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Original Article

Factors Influencing Adherence to Vestibular Rehabilitation Exercise Program in Patients with Dizziness

Hyun Jung Lee1, Choi-Kwon Smi2
Korean Journal of Adult Nursing 2014;26(4):434-443.
Published online: August 31, 2014

1Dankook University Medical Center, Cheonan

2College of Nursing ․ Research Institute of Nursing Science, Seoul National University, Seoul, Korea

Corresponding author: Choi-Kwon, Smi College of Nursing, Seoul National University, 28 Yeongeon-dong, Jongro-gu, Seoul 110-799, Korea. Tel: +82-2-740-8830, Fax: +82-2-765-4103, E-mail: smi@snu.ac.kr
• Received: May 9, 2014   • Accepted: August 5, 2014

Copyright © 2014 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    This study investigated the level of adherence to vestibular rehabilitation exercise program(VREP) and evaluated how health belief model (HBM) variables are related with adherence to VREP in patients with dizziness.
  • Methods
    The data were collected from 150 individuals, who agreed to participate in the study between December, 2012 and May, 2013. Adherence to VREP, severity of dizziness, health belief variables (health belief scale) and self-efficacy (self-efficacy scale) were measured.
  • Results
    The result of this study showed poor adherence to VREP. The mean adherence score to VREP was 2.11±1.05 (1-5). In multivariate analysis, severity of dizziness (p<.001), taking sedative medication (p<.001), high self-efficacy (p<.001), high perceived seriousness (p=.019) & benefit (p=.036) were independent predicting factors explaining 57.7% of adherence to VREP.
  • Conclusion
    Adherence to VREP was poor among these patients. To improve the patient's adherence to VREP, strategies to increase perceived seriousness, benefit, or self-efficacy and to decrease barriers are urgently needed.
  • Key Words: Dizziness; Adherence; Rehabilitation; Self-efficacy
Table 1.
Reported Post-discharge Participation in a Prescribed VREP (N=150)
Variables Categories n(%)
Frequency in past 4 wks (/day) Never 30 (20.0)
Once 51 (34.0)
Twice 31 (20.7)
≥3 times 38 (25.3)
Duration (/day) None 30 (20.0)
＜15 min 66 (44.0)
15~＜30 min 33 (22.0)
30~＜60 min 14 (9.3)
≥60 min 7 (4.7)
Mode None 30 (20.0)
Vestibular adaptation 88 (58.7)
Balance＋Gait 0 (0.0)
ALL 32 (21.3)

VREP=Vestibular Rehabilitation Exercise Program.

Table 2.
Degree of Adherence of VREP
Variables Vestibular rehabilitation exercise M±SD Range (1~5)
Vestibular adaptation exercise 1. In a sitting position head turning to the right & left (eyes focusing on finger) 2.86±1.31
2. In a sitting position head turning to the up & down (eyes focusing on finger) 2.85±1.32
3. In a sitting position head turn right & left (at each side head up & down with eyes focusing on finger) 2.75±1.35
4. In a sitting position head turning to the right & left (eye closed & imagine eyes focusing on finger) 2.34±1.40
5. In a sitting position head turning to the up & down (eye closed & I imagine eyes focusing on finger) 2.33±1.41
6. In a sitting position head turn right & left (at each side head up & down with eyes closed & imagine eyes focusing on finger 2.24±1.40
M±SD 2.56±1.26
Vestibular adaptation ＋balance & gait exercise 7. Standing, head turning to the right & left (eyes closed & eyes open) 1.74±1.24
8. Walking, head turning to the right & left (eyes focusing on wall) 1.72±1.24
9. Walking, head turning to the up & down (eyes focusing on wall) 1.71±1.25
10. Walking with eyes closed 1.49±1.14
11. Walking on the mattress (perform first with eyes open then eyes closed) 1.21±0.81
M±SD 1.57±1.04
Total M±SD 2.11±1.05

VREP=Vestibular Rehabilitation Exercise Program.

