Association of Multidomain Assessment Outcomes with Referral for Vestibular Therapy following Concussion

Abstract

Context: Multiple aspects of a multidomain assessment have been validated for identifying concussion, however, researchers have yet to determine which components are related to referral for vestibular therapy. Objective: To identify which variables from a multidomain assessment were associated with receiving a referral for vestibular therapy following a concussion. Design: Retrospective chart review, level of evidence 3. Patients or other Participants: Participants (n=331; age: 16.9±7.2; 39.3% female) were diagnosed with a concussion per international consensus criteria by a clinical neuropsychologist after presenting to a concussion specialty clinic. Main Outcome Measures: Medical chart data was extracted from the first clinical visit regarding pre-injury medical history, computerized neurocognition, Post-Concussion Symptom Scale (PCSS), Concussion Clinical Profiles Screen (CP-Screen) and Vestibular Ocular Motor Screening (VOMS) within 16.2±46.7 days of injury. Five backwards logistic regression models were built to associate the outcomes from each of the five included assessments with referral for vestibular therapy. A final logistic regression model was built using variables retained in the previous five models as potential predictors of referral for vestibular therapy. Results: The five models built from individual components of the multidomain assessment predicted referral for vestibular therapy (R2= 0.01–0.28) with 1 to 6 statistically significant variables. The final multivariate model (R2= 0.40) retained 9 significant variables, represented by each of the five multidomain assessments except neurocognition. Variables with the strongest association to vestibular therapy referral were motor vehicle accident mechanism of injury (odds ratio [OR]=15.45), migraine history (OR=3.25), increased headache when concentrating (OR=1.81) and horizontal vestibular ocular reflex (OR=1.63). Conclusions: The present study demonstrates the utility of a multidomain assessment, and identifies outcomes associated with a referral for vestibular therapy following a concussion.