Involvement with Long-Term Disability Insurance, Legal Claims May Hinder Recovery from Chronic Dizziness

How does symptom recovery from chronic dizziness (CD) in patients receiving/pursuing long-term disability (LTD) insurance or legal claims (LCs) compare with CD recovery in patients who do not receive these things, and what factors might contribute to changes in symptom severity?

BOTTOM LINE

Patients receiving or pursuing LTD insurance or LCs did not improve from CD and dizziness catastrophizing compared to those who were not.

BACKGROUND: Chronic dizziness arises from vestibular and nonvestibular etiologies and is often associated with psychiatric/psychological comorbidities. Despite a comprehensive, integrated treatment approach, not all CD cases resolve, for a variety of biological and/or psychosocial reasons. One possible recovery barrier is receiving or pursuing LTD insurance compensation or an LC.

STUDY DESIGN: Retrospective cohort study.

SETTING: Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada.

SYNOPSIS: Researchers extracted dizziness-related diagnoses on 195 adults in an outpatient interdisciplinary neurotology clinic. Criteria included baseline Dizziness Handicap Inventory (DHI) and Dizziness Catastrophizing Scale (DCS) assessments between August 2012 and July 2018 and a mean follow-up visit within approximately 10 months. Participants were categorized as either receiving/pursuing LTD/LC (LTD/LC+, 92 patients) or not (LTD/LC–, 103 patients). Results showed that individuals in the LTD/LC+ group did not appear to improve with CD treatment independent of neurotologic or mental health diagnoses, whereas individuals in the LTD/LC– group responded to interdisciplinary CD treatment, despite both groups having equal access to multiple forms of intervention. The LTD/LC+ group showed 8.0% and 7.6% mean increases in DHI and DCS scores, respectively, whereas LTD/LC– patients showed 21.5% and 25.9% reductions in DHI and DCS scores, respectively, controlling for age, sex, and baseline illness severity. Authors note that most existing data relate to injury/motor vehicle collision claims. Limitations included its retrospective design and the possibility that data might have been influenced by greater baseline illness severity in the LTD/LC+ group.

CITATION: Shah P, Attia M, Dillon WA, et al. Receiving long-term disability or pursuing a legal claim may prevent recovery from chronic dizziness. Laryngoscope. 2022;132:655-661