Table 3.
Adherence to VREP according to Patients’ Demographic and Medical Characteristics (N=150)
Characteristics Classification n (%) M±SD t or F (p) Scheffé
Gender Male 59 (39.3) 2.21±1.13 0.96  
Female 91 (60.7) 2.04±1.00 (.337)  
Age (year) ＜40 24 (16.0) 2.33±1.09 2.11  
40~＜50 36 (24.0) 1.94±0.86 (.101)  
50~＜60 38 (25.3) 2.39±1.24  
≥60 52 (34.7) 1.92±0.96  
Marital status Yes 120 (80.0) 2.12±1.07 0.10  
No (divorced, bereaved & single) 30 (20.0) 2.09±0.97 (.919)  
Living with No 22 (14.7) 2.10±1.01 0.20  
Wife/husband 43 (28.7) 2.19±1.14 (.937)  
Children 7 (4.7) 1.81±0.76  
Wife/husband/children 71 (47.3) 2.10±1.06  
Parents 7 (4.7) 2.10±1.00  
Education level (year) No educated 15 (10.1) 1.58±0.73 1.27  
Elementary school 25 (16.8) 2.08±0.79 (.284)  
Middle school 18 (12.1) 2.07±1.20  
High school 56 (37.6) 2.20±1.13  
≥College graduate 35 (23.5) 2.26±1.10  
Employment status Yes 72 (48.0) 2.18±1.13 1.17  
Housewife 34 (22.7) 2.27±1.14 (.323)  
Student 4 (2.7) 2.02±0.96  
No 40 (26.7) 1.86±0.79  
Allowance (10,000 won/monthly) ＜100 30 (20.0) 1.83±0.73 1.43  
100~＜200 23 (15.3) 2.28±1.13 (.235)  
200~＜300 54 (36.0) 2.05±1.03  
≥300 43 (28.7) 2.30±1.20  
Severity of dizziness Onset (VAS: 1~10) 1~4a 25 (16.7) 1.47±6.80 12.12 a, b＜c
5~7b 47 (31.3) 1.88±7.90 (＜.001)
8~10c 78 (52.0) 2.47±1.15
M±SD: 7.28±2.33    
Severity of dizziness after 1 month (VAS: 1~10) 1~4a 119 (63.0) 1.99±0.99 4.15 a, b＜c
5~7b 20 (10.6) 2.01±1.09 (.018)
8~10c 11 (5.8) 2.91±1.10
M±SD: 2.9±2.2    
Duration of dizziness ＜1 week 10 (6.7) 2.87±1.16 1.78
1 week~15 days 12 (8.0) 2.13±1.00 (.135)
＞15 days~1 month 22 (14.7) 1.98±1.11
＞1 month~3 month 23 (15.3) 2.28±0.93
＞3 months 83 (55.3) 2.01±1.04
Frequency of dizziness Temporary 26 (17.3) 2.18±1.03 0.35
Intermittent 98 (65.3) 2.13±1.04 (.702)
Chronic (＞3 month) 26 (17.3) 1.96±1.14
Fear of falling Yes 98 (65.3) 2.18±1.10 1.11
No 52 (34.7) 1.98±0.94 (.268)
Taking sedative medication Noa 20 (13.3) 2.78±1.10 7.78 a, b＞c
Intermittentb 105 (70.0) 1.98±1.14 (＜.001)
Chronicc 25 (16.7) 1.83±0.76

VREP=Vestibular Rehabilitation Exercise Program; VAS=Visual Analog Scale

Table 4.
Correlation of Health Belief, Self-efficacy, and Adherence of VR (N=150)
Variables Susceptibility Seriousness Benefit Barrier Self-efficacy Adherence of VR
r (p) r (p) r (p) r (p) r (p) r (p)
Susceptibility 1          
Seriousness .539 (＜.001) 1        
Benefit -.301 (＜.001) -.301 (＜.001) 1      
Barrier .362 (＜.001) .420 (＜.001) -.698 (＜.001) 1    
Self-efficacy -.110 (.021) -.163 (.031) .666 (＜.001) -.545 (＜.001) 1  
Adherence of VR -.015 (.856) .038 (.643) .582 (＜.001) -.460 (＜.001) .671 (＜.001) 1

VR=vestibular rehabilitation.

