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The assessment of increased sensitivity to visual stimuli in patients with chronic dizziness
Abstract
Patients with chronic vestibular dysfunction often experience visually-induced aggravation of dizzy symptoms (visual vertigo; VV). The Situational Characteristics Questionnaire (SCQ), Computerized Dynamic Posturography or Rod and Frame Test (RFT) are used to assess VV symptoms. This study evaluates whether correlations exist between these three tests, their ability to identify patients with VV and whether emotional state correlates with VV symptoms. Tests were completed by 20 normal controls (Group NC), 20 patients with vestibular dysfunction plus VV (Group VV) and 13 without VV (Group NVV). Additionally, the Vertigo Symptom Scale (VSS-V) was applied to quantify general, non-visually induced vertigo (dizziness, lightheadedness and/or spinning) and imbalance. Autonomic (VSS-A) and psychological symptoms (Hospital Anxiety and Depression questionnaire; HAD) were also assessed. With the SCQ 100% of Group VV scored outside normal ranges and scores differed significantly between Group VV and both Groups NC and NVV. RFT values were not significantly different between groups; only 15% of patients scored outside normal ranges. Posturography scores were abnormal for 50% of patients; significant differences were noted between Groups NC and VV for composite scores and ratios 3/1, 4/1, 5/1 and 6/1 (indicative of abnormal sensory re-weighting). There were no correlations between the three data sets in patients. Anxiety and depression scores significantly differed between Groups NC and VV but not between patient groups; this indicates that psychological symptoms may be present in either patient group. The SCQ can be used to corroborate an initial clinical diagnosis of VV and quantify its severity in patients with vestibular dysfunction. Posturography data suggested patients with VV have a sensory re-weighting abnormality. The rod and frame test results and posturography findings agree less with the clinical diagnosis of VV. Psychological symptoms may need to be addressed.
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Environments that contain full field visual flow, large complex patterns, or wide-open spaces with distant or indistinct visuospatial reference points are most troublesome for patients with PPPD.
“Environments that contain full field visual flow (e.g., passing traffic especially at high speed on a highway or motorway, large crowds of people milling about), large complex patterns (e.g., an expanse of busy carpeting, large store displays), or wide-open spaces with distant or indistinct visuospatial reference points (e.g., large fields, warehouses, atria) are most troublesome [15, 29, 39, 43,”
Bronstein and colleagues showed that people with VV manifested visual dependence, a trait-like tendency to rely on visual information for spatial orientation.
“Bronstein and colleagues [15, 29, 63] showed that people with VV manifested visual dependence, a trait-like tendency to rely on visual information for spatial orientation.”
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“Bronstein and colleagues [15, 29, 63] showed that people with VV manifested visual dependence, a trait-like tendency to rely on visual information for spatial orientation.”
BackgroundInfluentialSelf-citationVisual Dependency and Dizziness after Vestibular Neuritis
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“[39,42,43] The relationship between visual dependency and clinical handicap in VN patients, unselected for the presence of visually induced symptoms, is unknown.”
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“6 (9-600) Presence of migraine, n (%) 10 (50) 10 (50) 13 (65) Diagnosis, n VN 7 5 4 VM 6 9 9 BPPV (+VM) 1 2 (1) 1 (1) BVH (+M) 2 2 1 (1) Posttraumatic dizziness (+M) 0 (2) 0 0 Acoustic neuroma (+M) 0 0 0 (1) MDS(15) (+M) 0 (2) 1 1 (1) Vestibular findings, n CP 5 6 6 BPPV 1 3 2 BVH 2 2 2 No abnormal findings 12 9 10”
Self-citationRomberg ratio in quiet stance posturography—Test to retest reliability
Tjernström, F., Björklund, M., & Malmström, E.-M. (2014) · Gait & Posture · doi:10.1016/j.gaitpost.2014.12.007 · Cited by 83
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Altered functional brain connectivity in patients with visually induced dizziness
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“Later, a study by Pavlou and co-workers also reported that patients with VID show increased postural sway and worse results on the situational characteristics questionnaire (SCQ) when confronted with conflicting visual stimuli (Pavlou et al., 2006).”
