Peripheral vestibular disorders (PVDs) involve the vestibular system, particularly the inner ear or vestibular nerve, leading to either acute or persistent vestibular syndromes. ^[1–3] Key symptoms include vertigo, postural instability, and difficulties with balance during head movements. Common forms of PVDs are benign paroxysmal positional vertigo (BBPV), Meniere’s disease, and vestibular neuritis.^[2]PVDs are responsible for 44% of dizziness cases, with approximately one-third of acute dizziness episodes linked to peripheral vestibular causes.^{[4, 5]} Poor compensation for dizziness can exacerbate or prolong symptoms.^[4]

Kinesiophobia, the fear of movement due to past trauma, results in both physical and psychological symptoms. This fear leads to restricted movement, reduced physical activity, and a decline in quality of life. It causes excessive concern over movement, anxiety about engaging in physical activities, and further deterioration of strength and fitness due to inactivity.^{[6, 7]} In elderly patients with BBPV, fear of falling is a key factor that reduces self-confidence, impairs function, and leads to avoidance of daily activities.^[8]

Balance issues are a critical concern in PVDs, as the vestibular system plays a vital role in maintaining balance and spatial orientation. When disrupted, it causes vertigo and imbalance, increasing the risk of falls.^[9] Individuals afflicted with vestibular hypofunction often report that their symptoms intensify in circumstances such as darkness or uneven surfaces, where other sensory faculties are unable to provide adequate compensation. However, falls typically occur during daily activities, such as walking or turning. ^[10] Contributing factors to falls in these patients include a sedentary lifestyle, aging, and cognitive impairments.^[10]

PVDs significantly impact patients’ quality of life, with symptoms like dizziness and balance disturbances leading to difficulties in daily functioning.^[1] The physical strain of maintaining balance, coupled with ongoing dizziness, often results in fatigue and physical decline and may contribute to psychological conditions like anxiety or depression.^[11–13] As a result, these factors collectively contribute to a reduced quality of life and increased disability among those affected by PVDs.^[12]

Studies that investigated kinesiophobia in PVDs are limited. To our knowledge, there is no study investigating the association between kinesiophobia, balance, and quality of life in PVD. Therefore, the aim of the present study was to assess the relationship between kinesiophobia, quality of life, and balance in patients in the acute and subacute phases of PVDs.

The characteristics of the samples are presented in Table 1. A total of 65.70% of the participants demonstrated proficiency in self-service. Thirty-seven point one percent of the subjects reported no difficulty in daily activities, while forty-two point nine percent reported moderate problems in mobility. The survey revealed that 51.40% of the participants reported experiencing moderate anxiety or depression, while 51.40% reported no discomfort or pain.

Table 2 shows the mean, standard deviation, minimum and maximum values of the EQ-5D-5L questionnaire, the EQ-VAS scale and the TSK-GR scale. The mean score of the quality of life was 0.69, while the mean score of the EQ-VAS of the EQ-5D-5L questionnaire was 73.31 with a maximum possible score of 100. The mean score of kinesiophobia was 38.49 (SD=9.10) indicating the relative existence of kinesiophobia of the sample (Table 2).

Table 3 showed a positive statistically significant correlation between the quality of life from the European Quality of Life Questionnaire and the Visual Analogue Scale of the questionnaire (r=0.51, p<0.01). No significant correlations were found between kinesiophobia, quality of life, and static balance in patients with PVDs.

Table 4 presents the p-values of Spearman’s rho correlations between kinesiophobia (TSK-GR), quality of life (EQ-5D-5L), health status (EQ-VAS), and balance (Romberg test). Significant correlation was observed between EQ-5D-5L and EQ-VAS (p=0.002).

The aim of the study was to investigate the relationship between kinesiophobia, quality of life, and balance in patients that have been diagnosed with a PVD, were in the subacute stage of the disease, and had symptoms of vertigo.

