REFERENCE · DIAGNOSTIC TECHNIQUE

PPPD Questionnaires and Everyday Function

Clinician-focused educational reference; select assessment within professional competence, consent and an individual clinical plan.

Purpose and Suitability
Anatomy and Physiology
Preparation and Safety
Performing the Assessment
Interpreting Findings
Explaining the Result
Evidence and Limitations
Media and Accessibility
Research and Sources

Purpose and Suitability

Use this guide to select a symptom measure and record what dizziness changes in ordinary life. Vestibular physiotherapists, occupational therapists and the wider team can agree complementary questions and avoid asking the person to complete overlapping forms without a purpose.

Patient-reported outcome: Information the person reports about their symptoms, function or experience, rather than a result inferred from an examination.

Keep three records distinct: whether PPPD criteria are met; what a questionnaire or observed task sampled; and what help or adaptations the person needs. The criteria guide owns diagnosis.

Anatomy and Physiology

A questionnaire records experience; it does not locate a lesion or measure vestibular physiology. Its domains can organize a conversation about posture, movement and visual surroundings without establishing why symptoms happen.

When discussing an observed activity, describe the actual task and conditions. Do not infer that a lower questionnaire score demonstrates normalized brain processing, or that successful performance once proves reliable performance throughout a day.

Preparation and Safety

Agree the decision a measure will inform before selecting it. Check language, reading, vision, screen tolerance, fatigue and whether the person prefers supported completion. Use the published version and instructions; record assistance or adaptations that could change interpretation.

A questionnaire asks about experience. Do not send a person into a crowd, make them watch moving patterns or remove a mobility aid to generate an answer. Record uncertainty or activities not encountered according to the instrument’s instructions rather than silently treating them as symptom-free.

Use a short record at an agreed review interval when useful. Do not require continuous monitoring or an exhausting demonstration of disability.

Performing the Assessment

Niigata PPPD Questionnaire

The original NPQ has 12 items: four each for upright posture/walking, movement and visual stimulation. Items score 0–6; each domain totals 0–24 and the total is 0–72. Use the published instrument and scoring instructions through the original article, rather than recreating items from this summary. It supplements the clinical assessment. [2]

Everyday activity and review record

This is an authored discussion aid, not a validated scale, a diagnostic checklist or a prescribed rehabilitation programme. Select one or two activities the person wants help with.

Record	Baseline and review questions
Activity and purpose	What does the person want or need to do: prepare a meal, read, travel, shop, study or work?
Conditions	Seated or upright? Quiet or visually busy? Alone or with support? What duration and repetition?
Participation	Completed, partly completed, stopped or not attempted? What was achieved?
Assistance and adaptations	Which aid, person, rest break or environmental change was needed?
Symptoms and other barriers	What happened during the task? Were pain, fatigue, hearing, vision or another condition relevant?
Recovery and repeatability	How long until the usual baseline returned? Could another necessary task follow?
Person’s judgement	Was this worthwhile and manageable? What would meaningful improvement look like?
Review conditions	What changed in the task, support, treatment or wider circumstances? What should happen next?

If OT selects an occupation-based measure, use its own manual and population limits. The FCD measurement guide explains the distinction between occupation-based outcomes and diagnosis; its FCD-specific test discussion should not be transferred wholesale to PPPD.

A dizziness-impact questionnaire such as DHI and a separate mood assessment may answer additional questions. The French study below used both alongside NPQ; that does not prescribe a universal battery. [3]

Interpreting Findings

Interpret the NPQ alongside the complete history and differential assessment. Its score does not establish all five criteria. A score should not determine work capacity, driving safety or withdrawal of assistance.

At review, compare the same instrument/version and document changed conditions. Ask whether an apparent improvement reflects easier activity, more support, less exposure, better tolerance or some combination; do not assume the answer. Participation may increase while symptoms remain, and a smaller symptom score may leave important activity restrictions unresolved.

This draft supplies no universal meaningful-change threshold for PPPD. Use the relevant measure’s evidence and the person’s priorities rather than inventing a percentage target.

Explaining the Result

Authored explanation example: “The questionnaire helps us describe the situations that are difficult. The activity record tells us what you can do, what help makes it possible and what happens afterwards. Neither score alone decides your diagnosis or how much support you need. At review we will compare those details and your own priorities.”

Offer the person a copy. Distinguish what they reported, what was observed and what the team inferred; invite corrections before using the summary for care planning.

Evidence and Limitations

Yagi and colleagues compared 50 PPPD patients with 50 other vestibular patients in a tertiary-centre retrospective study. A total-score threshold of 27 had 70% sensitivity and 68% specificity in that sample. These values leave substantial overlap; they are not universal diagnostic or disability cutoffs. [2]

Sensitivity and specificity: How often a test identifies people with the studied diagnosis and correctly classifies people without it, respectively, within the study’s setting.

Meletaki and colleagues studied 50 French-speaking PPPD patients, 50 other vestibular patients and 50 controls. Internal consistency was high, but discrimination between patient groups was poor (AUC 0.664). PPPD participants reported greater dizziness-related handicap and some psychological symptoms; associations do not establish cause. This cross-sectional, specialist sample does not establish individual prognosis or treatment responsiveness. [3]

Internal consistency: How closely items within a questionnaire relate to one another; it is not proof of diagnostic accuracy or sensitivity to change.

AUC: Area under a discrimination curve; 0.5 indicates chance-level separation and 1 perfect separation in the studied comparison.

The authored activity record has no validation data. It makes relevant questions visible while preserving the limits of questionnaire and clinic findings.

Media and Accessibility

Provide a simple printable record with generous writing space and a text version that works with screen readers. Keep standard questionnaire forms separate from this authored aid and respect their reproduction and translation terms.

Use static examples of completed records, with invented entries clearly labelled. Any future demonstration should show a consented conversation and interpretation, not an escalating symptom challenge. No motion imagery is needed to explain a score.

Research and Sources

The original NPQ study supports its format and selected-sample accuracy; the French validation qualifies how well it separates clinical groups. These sources do not validate the authored record or establish a PPPD-specific occupational capacity threshold. The consensus supports keeping meaningful impact and the full diagnostic criteria distinct.

Citation	Figure	Full citation
[1]	—	Staab JP, Eckhardt-Henn A, Horii A, Jacob R, Strupp M, Brandt T, Bronstein A. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. Journal of Vestibular Research. 2017;27(4):191–208. FND-CIT-0027. https://doi.org/10.3233/VES-170622
[2]	—	Yagi C, Morita Y, Kitazawa M, et al. A Validated Questionnaire to Assess the Severity of Persistent Postural-Perceptual Dizziness (PPPD): The Niigata PPPD Questionnaire (NPQ). Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 2019;40(7):e747-e752. DOI. PMID: 31219964. FND-CIT-0156.
[3]	—	Meletaki V, Gobinet M, Léonard J, Elzière M, Lopez C. French adaptation and validation of the Niigata PPPD Questionnaire: measure of severity of Persistent Postural-Perceptual Dizziness and its association with psychiatric comorbidities and perceived handicap. Frontiers in Neurology. 2024;15:1388805. DOI. FND-CIT-0262.

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