Health care utilization, prognosis and outcomes of vestibular disease in primary care settings: systematic review

Grill, Eva; Penger, Mathias; Kentala, Erna

doi:10.1007/s00415-015-7913-2

Cited by 62 publications

(68 citation statements)

References 48 publications

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“…Although some studies have reported a similar effect on symptom resolution in patients treated with the EM regardless of whether they had a positive DHT with or without nystagmus, 9,25 the authors found that the manoeuvre only resulted in significant improvements in DHT responses and vertigo severity in patients with nystagmus. In view of the conflicting results, the authors believe that the decision to treat patients with a positive DHT without nystagmus should be taken at the clinician's discretion, on a case-by-case basis.…”

Section: Comparison With Existing Literaturementioning

confidence: 95%

“…8 Little is known about the use of the EM in primary care, even though approximately 60% to 80% of patients with BPPV are first seen by a GP. There have also been reports of suboptimal management of vertigo and BPPV in this setting due to poor awareness 9 and inadequate use of diagnostic and treatment tools. [10][11][12][13] Munoz et al 14 reported an improvement in nystagmus (evaluated by the DHT), but not in vertigo symptoms, 1 week after treatment in primary care.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of the Epley manoeuvre in posterior canal benign paroxysmal positional vertigo: a randomised clinical trial in primary care

et al. 2018

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BackgroundEvidence on the effectiveness of the Epley manoeuvre in primary care is scarce.AimTo evaluate effectiveness at 1 week, 1 month, and 1 year of a single Epley manoeuvre versus a sham manoeuvre in primary care.Design and settingMulticentre, double-blind randomised controlled trial in two primary care practices in Spain from November 2012 to January 2015.MethodPatients were ≥18 years diagnosed with subjective or objective posterior benign paroxysmal positional vertigo (vertigo only, or vertigo and nystagmus after a Dix–Hallpike test [DHT]). The intervention group received the Epley manoeuvre, and the control group received a sham manoeuvre. Betahistine was prescribed following the same regimen in both groups. The main outcome measures were the DHT result classified as negative (neither vertigo nor nystagmus) or positive. Positive results were further divided into a positive result for both vertigo and nystagmus (positive DHT with nystagmus), and a positive result for vertigo only (positive DHT without nystagmus); self-reported resolution of vertigo; and self-reported severity of vertigo evaluated on a 10-point Likert scale (10 = worst imaginable vertigo).ResultsIn total, 134 patients were randomised to either the intervention group (n = 66) or the sham group (n = 68). The intervention group showed better results in the unadjusted analyses at 1 week, with a lower rate of positive DHT with nystagmus (P = 0.022). A positive baseline DHT with nystagmus was associated with a reduction in vertigo severity (marginal effect for 10-point Likert-like question −1.73, 95% confidence interval [CI] = −2.95 to −0.51) and better positive DHT rates in the intervention group (adjusted odds ratio 0.09, 95% CI = 0.01 to 0.92) in the multivariate analyses.ConclusionA single Epley manoeuvre performed in primary care is an effective treatment for reversing a positive DHT and reducing vertigo severity in patients with baseline nystagmus in the DHT.

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Section: Comparison With Existing Literaturementioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Effectiveness of the Epley manoeuvre in posterior canal benign paroxysmal positional vertigo: a randomised clinical trial in primary care

et al. 2018

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“…The most important reasons are restrictions in mobility, falls and secondary psychological consequences like anxiety, panic disorders or depression [4,5]. In chronic vestibular disorders, several factors were identified, which contribute to symptom severity, HRQoL and psychological comorbidity [6][7][8]. Symptom intensity in chronic central and functional vestibular disorders is higher than in peripheral vestibular disorders.…”

Section: Introductionmentioning

confidence: 99%

Health‐related quality of life and functional impairment in acute vestibular disorders