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Tjernström, F., Zur, O., & Jahn, K. (2016) · Journal of Neurology · doi:10.1007/s00415-015-7914-1 · Cited by 71
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Anxiety among individuals with visual vertigo and vestibulopathy
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Dannenbaum, E., Chilingarian, G., & Fung, J. (2019) · Journal of Neurologic Physical Therapy · doi:10.1097/npt.0000000000000261 · Cited by 33
Bronstein, A. M., & Pavlou, M. (2013) · Handbook of clinical neurology · doi:10.1016/b978-0-444-52901-5.00016-2 · Cited by 32
Self-citationHoppes, C. W., Sparto, P. J., Whitney, S. L., FURMAN, J. M. R., & Huppert, T. J. (2018) · NeuroImage Clinical · doi:10.1016/j.nicl.2018.08.034 · Cited by 32
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Chronic dizziness: a practical approach
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Self-citationMempouo, E., Lau, K., Green, F., Bowes, C., & Ray, J. (2021) · The Journal of Laryngology & Otology · doi:10.1017/s0022215121002127 · Cited by 26
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Self-citationMagnetic resonance brain imaging in patients with visual vertigo
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“…denied any visual vertigo symptoms on direct questioning and were therefore not asked to complete the SCQ. Patients with vestibular dysfunction and no VV might positively answer some of the distinct queries of the questionnaire, as demonstrated previously (Guerraz et al. 2001; Pavlou et al. 2006).”
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“However the majority of studies use part I of the scale to measure space and motion discomfort in relation to anxiety disorders (7, 42).”
Aharoni, M. M. H., Lubetzky, A. V., Arie, L., & Krasovsky, T. (2021) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/s12984-021-00852-0 · Cited by 19
“Increased visual reliance in PPPD has been shown to be associated with balance performance [11, 12] and likelihood to develop chronic symptoms [13].”
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Klatt, B. N., Sparto, P. J., Terhorst, L. A., Winser, S. J., Heyman, R. A., & Whitney, S. L. (2018) · Physiotherapy Research International · doi:10.1002/pri.1757 · Cited by 19
Zaleski-King, A. C., Pinto, R., Lee, G., & Brungart, D. S. (2019) · Ear and Hearing · doi:10.1097/aud.0000000000000736 · Cited by 18
“…scene becomes distorted, either through illusory tilts or dynamic changes to the visual environment, healthy individuals are typically able to rely on the redundancy of orienting proprioceptive and vestibular cues enough to supersede the effect of the misleading visual cue (Pavlou et al. 2006).”
BackgroundBamiou, D., Kikidis, D., Bibas, A. G., Koohi, N., Macdonald, N., Maurer, C., Wuyts, F. L., Ihtijarevic, B., Celis, L., Mucci, V., et al. (2021) · Journal of Neurology · doi:10.1007/s00415-021-10829-7 · Cited by 17
“Non-specialist physicians can be overwhelmed when faced with a patient complaining of these symptoms, due to the vagueness of the symptom report, the plethora of underlying pathologies, complexity of balance control mechanisms, and the lack of medical expertise [9, 10], resulting in late diagnosis and mismanagement of…”
BackgroundLubetzky, A. V., Aharoni, M. M. H., Arie, L., & Krasovsky, T. (2021) · Journal of Vestibular Research · doi:10.3233/ves-201552 · Cited by 16
“PeoplewithPPPDreportimbalance,increase insymptomsandimpairedfunctionwithincomplex visualenvironments[26,40],buttheunderstanding ofthemechanismforthesebehaviorsisstilllacking.”
Acetazolamide: A New Treatment for Visual Vertigo
Sluch, I. M., Elliott, M. S., Dvorak, J., Ding, K., & Farris, B. K. (2017) · Neuro-Ophthalmology · doi:10.1080/01658107.2017.1326944 · Cited by 15
“However, VV is different from “true” rotational vertigo, because the patients do not experience “rotation” of their environment but rather the actual movement in their environment triggers their symptoms.(2) Symptoms typically occur in the latent phase after an acute vestibular insult, such as vestibular neuritis, ben…”
BackgroundHolmberg, J. M. (2020) · Perspectives of the ASHA Special Interest Groups · doi:10.1044/2019_persp-19-00105 · Cited by 17
Brouwer, D., Morrin, H., Nicholson, T. R., Terhune, D. B., Schrijnemaekers, M., Edwards, M. J., Gelauff, J., & Shotbolt, P. (2024) · BMJ Neurology Open · doi:10.1136/bmjno-2023-000622 · Cited by 14
Storm, R., Wrobel, V., Frings, A., Sprenger, A., & Helmchen, C. (2025) · Scientific Reports · doi:10.1038/s41598-025-11529-2 · Cited by 16
“This visual dependence resembles functional neural reorganization in patients who suffered from unilateral vestibulopathy with subsequently developing abnormal visual impact on vestibular perception during the course of the disease 12,13 .”