Table 5.
The Factors Affecting Adherence to VREP
Variables Model 1 Model 2
B β t p B β t p
(Constant) 1.73   4.86 ＜.001 -.53   -0.83 .411
Taking sedative medication -0.31 -.27 -3.63 ＜.001 -.19 -.16 -2.65 .009
Severity of dizziness 0.16 .35 4.73 ＜.001 .07 .15 2.44 .016
Susceptibility         .18 .09 1.30 .198
Seriousness         .21 .17 2.38 .019
Benefit         .24 .19 2.11 .036
Barrier         -.13 -.11 -1.35 .180
Self-efficacy         .39 .45 5.87 ＜.001
  R2=.226, Adj. R2=.216, F=21.36, p＜.001 R2=.577, Adj. R2=.556, F=27.53, p＜.001

VREP=Vestibular Rehabilitation Exercise Program.

  • Balci B. D., Akdal G., Yaka E., Angin S.. 2013a;Vestibular rehabilitation in acute central vestibulopathy: A randomized controlled trial. Journal of Vestibular Research. 23(4):259–-267. http://dx.doi.org/10.3233/VES-130491.
  • Bandura A.. 1977;Self-efficacy: toward a unifying theory of behavioral change. Psychological Review. 84(2):191–-215. http://dx.doi.org/10.1037/0033-295X.84.2.191.
  • Chung W. H., Lee H. S., Park K. H.. 2006;Medical treatment of ménière's disease. Research in Vestibular Science. 5(1):164–-172.
  • Forkan R., Pumper B., Smyth N., Wirkkala H., Ciol M. A., Shumway-Cook A.. 2006;Exercise adherence following physical therapy intervention in older adults with impaired balance. Physical Therapy. 86(3):401–-410.
  • Giray M., Kirazli Y., Karapolat H., Celebisoy N., Bilgen C., Kirazli T.. 2009;Short-term effects of vestibular rehabilitation in patients with chronic unilateral vestibular dysfunction: A randomized controlled study. Archives Physical Medicine and Rehabilitation. 90(8):1325–-1331. http://dx.doi.org/10.1016/j.apmr.2009.01.032.
  • Godemann F., Siefert K., Hantschke-Bruggemann M., Neu P., Seidl R., Strohle A.. 2005;What accounts for vertigo one year after neuritis vestibularis-anxiety or a dysfunctional vestibular organ? Journal of Psychiatric Research. 39(5):529–-534. http://dx.doi.org/10.1016/j.jpsychires.2004.12.006.
  • Hamid M. A.. 1992;Vestibular Rehabilitation. Advances in Otolaryngol-Head and Neck Surgery. 6:27–-36.
  • Health Insurance Review & Assessment Service. 2013;Cause of dizziness Retrieved April 30, 2013 from the Health Insurance Review & Assessment Service Web site:.http://www.hira.or.kr/dummy.do?pgmid=HIRAA020041000000&cmsurl=/cms/notice/02/1317301_13390.html.
  • Herdman S. J.. 1998;Role of vestibular adaptation in vestibular rehabilitation. Otolaryngology-Head Neck Surgery. 119(1):49–-54.
  • Hillier S. L., McDonnell M.. 2011;Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Clinical Otolaryngology. 36(3):248–-249. http://dx.doi.org/10.1111/j.1749-4486.2011.02309.x.
  • Jo H. S., Kim C. B., Lee H. W., Jeong H. J.. 2004;A Meta-analysis of health related behavior study based on health belief model in Korean. The Korean Journal of Health Psychology. 9(1):69–-84.
  • Kang J. S., Kang H. S., Yun E. K., Choi H. R.. 2012;Factors influencing health behavior compliance of patients with metabolic syndrome. Korean Journal of Adult Nursing. 24(2):191–-199.
  • Kao C. L., Chen L. K., Chern C. M., Hsu L. C., Chen C. C., Hwang S. J.. 2010;Rehabilitation outcome in home-based versus supervised exercise programs for chronically dizzy patients. Archives of Gerontology and Geriatrics. 51(3):264–-267. http://dx.doi.org/10.1016/j.archger.2009.11.014.
  • Kim H. W.. 2007;The relationship between the therapeutic exercise practice, health beliefs and self-efficacy in patients with restricted shoulder range of motion Unpublished master's thesis, Yonsei University, Seoul..
  • Kim S. H.. 1987;A study on range of motion exercise compliance of impaired physical mobility patient Unpublished master's thesis, Ewha Womans University, Seoul..
  • Lee D. J., Rhee C. K., Suh M. W.. 2011;Rehabilitation of vestibular hypofunction. Research in Vestibular Science. 10:32–-37.
  • Michael B., Hannelore N.. 2011;Epidemiological evidence for a link between vertigo and migraine. Journal of Vestibular Research. 21(6):299–-304.
  • Rhee C. K.. 2010;Vestibular rehabilitation. Korean Academy of Audiology. 6:1–-9.
  • Rosenstock I.. 1991. The health belief model: Explaining health behavior through expectancies. In: Glanz K., Lewis F., Rimer B., editors. Health behavior and health education. San Francisco: Jossey-Bass.
  • Sung K. B.. 2002;Understanding of dizziness. Research in Vestibular Science. 1(2):157–-164.
  • Toupet M., Ferrary E., Grayeli A. B.. 2011;Visual analog scale to assess vertigo and dizziness after repositioning maneuvers for benign paroxysmal positional vertigo. Journal of Vestibular Research. 21(4):235–-241. http://dx.doi.org/10.3233/VES-2011-0420.
  • Walsh B., Yardley L., Donovan-Hall M., Smith H.. 2007;Implementation of nurse-delivered vestibular rehabilitation in primary care: A qualitative study of nurses' views on involvement in an innovative service. Journal of Clinical Nursing. 16(6):1072–-1081.
  • Yuen H. K., Wang E., Holthaus K., Vogtle L. K., Sword D., Bre-land H. L., et al. 2013;Self-reported versus objectively assessed exercise adherence. The American Journal of Occu-patinal Therapy. 67(4):484–-489. http://dx.doi.org/10.5014/ajot.2013.007575.

