---
title: "Adherence to treatment recommendations in older adults with vertigo, dizziness, and balance disord"
id: "pubmed-42844416"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42844416"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42844416/"
doi: "10.1007/s00415-026-14195-0"
published_at: "2026-10-08T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Adherence to treatment recommendations in older adults with vertigo, dizziness, and balance disord
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42844416
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42844416/)
- **DOI:** [10.1007/s00415-026-14195-0](https://doi.org/10.1007%2Fs00415-026-14195-0)
- **Published At:** 2026-10-08T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This prospective cohort (MobilE-TRA 2) evaluated adherence to therapeutic recommendations in adults aged ≥60 years treated for **vertigo, dizziness, and balance disorders (VDB)** at a German tertiary referral centre, with assessments at baseline, 3 months and 12 months. - The analytic sample included 337 participants (53% women; mean age 71 years). Adherence was self-reported on a five-point Likert scale and dichotomised for analysis. - Two recommendation types were assessed: **specific exercises** and **lifestyle-related recommendations**. Perceived dizziness-related handicap was measured with the **Dizziness Handicap Inventory (DHI)**. - Longitudinal associations were estimated with logistic generalized linear mixed-effects models including random intercepts to account for repeated measures. - Key findings: adherence to **specific exercises** declined between 3 and 12 months (adjusted OR 0.28; 95% CI 0.12–0.67). Higher baseline DHI score was associated with greater adherence to specific exercises (OR 1.03 per DHI point; 95% CI 1.00–1.06). - For **lifestyle-related recommendations**, DHI was not associated with adherence (OR 1.00; 95% CI 0.98–1.02). Male gender predicted lower adherence to lifestyle recommendations (OR 0.37; 95% CI 0.16–0.88), while higher **self-efficacy** predicted higher adherence (OR 1.65; 95% CI 1.02–2.66). - The study concludes that adherence varies by recommendation type, patient characteristics, and over time, highlighting the need for strategies to support adherence beyond initial follow-up in **older adults with VDB**. - Ethical approval was obtained from the Ethics Committee of the Medical Faculty at Ludwig Maximilian University of Munich (reference #20–727). Authors declared no relevant conflicts of interest.
## Clinical Analysis & Structured Key Points
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Adherence to treatment recommendations in older adults with vertigo, dizziness, and balance disorders: the MobilE-TRA 2 cohort study [Sophia P Schulze](https://pubmed.ncbi.nlm.nih.gov/?term=Schulze+SP&cauthor_id=42844416)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#full-view-affiliation-1 "Institute for Medical Information Processing, Biometry, and Epidemiology \(IBE\), LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#full-view-affiliation-2 "Pettenkofer School of Public Health, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany."), [Benedict Katzenberger](https://pubmed.ncbi.nlm.nih.gov/?term=Katzenberger+B&cauthor_id=42844416)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#full-view-affiliation-1 "Institute for Medical Information Processing, Biometry, and Epidemiology \(IBE\), LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#full-view-affiliation-2 "Pettenkofer School of Public Health, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany."), [Daniela Koller](https://pubmed.ncbi.nlm.nih.gov/?term=Koller+D&cauthor_id=42844416)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#full-view-affiliation-1 "Institute for Medical Information Processing, Biometry, and Epidemiology \(IBE\), LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#full-view-affiliation-3 "Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich \(MUM\), LMU University Hospital, LMU Medizin, LMU Munich, Munich, Germany."), [Doreen Huppert](https://pubmed.ncbi.nlm.nih.gov/?term=Huppert+D&cauthor_id=42844416)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#full-view-affiliation-4 "German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#full-view-affiliation-5 "Department of Neurology, LMU University Hospital, LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany."), [Eva Grill](https://pubmed.ncbi.nlm.nih.gov/?term=Grill+E&cauthor_id=42844416)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#full-view-affiliation-1 "Institute for Medical Information Processing, Biometry, and Epidemiology \(IBE\), LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#full-view-affiliation-4 "German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany."), [Ralf Strobl](https://pubmed.ncbi.nlm.nih.gov/?term=Strobl+R&cauthor_id=42844416)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#full-view-affiliation-6 "Institute for Medical Information Processing, Biometry, and Epidemiology \(IBE\), LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. ralf.strobl@med.uni-muenchen.de.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#full-view-affiliation-7 "German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. ralf.strobl@med.uni-muenchen.de.") Affiliations Expand ### Affiliations * 1 Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. * 2 Pettenkofer School of Public Health, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany. * 3 Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Medizin, LMU Munich, Munich, Germany. * 4 German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. * 5 Department of Neurology, LMU University Hospital, LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. * 6 Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. ralf.strobl@med.uni-muenchen.de. * 7 German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. ralf.strobl@med.uni-muenchen.de. * PMID: **42844416** * DOI: [ 10.1007/s00415-026-14195-0 ](https://doi.org/10.1007/s00415-026-14195-0) Item in Clipboard # Adherence to treatment recommendations in older adults with vertigo, dizziness, and balance disorders: the MobilE-TRA 2 cohort study Sophia P Schulze et al. J Neurol. 2026. Show details Display options Display options Format Abstract PubMed PMID J Neurol Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Neurol%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Neurol%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42844416/) . 