Fabre, M., Beullier, L., Sutter, C., Kebritchi, A., Chavet, P., Simoneau, M., Toupet, M., Blouin, J., & Mouchnino, L. (2023) · Journal of Neurophysiology · doi:10.1152/jn.00406.2022 · Cited by 16
The development of the ICF vestibular environmental scale
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“Persons who poorly compensate after a vestibular disorder may have problems with environmental cues [13, 34, 35].”
Altena, E., Buguet, E., Higginson, C., Lee, E. K., Douglass, A. B., Spitale, N., & Robillard, R. (2023) · Journal of Vestibular Research · doi:10.3233/ves-220113 · Cited by 14
“Nevertheless, scores above 0 are considered to suggest the presence of vestibular problems [20, 28, 29, 31, 37].”
BackgroundHelmchen, C., Blüm, S.-K., Storm, R., Krause, J., & Sprenger, A. (2024) · Journal of Neurology · doi:10.1007/s00415-024-12415-z · Cited by 12
“This visual dependence resembles functional neural reorganization in patients who suffered from unilateral vestibulopathy with subsequently developing abnormal visual impact on vestibular perception during the course of the disease [16, 17].”
BackgroundResearch Progress on the Potential Pathogenesis of Persistent Postural–Perceptual Dizziness
Chen, Q., Zhang, R., & Yan, Z. (2024) · Brain and Behavior · doi:10.1002/brb3.70229 · Cited by 13
Categorizing individuals based on the severity of Visual Vertigo Analogue Scale symptoms
Frank, A. J., Hoppes, C. W., Dunlap, P. M., Costa, C. M., & Whitney, S. L. (2022) · Journal of Vestibular Research · doi:10.3233/ves-210131 · Cited by 11
“Depressionscoreshavebeencor-relatedwithincreasedreportsofsymptomsprovoked oraggravatedbycomplexvisualstimuli[20].”
InfluentialMoaty, A. S., Elmahallawy, T. H., Emara, A. A., Talaat, H. S., Abedein, A. Z. E., Dimitriadis, P. A., Allam, A., Bowes, C., & Ray, J. (2017) · Hearing Balance and Communication · doi:10.1080/21695717.2017.1347367 · Cited by 9
“SCQ provides the initial diagnostic support to the clinical diagnosis of VV and gives a measure of the intensity of symptoms [16].”
BackgroundPerceptual Postural Imbalance and Visual Vertigo
Hebert, J. R., & Subramanian, P. S. (2019) · Current Neurology and Neuroscience Reports · doi:10.1007/s11910-019-0939-6 · Cited by 7
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“Patients with visual vertigo with pathologies similar to PPPD manifested dependenceonvisualinput,tendencytorelyonvisual informationforspatialorientation[4,14,25].”
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“The complexity of balance control mechanisms, the lack of medical expertise, and the absence of specialised equipment can be contributory factors to this late diagnosis and the resulting mismanagement of patients with balance disorders [5, 6].”
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“Currently, only the Visual Vertigo Analogue Scale 44 and Situational Characteristic Questionnaire 45 are validated outcome measures for the assessment of visually induced dizziness.”
InfluentialMarsden, J. F., Dennett, R., Gibbon, A., et al. (2025) · Neurorehabilitation and neural repair · doi:10.1177/15459683251345444 · Cited by 6
“20 Secondary outcome measures were the Vertigo Symptom Scale-Short Form (VSS) 24,29 ; Dynamic Gait Index (DGI) 8,28 ; Situational Characteristic Questionnaire 30 ; dynamic visual acuity 31,32 ; Rod and Disc test 33,34 ; Symbol Digit Modalities Test 35 ; self-report MS Walking Scale (MSWS-12 Version 2.0) 36 ; MSWS-12 V…”
InfluentialSelf-citationArabic version of the visual vertigo analogue scale for assessment visual vertigo syndrome
Talaat, H. S., Abedein, A. Z. E., & Ali, R. (2019) · Egyptian Journal of Ear Nose Throat and Allied Sciences · doi:10.21608/ejentas.2019.9894.1081 · Cited by 5
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Elevated visual dependency in young adults after chemotherapy in childhood
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Rehabilitación vestibular en la dependencia visual y somatosensorial.