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    Citations to this article as recorded by  
    • Barriers and Facilitators of Vestibular Rehabilitation: Patients and Physiotherapists’ Perspectives
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      Journal of Neurologic Physical Therapy.2024; 48(3): 140.     CrossRef
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      The Journal of Korean Physical Therapy.2017; 29(6): 316.     CrossRef
    • Effectiveness of Self-efficacy Promoting Vestibular Rehabilitation Program for Patients with Vestibular Hypofunction
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      Journal of Korean Academy of Nursing.2016; 46(5): 710.     CrossRef

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    Factors Influencing Adherence to Vestibular Rehabilitation Exercise Program in Patients with Dizziness
    Korean J Adult Nurs. 2014;26(4):434-443.   Published online August 31, 2014
    DOI: https://doi.org/10.7475/kjan.2014.26.4.434
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    Factors Influencing Adherence to Vestibular Rehabilitation Exercise Program in Patients with Dizziness
    Korean J Adult Nurs. 2014;26(4):434-443.   Published online August 31, 2014
    DOI: https://doi.org/10.7475/kjan.2014.26.4.434
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    Factors Influencing Adherence to Vestibular Rehabilitation Exercise Program in Patients with Dizziness
    Factors Influencing Adherence to Vestibular Rehabilitation Exercise Program in Patients with Dizziness

    Reported Post-discharge Participation in a Prescribed VREP (N=150)

    Variables Categories n(%)
    Frequency in past 4 wks (/day) Never 30 (20.0)
    Once 51 (34.0)
    Twice 31 (20.7)
    ≥3 times 38 (25.3)
    Duration (/day) None 30 (20.0)
    ＜15 min 66 (44.0)
    15~＜30 min 33 (22.0)
    30~＜60 min 14 (9.3)
    ≥60 min 7 (4.7)
    Mode None 30 (20.0)
    Vestibular adaptation 88 (58.7)
    Balance＋Gait 0 (0.0)
    ALL 32 (21.3)

    VREP=Vestibular Rehabilitation Exercise Program.