2026 Oct 8;273(10):649. doi: 10.1007/s00415-026-14195-0. ### Authors [Sophia P Schulze](https://pubmed.ncbi.nlm.nih.gov/?term=Schulze+SP&cauthor_id=42844416)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#short-view-affiliation-1 "Institute for Medical Information Processing, Biometry, and Epidemiology \(IBE\), LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#short-view-affiliation-2 "Pettenkofer School of Public Health, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany."), [Benedict Katzenberger](https://pubmed.ncbi.nlm.nih.gov/?term=Katzenberger+B&cauthor_id=42844416)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#short-view-affiliation-1 "Institute for Medical Information Processing, Biometry, and Epidemiology \(IBE\), LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#short-view-affiliation-2 "Pettenkofer School of Public Health, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany."), [Daniela Koller](https://pubmed.ncbi.nlm.nih.gov/?term=Koller+D&cauthor_id=42844416)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#short-view-affiliation-1 "Institute for Medical Information Processing, Biometry, and Epidemiology \(IBE\), LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#short-view-affiliation-3 "Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich \(MUM\), LMU University Hospital, LMU Medizin, LMU Munich, Munich, Germany."), [Doreen Huppert](https://pubmed.ncbi.nlm.nih.gov/?term=Huppert+D&cauthor_id=42844416)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#short-view-affiliation-4 "German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#short-view-affiliation-5 "Department of Neurology, LMU University Hospital, LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany."), [Eva Grill](https://pubmed.ncbi.nlm.nih.gov/?term=Grill+E&cauthor_id=42844416)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#short-view-affiliation-1 "Institute for Medical Information Processing, Biometry, and Epidemiology \(IBE\), LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#short-view-affiliation-4 "German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany."), [Ralf Strobl](https://pubmed.ncbi.nlm.nih.gov/?term=Strobl+R&cauthor_id=42844416)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#short-view-affiliation-6 "Institute for Medical Information Processing, Biometry, and Epidemiology \(IBE\), LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. ralf.strobl@med.uni-muenchen.de.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42844416/#short-view-affiliation-7 "German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. ralf.strobl@med.uni-muenchen.de.") ### Affiliations * 1 Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. * 2 Pettenkofer School of Public Health, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany. * 3 Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Medizin, LMU Munich, Munich, Germany. * 4 German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. * 5 Department of Neurology, LMU University Hospital, LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. * 6 Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. ralf.strobl@med.uni-muenchen.de. * 7 German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Medizin, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. ralf.strobl@med.uni-muenchen.de. * PMID: **42844416** * DOI: [ 10.1007/s00415-026-14195-0 ](https://doi.org/10.1007/s00415-026-14195-0) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Background:** Specific exercises and lifestyle-related recommendations are used to manage vertigo, dizziness, and balance disorders (VDB), but evidence on adherence and its determinants in older adults is limited. This study examined adherence changes and associations with condition-related and patient-related factors from 3 to 12 months after therapeutic recommendations. **Methods:** We used data from the MobilE-TRA 2 prospective cohort of adults aged ≥60 years treated for VDB at a tertiary referral centre in Germany. The participants were assessed at baseline and followed up after 3 and 12 months. Self-reported adherence was measured using a five-point Likert scale and dichotomised at predefined cut-offs. Perceived dizziness-related handicap was assessed using the Dizziness Handicap Inventory (DHI). Longitudinal associations were analysed using logistic generalised linear mixed-effects models with random intercepts. **Results:** Overall, 337 participants were included (53% women; mean age 71 years). In adjusted analyses, adherence to specific exercises was lower at 12 than at 3 months (odds ratio (OR) 0.28; 95% confidence interval (CI) 0.12-0.67). Higher baseline DHI scores were significantly associated with higher adherence to specific exercises (OR 1.03; 95% CI 1.00-1.06), but not with lifestyle-related recommendations (OR 1.00; 95% CI 0.98-1.02). Male gender was associated with lower adherence to lifestyle-related recommendations (OR 0.37; 95% CI 0.16-0.88), while higher self-efficacy was associated with higher adherence (OR 1.65; 95%CI 1.02-2.66). **Conclusions:** Adherence differed by recommendation type, participant characteristics and over time in older adults with VDB. These findings may inform strategies to support adherence in VDB beyond initial follow-up. **Keywords:** Balance disorders; Dizziness; Older adults; Patient adherence; Therapy recommendations; Vertigo. © 2026. The Author(s). [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Conflicts of interest: The authors have no relevant financial or non-financial interests to disclose. Ethical approval: The study involving human participants was approved by the Ethics Committee of the Medical Faculty at Ludwig Maximilian University of Munich (reference #20–727). All procedures were carried out in accordance with applicable local regulations and institutional guidelines. Written informed consent was obtained from all participants prior to enrolment. Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent for publication: Not applicable. ## References 1. 1. Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB (2009) Disorders of balance and vestibular function in US adults: data from the national health and nutrition examination survey, 2001–2004. Arch Intern Med 169:938–944 - [DOI](https://doi.org/10.1001/archinternmed.2009.66) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/19468085/) 2. 1. Anderson LR, Mellor JM (2008) Predicting health behaviors with an experimental measure of risk preference. J Health Econ 27:1260–1274 - [DOI](https://doi.org/10.1016/j.jhealeco.2008.05.011) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/18621427/) 3. 1. Argent R, Daly A, Caulfield B (2018) Patient involvement with home-based exercise programs: can connected health interventions influence adherence? JMIR Mhealth Uhealth 6:e47 - [DOI](https://doi.org/10.2196/mhealth.8518) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/29496655/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/5856927/) 4. 1. Bandura A (1997) Self-efficacy: the exercise of control. W H Freeman/Times Books/Henry Holt and Co, New York, NY, US 5. 1. Barin K, Dodson EE (2011) Dizziness in the elderly. Otolaryngol Clin North Am 44(437–454):x - [PubMed](https://pubmed.ncbi.nlm.nih.gov/21474016/) Show all 44 references ## MeSH terms * Aged Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Aged%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Aged) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42844416/) * Aged, 80 and over Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Aged%2C+80+and+over%2
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