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“This may be explained by the fact that over-reliance on visual information is a common malcompensation that contributes to persistent dizziness symptoms, and thus should be treated [23-25].”
BackgroundRod and frame test parameters for neuropsychology studies
Czarnolewski, M. Y. (2024) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2024.2356297 · Cited by 3
“…assessment of horizontality with verticality when administering an RFT task may provide additional understanding of patients with chronic vestibular dysfunction who experience dizzy symptoms and exhibit visual vertigo (Pavlou et al., 2006), as well as those with spatial neglect (Funk et al., 2011).”
InfluentialVisual dependency and postural control on swing performance in golf players
Micarelli, A., Viziano, A., Lanzillotta, A., Ruscello, B., D'Ottavio, S., & Alessandrini, M. (2019) · European Journal of Sport Science · doi:10.1080/17461391.2019.1571635 · Cited by 3
Persistent postural-perceptual dizziness as a regulatory dysfunction of the balance system
Мирзаева, Л. М., Voronov, V. A., Demidenko, D. Y., Savinova, A. K., & Griva, A. I. (2023) · HERALD of North-Western State Medical University named after I I Mechnikov · doi:10.17816/mechnikov115269 · Cited by 2
‘Visual Vertigo’ and Motion Sickness
Bronstein, A. M., Golding, J. F., & Gresty, M. A. (2014) · Springer eBooks · doi:10.1007/978-3-319-07022-3_8 · Cited by 3
“The limited evidence so far does not indicate that anxiety or depression levels are higher in visual vertigo patients than in other patients seen in dizzy clinics [ 9 , 10 , 13 ].”
BackgroundSelf-citationIs spatial orientation affected by Ramadan fasting?
Razzak, R. A., Mohamed, M. W., Alshaiji, A. F., et al. (2018) · Nutrition & Food Science · doi:10.1108/nfs-08-2018-0224 · Cited by 2
A Haptic Feedback Device Reduces Dizziness in Users Watching a Virtual Reality Video
Tsai, W.-T., & Chen, C. (2020) · doi:10.1145/3416797.3416806 · Cited by 2
“These given perceptions are a combination of comprehensive cues [11].”
BackgroundPersistent Postural-Perceptual Dizziness: Overview and Diagnostic Criteria
Kim, S. (2020) · Research in Vestibular Science · doi:10.21790/rvs.2020.19.2.42 · Cited by 1
“시 야 전체를 채우는 주위 환경(빙빙 도는 움직임을 보이는 대규모 군중, 고속도로에서 빠른 속도로 지나가는 차량 들), 크고 복잡한 패턴, 또는 시공간감각의 준거점이 불명 확해지는 탁 트인 공간(초원이나 커다란 창고)들이 증상 악화를 잘 일으키는 시자극으로 알려져 있다[3,4,9,11,12].”
Hoppes, C. W., Dunlap, P. M., Sparto, P. J., Alshebber, K. M., Klatt, B. N., Lambert, K. H., FURMAN, J. M. R., Huppert, T. J., & Whitney, S. L. (2026) · Journal of Vestibular Research · doi:10.1177/09574271261435448 · Cited by 1
PERCEPTUAL-POSTURAL CORRELATION OF VISUAL DEPENDENCE IN HEALTHY ADULTS ACROSS AGE GROUPS
Lee, S. (2017) · International Journal of Physiotherapy and Research · doi:10.16965/ijpr.2017.147 · Cited by 1
“found the positive correlation of the value of SVV tilt measured by the Rod and Frame test (RFT) and the score in a Sensory Organization Test in which both visual and proprioceptive inputs were altered [12].”
BackgroundMethodArabic version of situational characteristic questionnaire for diagnosis of visual vertigo syndrome
Talaat, H. S., Moaty, A. S., & Koura, Y. A. E. A. (2018) · Hearing Balance and Communication · doi:10.1080/21695717.2018.1539316 · Cited by 1
“scores were significantly high in patients with VV [9].”
BackgroundMethodInfluentialAssessment, diagnosis and management of the dizzy patient
Mullin, N., Mcphee, O., Morrow, C., & Youssef, A. M. (2020) · British Journal of Hospital Medicine · doi:10.12968/hmed.2020.0469 · Cited by 1
Polat, Z., Çankaya, S., Deniz, B., & Kılıç, M. (2025) · Journal of Vestibular Research · doi:10.1177/09574271251371540 · Cited by 2
“19 Likewise, patients with bilateral vestibulopathy demonstrated increased susceptibility to tilted visual frames and greater within-group variability compared to controls, 20 illustrating the role of vestibular impairment in spatial orientation errors.”