The results showed a significant correlation between the EQ-5D-5L and the EQ-5D VAS. The results of patients’ responses to mobility, self-care, usual activities, pain or discomfort, and anxiety or depression were significantly correlated with their responses to the subjective assessment of their health status based on the EQ-5D VAS. Similarly, Golicki et al.^[17] found correlations between the EQ-5D-5L and the EQ-5D VAS in stroke patients. The mean changes in the 3L version of the EQ-5D-5L were greater than the mean changes in the 5L version, and the latter was greater than the mean changes in the 5Q-5D VAS. Correlations showed that changes in the 5L version of the EQ-5D-5L had a statistically significant correlation with changes in the 3L version and showed a moderate correlation with changes in the EQ-5D VAS.

In this study, no significant correlations were found between kinesiophobia, quality of life, and static balance in patients with PVDs, likely due to multiple factors related to disease, patient demographics, or external influences. Vestibular function is complex and multifactorial, significantly impacting quality of life. Although balance assessment via the Romberg test indicated adequate ability typical in unilateral vestibular dysfunction, chronic conditions like persistent postural perceptual dizziness may distort patients’ perception of static balance due to maladaptive plasticity. ^{[18, 19]} Furthermore, different types of vestibular pathology affect these factors differently, with bilateral cases posing a higher fall risk than unilateral ones.^[20]

The study’s results may vary depending on the stage of the disorder, as patient adaptation and vestibular compensation progress. Clinicians often focus on measurable parameters, which may explain the previously underrecognized cognitive deficits in patients with peripheral vestibular disorders.^[21] This justified the inclusion of kinesiophobia as an outcome measure. Some variables like kinesiophobia, quality of life, and balance might not be directly influenced by the disorder but rather by chronic conditions.^{[22, 23]} For example, balance issues are common in older adults and considered a geriatric syndrome with multifactorial causes, increasing vulnerability to daily life challenges.^[24] This complexity and symptom adaptation may explain the lack of significant correlations among the study variables.

Antihistamines, antiemetics, and antivertigo drugs suppress vestibular activity and relieve symptoms for 4-12 hours in PVD patients.^{[25, 26]} After a vestibular lesion, imbalance between the affected and unaffected ear is managed by suppressing both sides, which may also reduce the overall vestibular function. However, vertigo acts as essential sensory feedback for brain compensation, so symptom suppression can hinder recovery. Thus, reducing dizziness and promoting compensation are often conflicting goals. ^[25] Despite this, static balance seemed unaffected in participants, suggesting that testing on unstable surfaces or with dynamic gait assessments may be more informative. ^[27] Additionally, polypharmacy may disrupt balance and worsen symptoms, potentially influencing kinesiophobia outcomes.^[24] This may have affected the results of the assessment of kinesiophobia.

In the present study, 60% of the respondents were females. Petri et al.^[11] observed female mastery at 72%. This is attributed to a variety of causes, such as menopause, osteoporosis, cardiovascular problems, and hormonal changes that can cause vertigo. Obermann et al.^[28] claimed that selection bias of older women may affect the study outcomes. Future studies should be conducted with more homogenous samples regarding the sex of the participants. Furthermore, both Lucieer et al.^[21] and the present study were unable to determine whether the severity of symptoms was related to the advanced age of the participants.

A large proportion of the sample in the present study had received canalith repositioning maneuvers (CRM) before their assessment, which could have influenced the results. Patients with paroxysmal positional vertigo may benefit from these maneuvers. A significant improvement in symptoms is observed after CRM, demonstrating the beneficial effects of the treatment even in people without objective evidence of paroxysmal positional vertigo.^[29] In addition, CRM treatment improves health-related quality of life, particularly in the physical domain.^[30]

The results of the present study showed a statistically significant correlation between quality-of-life variables but no other correlations between kinesiophobia, balance, and quality of life. Future studies with a larger sample size, equal participation of women and men, and a wider age range will provide a successful generalization of the results to the population. The use of modified tests to assess balance by examining parameters such as tremor and sway, which are critical factors in maintaining upright posture, will provide additional evidence on the impact of PVD on balance. Understanding the correlation between these factors will enhance the development of appropriate rehabilitation methods, improving the overall health status of this clinical population

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Conceptualization: A.C.; methodology: P.K., K.A., C.N., M.C., and A.C.; investigation: P.K. and K.A.; data curation: P.K. and K.A.; writing—original draft preparation: P.K., K.A., and A.C.; writing—review and editing: P.K., K.A., C.N., M.C., and A.C.; supervision: A.C. All authors have read and agreed to the published version of the manuscript.