    Degree of Adherence of VREP

    Variables Vestibular rehabilitation exercise M±SD Range (1~5)
    Vestibular adaptation exercise 1. In a sitting position head turning to the right & left (eyes focusing on finger) 2.86±1.31
    2. In a sitting position head turning to the up & down (eyes focusing on finger) 2.85±1.32
    3. In a sitting position head turn right & left (at each side head up & down with eyes focusing on finger) 2.75±1.35
    4. In a sitting position head turning to the right & left (eye closed & imagine eyes focusing on finger) 2.34±1.40
    5. In a sitting position head turning to the up & down (eye closed & I imagine eyes focusing on finger) 2.33±1.41
    6. In a sitting position head turn right & left (at each side head up & down with eyes closed & imagine eyes focusing on finger 2.24±1.40
    M±SD 2.56±1.26
    Vestibular adaptation ＋balance & gait exercise 7. Standing, head turning to the right & left (eyes closed & eyes open) 1.74±1.24
    8. Walking, head turning to the right & left (eyes focusing on wall) 1.72±1.24
    9. Walking, head turning to the up & down (eyes focusing on wall) 1.71±1.25
    10. Walking with eyes closed 1.49±1.14
    11. Walking on the mattress (perform first with eyes open then eyes closed) 1.21±0.81
    M±SD 1.57±1.04
    Total M±SD 2.11±1.05

    VREP=Vestibular Rehabilitation Exercise Program.

    Adherence to VREP according to Patients’ Demographic and Medical Characteristics (N=150)

    Characteristics Classification n (%) M±SD t or F (p) Scheffé
    Gender Male 59 (39.3) 2.21±1.13 0.96  
    Female 91 (60.7) 2.04±1.00 (.337)  
    Age (year) ＜40 24 (16.0) 2.33±1.09 2.11  
    40~＜50 36 (24.0) 1.94±0.86 (.101)  
    50~＜60 38 (25.3) 2.39±1.24  
    ≥60 52 (34.7) 1.92±0.96  
    Marital status Yes 120 (80.0) 2.12±1.07 0.10  
    No (divorced, bereaved & single) 30 (20.0) 2.09±0.97 (.919)  
    Living with No 22 (14.7) 2.10±1.01 0.20  
    Wife/husband 43 (28.7) 2.19±1.14 (.937)  
    Children 7 (4.7) 1.81±0.76  
    Wife/husband/children 71 (47.3) 2.10±1.06  
    Parents 7 (4.7) 2.10±1.00  
    Education level (year) No educated 15 (10.1) 1.58±0.73 1.27  
    Elementary school 25 (16.8) 2.08±0.79 (.284)  
    Middle school 18 (12.1) 2.07±1.20  
    High school 56 (37.6) 2.20±1.13  
    ≥College graduate 35 (23.5) 2.26±1.10  
    Employment status Yes 72 (48.0) 2.18±1.13 1.17  
    Housewife 34 (22.7) 2.27±1.14 (.323)  
    Student 4 (2.7) 2.02±0.96  
    No 40 (26.7) 1.86±0.79  
    Allowance (10,000 won/monthly) ＜100 30 (20.0) 1.83±0.73 1.43  
    100~＜200 23 (15.3) 2.28±1.13 (.235)  
    200~＜300 54 (36.0) 2.05±1.03  
    ≥300 43 (28.7) 2.30±1.20  
    Severity of dizziness Onset (VAS: 1~10) 1~4a 25 (16.7) 1.47±6.80 12.12 a, b＜c
    5~7b 47 (31.3) 1.88±7.90 (＜.001)
    8~10c 78 (52.0) 2.47±1.15
    M±SD: 7.28±2.33    
    Severity of dizziness after 1 month (VAS: 1~10) 1~4a 119 (63.0) 1.99±0.99 4.15 a, b＜c
    5~7b 20 (10.6) 2.01±1.09 (.018)
    8~10c 11 (5.8) 2.91±1.10
    M±SD: 2.9±2.2    
    Duration of dizziness ＜1 week 10 (6.7) 2.87±1.16 1.78
    1 week~15 days 12 (8.0) 2.13±1.00 (.135)
    ＞15 days~1 month 22 (14.7) 1.98±1.11
    ＞1 month~3 month 23 (15.3) 2.28±0.93
    ＞3 months 83 (55.3) 2.01±1.04
    Frequency of dizziness Temporary 26 (17.3) 2.18±1.03 0.35
    Intermittent 98 (65.3) 2.13±1.04 (.702)
    Chronic (＞3 month) 26 (17.3) 1.96±1.14
    Fear of falling Yes 98 (65.3) 2.18±1.10 1.11
    No 52 (34.7) 1.98±0.94 (.268)
    Taking sedative medication Noa 20 (13.3) 2.78±1.10 7.78 a, b＞c
    Intermittentb 105 (70.0) 1.98±1.14 (＜.001)
    Chronicc 25 (16.7) 1.83±0.76

