these findings, future directions for research, and implications for therapy.

Adult↗
PubMed1995

Effects of anxiety arousal and mental stress on the vestibulo-ocular reflex.

Although the subjective reports of patients suggest that anxiety may aggravate vertigo and imbalance, there has been little research into how anxiety might directly affect balance system functioning. We conducted two studies to examine the effect of anxiety and arousal on the vestibulo-ocular reflex (VOR). In the first study, pre-lest fear ratings were obtained from 20 normal subjects and 36 anxious subjects immediately prior to rotation and caloric testing. Fear ratings were significantly correlated with the maximum slow-phase velocity (SPV) of nystagmus induced by caloric testing. In the second study, we assessed the VOR response to rotation of 36 normal subjects under 3 task conditions: a) minimal alerting (counting backwards during rotation), b) physical arousal (induced by exertion prior to rotation); c) mental arousal (induced by performance of stressful mental tasks during rotation). Both the physical and mental tasks induced a significant increase in heart rate compared with the alerting condition. The maximum SPV of the nystagmus induced by rotation was significantly greater during performance of the mental task than in the other two conditions. These combined results indicate that anxiety may influence the gain of the VOR.

Adolescent↗
PubMed1994

Prediction of handicap and emotional distress in patients with recurrent vertigo: symptoms, coping strategies, control beliefs and reciprocal causation.

Factors predicting handicap and distress were examined in a longitudinal study of 101 patients suffering from recurrent vertigo (dizziness). Analysis of a questionnaire assessing coping strategies yielded four distinct individualised coping styles: problem-focused information-seeking; distraction; denial; and relinquishing responsibility. After controlling for the severity of physical and psychological symptoms and distress, handicap was negatively related to internal locus of control and positively correlated with relinquishing responsibility. Symptoms of somatic anxiety predicted an increase in handicap over a 7 month period, while handicap and somatic anxiety symptoms predicted an increase in distress. These results are interpreted in terms of a reciprocal causal relationship between handicap and distress, mediated partly by somatic symptoms. Parallels with pain, panic and phobia suggest that patients with vertigo might benefit from psychological therapies.

Adaptation, Psychological↗
PubMed1994

A longitudinal study of symptoms, anxiety and subjective well-being in patients with vertigo.

In a prospective longitudinal study of the relationship between symptoms and anxiety in people with vertigo, 101 patients were evaluated on two occasions separated by a 7 month interval. At Time 1 the age, gender, vertigo type, duration of illness, medication, and audiovestibular test results of patients were recorded, and they completed questionnaires assessing handicap, emotional distress, predisposition to anxiety, and symptoms indicative of vertigo and of somatic anxiety. These questionnaires were re-administered at Time 2, and patients also indicated whether their vertigo was more or less severe than at Time 1. Although vertiginous symptoms at Time 2 were generally mild and intermittent, they were associated with significant handicap. Reported symptoms of somatic anxiety and arousal at Time 1 proved to be the only longitudinal predictors of perceived change in vertigo severity over the 7 month period.

Anxiety↗