Persistent Postural-Perceptual Dizziness
Baužaitė, I., Navickaitė, V., & Vaitkus, A. (2024) · Neurologijos seminarai · doi:10.15388/ns.2024.28.101.3 · Cited by 1
Sick in the City: A clinician's perspective
Kane, J., & Beyts, J. (2018) · Emotion, space and society · doi:10.1016/j.emospa.2018.03.001 · Cited by 1
Staab, J. P. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780198834380.003.0028 · Cited by 1
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Self-citationMild Traumatic Brain Injury Rehabilitation
Subbarao, B. S., Tapia, R. N., & Eapen, B. C. (2018) · Springer eBooks · doi:10.1007/978-3-319-74672-2_18
Epidemiology of Vestibular Impairments
Grill, E. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-809324-5.23887-x
Visual vertigo treatment through optokinetic stimulation with stationary anchoring
Chang, C.-P., & Hain, T. C. (2020) · Physiotherapy Research and Reports · doi:10.15761/prr.1000133
“The basic framework of calculating a destabilizing potential with the ratio of the foreground and background areas and the difference between their relative velocities also provide a simple, objective way to calculate the visual dependence threshold of a VV patient, which is valuable since available objective and cons…”
BackgroundTrends in vestibular pathology: persistent postural perceptual dizziness (PPPD)
Cîrpaciu, D., Budu, V. A., & Goanţă, C. M. (2022) · ORL ro · doi:10.26416/orl.57.4.2022.7288
Verwirrtes Gehirn – Funktioneller Schwindel
Saul, A. K. (2023) · physiopraxis · doi:10.1055/a-2130-2973 · Cited by 2
The principles of balance assessment and rehabilitation
Pavlou, M., & Whitney, S. L. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780198834380.003.0016
Self-citationOscillopsia and visuo-vestibular symptoms
Bronstein, A. M. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780198834380.003.0012
Self-citationVisual Motion Sensitivity in Vestibular Migraine
Bourdillon, A. T., Allen, J. W., Smith, J. L., Ahluwalia, V., Gore, R. K., & Sharon, J. D. (2026) · Otology & Neurotology · doi:10.1097/mao.0000000000004948
Meyer, S., Beppi, C., Bockisch, C. J., Penner, M., Straumann, D., & Feddermann‐Demont, N. (2026) · Brain Sciences · doi:10.3390/brainsci16070719
“This integrated approach allows for high-precision and individualised clinical diagnosis, ensuring appropriate management even for possible outliers within the vestibular population [35].”
InfluentialToward a neuroergonomic understanding of spatial disorientation
Carriot, J., Mackrous, I., Brochu, P., Corcos, S., Pelletier, M.-A., & Chacron, M. J. (2026) · Frontiers in Physiology · doi:10.3389/fphys.2026.1912219
Vestibular Rehabilitation for Unilateral Vestibular Hypofunction: A Clinical Practice Guideline
Wu, P., Yang, J., Nie, G., & Li, H. (2026) · ENT Discovery · doi:10.15302/entd.2026.090005
Metadata
- Authors
- Pavlou, M., Davies, R. A., & Bronstein, A. M.
- Affiliations
- King's College London (GB)
- National Hospital for Neurology and Neurosurgery (GB)
- Imperial College London (GB)
- Corresponding author
- Pavlou, Marousa
- Venue
- Journal of Vestibular Research
- Publisher
- SAGE Publications
- Published
- 2007-02-01
- Volume
- 16
- Issue
- 4-5
- Pages
- 223-231
- ISSN
- 0957-4271 (ISSN-L)
- 1878-6464
- OpenAlex
- W4295836492
- Cited by
- 77
- References
- 0
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 6 · 2023: 5 · 2022: 5 · 2021: 4 · 2020: 6 · 2019: 7 · 2018: 7 · 2017: 7 · 2016: 5 · 2015: 4 · 2014: 3 · 2013: 1 · 2012: 2
- FWCI
- 0.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Vestibular Research (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Keywords
- visual vertigo, chronic dizziness, vestibular dysfunction, computerized dynamic posturography, rod-and-frame test, anxiety, depression, Vertigo Symptom Scale, lightheadedness
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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