Möhwald

Hadzhikolev

Bardins

et al. 2020

Euro J of Neurology

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Background and purpose Acute vestibular symptoms have a profound impact on patients’ well‐being. In this study, health‐related quality of life (HRQoL) and functional impairment were investigated prospectively in patients with different peripheral and central vestibular disorders during the acute symptomatic stage to decipher the most relevant underlying factors. Methods In all, 175 patients with acute vestibular disorders were categorized as central vestibular (CV, n = 40), peripheral vestibular (PV, n = 68) and episodic vestibular disorders (EV, n = 67). All patients completed scores to quantify generic HRQoL (European Quality of Life Score Five Dimensions Five Levels, EQ‐5D‐5L) and disease‐specific HRQoL (Dizziness Handicap Inventory, DHI). Vestibular‐ocular motor signs were assessed by video‐oculography, vestibular‐spinal control by posturography and verticality perception by measurement of subjective visual vertical. Results Patients with PV had a poorer HRQoL compared to patients with CV and EV (EQ‐5D‐5L/DHI: PV, 0.53 ± 0.31/56.1 ± 19.7; CV, 0.66 ± 0.28/43.3 ± 24.0; EV, 0.75 ± 0.24/46.7 ± 21.4). After adjusting for age, gender, cardiovascular risk factors and non‐vestibular brainstem/cerebellar dysfunction patients with PV persisted to have poorer generic and disease‐specific HRQoL (EQ‐5D‐5L −0.17, DHI +11.2) than patients with CV. Horizontal spontaneous nystagmus was a highly relevant factor for subgroup differences in EQ‐5D‐5L and DHI, whilst vertical spontaneous nystagmus, subjective visual vertical and sway path were not. EQ‐5D‐5L decreased significantly with more intense horizontal subjective visual vertical in CV (rho = −0.57) and PV (rho = −0.5) but not EV (rho = −0.13). Conclusions Patients with PV have the highest functional impairment of all patients with acute vestibular disorders. Vestibular‐ocular motor disturbance in the yaw plane has more impact than vestibular‐spinal or vestibular‐perceptive asymmetry in the roll and pitch plane, suggesting that horizontal visual stability is the most critical for HRQoL.

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“…identi cation of appropriate patients was di cult and cannot be explained by characteristics of the GP practices alone. We hypothesize the frequently reported problem of diagnosing VBD, which favours extensive health care utilization [14,15] might have led to that issue.…”

Section: Discussionmentioning

confidence: 99%

“…Occurrence of these symptoms are common reasons for consultation in general practice, with stated consultation prevalence up to 15.5% [10]. Due to multifactorial aetiology [8,[11][12][13], the overutilization of health care in affected patients insu ciently treated in primary care has been shown [14,15]. Physical therapy is likely to be a valuable component in the management of patients with VDB regarding consequences like imbalance and falls that result in limited mobility and participation restrictions [16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Improving mobility and participation of older people with vertigo, dizziness and balance disorders in primary care using a care pathway: feasibility study and process evaluation

Seckler

Regauer

Krüger

et al. 2020

Preprint

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BackgroundCommunity-dwelling older people are frequently affected by vertigo, dizziness and balance disorders (VDB). We previously developed a Care Pathway (CPW) to improve their mobility and participation by offering standardised approaches for general practitioners (GPs) and physical therapists (PTs). We aimed to assess the feasibility of the intervention, its implementation strategy and the study procedures in preparation for the subsequent main trial.MethodsThis 12-week prospective cohort feasibility study was accompanied by a process evaluation designed according to the UK Medical Research Council’s guidance for developing and evaluating complex interventions. Patients with VDB (≥ 65 years), GPs and PTs in primary care were included. Intervention consisted of a diagnostic screening checklist for GPs and a guide for PTs. Implementation strategy contained specific educational trainings and a telephone helpline. Data for mixed-method process evaluation was collected via standardised questionnaires, field notes and qualitative interviews. Quantitative data were analysed using descriptive statistics, qualitative data via content analysis.ResultsA total of five GP practices (seven single GPs), 10 PT practices and 22 patients were included in the study. The recruitment of GPs and patients was challenging (response rate GP practices: 27,8%; PT practices: 38,5%). 91% of patients and all health professionals completed the study. The health professionals responded well to the educational trainings, the utilization of the telephone helpline was low (one call each from GPs and PTs). Routine in the intervention’s application and positive attitudes were emphasised as facilitators for the interventions’ implementation, whereas lack of time was mentioned as a barrier. Despite of difficulties in GPs’ adherence to intervention protocol, GPs, PTs and patients benefited from the intervention. The patients’ treatment adherence to physical therapy was good. There were minor issues in data collection, but no unintended consequences.ConclusionAlthough the process evaluation provides good support for the feasibility of study procedures, the intervention and its implementation strategy, we identified a need of improvement in recruitment, the GPs’ intervention part and data collection procedures. Findings will inform the main trial to prove the interventions effectiveness in a cluster RCT.Trial registrationDeutsches Register Klinischer Studien (German Clinical Trials Register) DRKS00022918, date of registration: 03.09.2020 (retrospectively registered); Projektdatenbank Versorgungsforschung Deutschland (German registry Health Services Research) VfD_MobilE-PHY_17_003910, date of registration: 30.11.2017

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Health care utilization, prognosis and outcomes of vestibular disease in primary care settings: systematic review

Cited by 62 publications

References 48 publications

Effectiveness of the Epley manoeuvre in posterior canal benign paroxysmal positional vertigo: a randomised clinical trial in primary care

Effectiveness of the Epley manoeuvre in posterior canal benign paroxysmal positional vertigo: a randomised clinical trial in primary care

Health‐related quality of life and functional impairment in acute vestibular disorders

Improving mobility and participation of older people with vertigo, dizziness and balance disorders in primary care using a care pathway: feasibility study and process evaluation

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