    VREP=Vestibular Rehabilitation Exercise Program; VAS=Visual Analog Scale

    Correlation of Health Belief, Self-efficacy, and Adherence of VR (N=150)

    Variables Susceptibility Seriousness Benefit Barrier Self-efficacy Adherence of VR
    r (p) r (p) r (p) r (p) r (p) r (p)
    Susceptibility 1          
    Seriousness .539 (＜.001) 1        
    Benefit -.301 (＜.001) -.301 (＜.001) 1      
    Barrier .362 (＜.001) .420 (＜.001) -.698 (＜.001) 1    
    Self-efficacy -.110 (.021) -.163 (.031) .666 (＜.001) -.545 (＜.001) 1  
    Adherence of VR -.015 (.856) .038 (.643) .582 (＜.001) -.460 (＜.001) .671 (＜.001) 1

    VR=vestibular rehabilitation.

    The Factors Affecting Adherence to VREP

    Variables Model 1 Model 2
    B β t p B β t p
    (Constant) 1.73   4.86 ＜.001 -.53   -0.83 .411
    Taking sedative medication -0.31 -.27 -3.63 ＜.001 -.19 -.16 -2.65 .009
    Severity of dizziness 0.16 .35 4.73 ＜.001 .07 .15 2.44 .016
    Susceptibility         .18 .09 1.30 .198
    Seriousness         .21 .17 2.38 .019
    Benefit         .24 .19 2.11 .036
    Barrier         -.13 -.11 -1.35 .180
    Self-efficacy         .39 .45 5.87 ＜.001
      R2=.226, Adj. R2=.216, F=21.36, p＜.001 R2=.577, Adj. R2=.556, F=27.53, p＜.001

    VREP=Vestibular Rehabilitation Exercise Program.
    Table 1. Reported Post-discharge Participation in a Prescribed VREP (N=150)

    VREP=Vestibular Rehabilitation Exercise Program.

    Table 2. Degree of Adherence of VREP

    VREP=Vestibular Rehabilitation Exercise Program.

    Table 3. Adherence to VREP according to Patients’ Demographic and Medical Characteristics (N=150)

    VREP=Vestibular Rehabilitation Exercise Program; VAS=Visual Analog Scale

    Table 4. Correlation of Health Belief, Self-efficacy, and Adherence of VR (N=150)

    VR=vestibular rehabilitation.

    Table 5. The Factors Affecting Adherence to VREP

    VREP=Vestibular Rehabilitation Exercise Program.

    Table 1.

    Table 2.

    Table 3.

    Table 4.

    Table 5.

    Korean J Adult Nurs : Korean Journal of Adult Nursing

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