PP1415 - Stigma Predicts Participation and Autonomy in Chronic Vestibulopathy: A WHO ICF Model Approach

Abstract:
Chronic vestibulopathy has known effects on physical, emotional, and cognitive well-being. This study uses the WHO International Classification of Functioning, Disability and Health (ICF) model as a framework to investigate the impact of symptom severity, balance confidence, and stigma on participation and autonomy in those with chronic vestibulopathy. Results, based on questionnaire data and multiple regression analysis, demonstrate that only stigma is a significant predictor. Findings highlight the importance of addressing stigma to improve quality of life for individuals with chronic vestibulopathy. Future directions include a qualitative component to validate findings between those with high and low stigma.

Summary:
Chronic vestibulopathy is known to affect physical, emotional, and cognitive well-being. The discreditable, or “invisible,” nature of vestibular symptoms can exacerbate challenges faced by those living with this condition. Research has explored the impact of various factors on chronic vestibulopathy, however there remains a gap in understanding factors influence participation and autonomy within the World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) framework. This study aims to assess the impact of symptom severity, balance confidence, and stigma on levels of participation and autonomy. By investigating these factors, interventions can be tailored to support those living with this condition and improve quality of life.

A cross-sectional survey of an online vestibular support group was conducted using questionnaires targeting symptom severity measured by the Vertigo Symptom Scale (VSS-sf), balance confidence measured by the Activities-Specific Balance Confidence Scale (ABC), and stigma measured by the Stigma Scale for Chronic Illness (SSCI-8). The outcome, participation and autonomy, was measured by the Participation and Autonomy Questionnaire (IPA). Demographic information including age, gender, and duration of the disorder was also collected. The WHO ICF framework is applied to organize variables into domains of body function, activities, participation, and environmental and personal factors. To examine that participation and autonomy can be predicted by these measures, multiple linear regression analysis is used.

56 adults responded with self-reported chronic vestibulopathy. Participants were predominantly female (70.9 %), followed by male (27.3%), and non-binary (1.8%). Ages were largely 65 or older (48.1%), followed by 55 to 64 years of age (25.9%), 45 to 54 (11.1%), 35 to 44 (9.3%), and 25 to 34 (5.6%). Illness duration revealed primarily 5 or more years (64.3%), followed by 1 to 2 years (21. 4%), 3 to 5 years (10.7%), 7 to 12 months (1.8%) and 4 to 6 months (1.8%). Demographic information was optional.

The results of the multiple linear regression to predict participation and autonomy was significant, F(3, 52) = 21.816, p < 0.001, suggesting that 53.2% of the variation is predicted by the factors. Individual predictors were examined further and indicated that stigma, t(52) = 4.592, p < 0.001, was a significant predictor, but balance confidence t(52) = -1.904, p = 0.062, and symptom severity, t(52) = 0.188, p = 0.851) were not. Stigma, β = 0.575, 95% CI (1.197, 3.056) predicted stigma. VIF scores were below 3 for all predictors, indicating no multicollinearity concerns. Residual plots showed random dispersion, affirming model assumptions. While the model fits well, it is crucial to note that it does not prove causation, and external factors not included may also affect participation and autonomy. Additionally, findings may be limited by the demographics of the sample. Future studies should consider a more diverse population.

Findings underscore the importance of addressing stigma in chronic vestibulopathy as it predicts lower participation and autonomy. Stigma impacts health behavior and is a critical area for clinical attention. Future directions include incorporating a qualitative component to explore experiences of stigma more deeply and validate the quantitative findings.