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How to Assess your Patient’s Complaints of Dizziness

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12/17/2021
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By Joseph Koley, PT, MPT Physical Therapist, Indiana

Non-specific complaints of "dizziness" are common when working with an older population. This article aims to guide clinicians in "stepping back" from their current treatment plan and subjectively assessing a patient's complaints of "dizziness." After spending about 10 minutes asking the patient questions and listening to their responses, a clinician should be able to move forward with an appropriate plan.  In all cases, a clinician should educate the patient on their findings and any need for further intervention.

What Do Patients Mean When They Say They’re Experiencing “Dizziness?”

Depending on how it is defined, "dizziness” (including vertigo) affects 15-20% of older adults. Therefore, large practitioners who see older adults will inevitably come into contact with these patients. These symptoms may be the reason for their referral or a complicating factor in the patient’s care.  Dizziness is described by the Mayo Clinic as “a term used to describe a range of sensations, such as feeling faint, woozy, weak or unsteady. Dizziness that creates the false sense that you or your surroundings are spinning or moving is called vertigo.” Clinicians are often confused by their patient's non-specific complaints of “dizziness” — especially when treating body systems that do not seem to be associated with a patient’s balance. Think of the orthopedic shoulder patient who talks about her dizzy spells. Should the clinician be concerned? The patient was referred for her shoulder, not her "dizziness." But the patient did almost fall and hurt her rotator cuff trying to catch herself. 

Three Steps for Assessing Patient Dizziness

The following steps should help clinicians efficiently learn the skill to "step back" from their current plan of care, assess these complaints and decide how to proceed.  This can be completed efficiently during a normal therapy treatment session and should last about 10 minutes.

Step 1: Ask the Right Questions and Listen to the Answers

Ask the patient an open-ended question and then listen for as long as the patient needs to answer. I use questions like “Tell me about your dizziness?”  Remember, don’t interrupt. Let your patient talk, and while they tell you their “dizziness story,” try to answer these questions: 
  1. What are their symptoms? (e.g. vertigo, feeling faint, weakness, unsteadiness) 
  2. When does it happen? (e.g. with movement, time of day/night) 
  3. How long does it last? (e.g. seconds, minutes, or hours? Does it come and go or does the patient always feel this way?)
  4. What makes it better or worse? 
  5. Have they ever seen a healthcare provider regarding this problem? 

Step 2: Follow Up with More Targeted Questions 

If you cannot answer all five questions initially with your first question, follow up with targeted questions for #1-5 above. 
  •  What are your symptoms?
    • Do you feel like you're spinning, rocking, or moving? Or that the room is moving around you?
    • Do you feel faint or like you may pass out? Is the room “going dark”?
    • Do you have double vision?
    • Do you feel as if you may lose your balance or feel unsteady?
    • Do you have nausea or vomiting?
  • When does it happen?
    • Do you have warning signs before you get “dizzy”?
    • What time of day? How often?
    • Does it happen with movement or any specific activity?
  •  How long does it last? 
    • Seconds: it’s gone before you know it.
    • Minutes: it takes a while to go away.
    • Hours/Days: it often ruins your day to be “dizzy” for so long.
  •  What makes it better or worse?
    • Does moving around make it worse?
    • Do “busy” environments make it worse? (e.g. going to the mall during the holidays, going to the grocery store the day before Thanksgiving)
    • Is it better if you lie down in a dark room?
    • Is it worse based on the surface you are walking on? Are you more “dizzy” walking on grass or sand than on carpeted or wooden floors?
    • Does closing your eyes make it worse?
    • Is it better if you hold onto something firm, like a chair or handrail?
  •  Have you seen a healthcare provider regarding these symptoms?
    • For all providers: Did they give you medicine to take for your dizziness? Do you take it? Did they send you for any rehab? What did you do in rehab? Did you get an MRI or CT scan?
    • If PCP/ER/Medcheck Provider: Did they diagnose a problem? Did they send you to a specialist?
    • If ENT Provider: Did they diagnose a problem? Did they do testing with you where you had water or air put in your ear or sat on a spinning chair? Did you have surgery on your ear?
    • If Neurologist: Did they diagnose a problem? Did they do any special testing with you, maybe using electricity or needles?

Step 3: Decide Your Next Steps

Assess all the subjective information you have collected and proceed with: 
  • Referring a patient to another provider 
  • Treating the patient's problem (after first requesting orders, if needed) 
  • Planning further targeted objective assessment
  • Taking no further action
At the end of the subjective assessment, each rehabilitation discipline will choose the most appropriate plan for their patient based on their knowledge and practice. As you then proceed with your patient’s shoulder exercises (from the example above), you will be satisfied that you addressed your patient’s complaint, listened, assessed their specific presentation, and have a plan in place to address their problem—even if the plan is taking no further action at this time. 

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