This prospective cohort (MobilE-TRA 2) followed older adults treated for vertigo, dizziness, and balance disorders (VDB) to describe adherence to therapeutic recommendations at 3 and 12 months. Adherence was self-reported using a five-point Likert scale and dichotomised for analysis. The study evaluated two categories of recommendations: specific exercises (for vestibular or balance rehabilitation) and lifestyle-related recommendations (behavioural or environmental advice intended to reduce dizziness or fall risk).
Overall adherence patterns differed by recommendation type and changed over time. In adjusted longitudinal analyses, adherence to specific exercises was significantly lower at 12 months than at 3 months (adjusted odds ratio [OR] 0.28; 95% confidence interval [CI] 0.12–0.67), indicating a substantial decline in exercise adherence after the early follow-up period.
MobilE-TRA 2 enrolled adults aged 60 years and older who were treated for VDB at a tertiary referral centre in Germany. The analytic sample comprised 337 participants, 53% of whom were women, with a mean age of 71 years. Participants completed baseline assessments and were followed up at 3 and 12 months.
Self-reported adherence used a five-point Likert response format and was dichotomised according to predefined cut-offs (details of cut-offs were reported in the source). Perceived dizziness-related handicap at baseline was measured with the Dizziness Handicap Inventory (DHI). The study also assessed patient-related factors including gender and self-efficacy; specific measurement instruments for self-efficacy were reported in the source.
Longitudinal associations between adherence and candidate predictors were analysed using logistic generalized linear mixed-effects models with random intercepts to account for repeated measures within participants. Models were adjusted for relevant covariates as reported in the source. Results are presented as adjusted odds ratios with 95% confidence intervals.
Adherence change over time
Associations with perceived handicap (DHI)
Patient characteristics associated with lifestyle recommendation adherence
The study therefore identified different determinants for adherence depending on recommendation type: perceived dizziness-related handicap influenced exercise adherence, while gender and self-efficacy influenced lifestyle-advice adherence.
The findings indicate that adherence in older adults with VDB is not uniform: it varies by type of recommendation, patient-perceived handicap, demographic factors and psychological resources such as self-efficacy, and it declines over time for exercise programmes. Clinicians and rehabilitation teams should be aware that exercise adherence may fall after the early follow-up period and that patients with higher perceived handicap may be more motivated to adhere to exercises.
For lifestyle-related recommendations, lower adherence among men and greater adherence among those with higher self-efficacy point to potential targets for intervention. Strategies that bolster self-efficacy (for example, goal setting, coaching, or structured follow-up) and gender-sensitive approaches to counselling could support longer-term adherence.
The authors highlight the importance of designing adherence support measures that extend beyond initial follow-up visits to sustain benefits from both exercise and lifestyle interventions in older adults with VDB.
Limitations: The source reports self-reported adherence measured via Likert scale and dichotomisation; potential biases related to self-report and the specific cut-offs used are inherent. The source did not provide additional detail beyond the reported measures and statistical approach in the abstract.
Ethics and declarations: The study received ethical approval from the Ethics Committee of the Medical Faculty at Ludwig Maximilian University of Munich (reference #20–727). Written informed consent was obtained from all participants. The authors declared no relevant financial or non-financial conflicts of interest.
These results derive from the MobilE-TRA 2 cohort as described in the source. Clinicians and researchers should consult the full article for detailed methods, measurement instruments, and supplementary analyses not presented in the abstract.