Dizziness - Melbourne Health Website
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Transcript Dizziness - Melbourne Health Website
Dizziness:
from an ad hoc approach to a
Vestibular Rehabilitation
Service
Evidence Week 2007
Anne McGann
Clinical Gr 4 Physiotherapist
Coordinator RMH Falls & Balance Clinic
Churchill Fellow 2003
Background
Dizziness is the most frequently reported symptom
for people > 75yrs seeking medical assistance
(Sloane & Dallara 1999)
34% Falls Clinic clients reported dizziness as a
symptom
28% have vestibular dysfunction at initial assessment
A standardised approach to clinical screening
and improved knowledge and skills in the
assessment & management of vestibular
dysfunction may further improve outcomes for
these clients
(K. Murray et al, unpublished NARI report 2003)
Background…….
Skill base was not in the workforce to enable
appropriate screening, assessment and management
of patients with dizziness
Access to opportunities to upskill clinicians in this
area - very limited
Patients were not referred specifically for
management of dizziness
Anecdotally, many patients reported dizziness as a
co-existing symptom to the presentation
Background…….
Churchill Fellowship 2003
visited and viewed models of Vestibular
diagnostic and rehabilitation services in
USA and UK
Completed competency - based Vestibular
Rehabilitation Service in Atlanta
Met with international experts and
researchers in the field of Vestibular
diagnostics and rehabilitation
Royal Melbourne Hospital
Vestibular Rehabilitation
Service
Royal Melbourne Hospital - Royal Park Campus
Vestibular Rehabilitation Service (VRS)
established in May 2004
Comprises a multidisciplinary team
0.4 EFT Physiotherapist
0.1 EFT Occupational Therapist
0.025 EFT Clinical Psychology
Medical Support via Falls & Balance Clinic
Patient Flow Through
Service
Initial Assessment (Physio)
OT
Clin Psych
Vestibular Rehab Program
(Physio & home exercise program)
Discharge
3 month Review Appointment (Physio)
Results
Initial Assessment
Vestibular Rehab Program (n=86)
Failed to
complete
program
Discharge(n=65)
(n= 21)*
3 month Review Appointment (n=45)
* Not included in analyses
Results
Population
Age (mean [SD]) years
Females (%)
CALD (%)
- interpreters
61.8 [15.2]
60
58.5
40
Falls: 1 or more (%)
Chronicity of symptoms
> 6 months (%)
> 3 years (%)
52.3
86
47.7
Results
Diagnosis
Unilateral peripheral
Bilateral peripheral
Central
Meniere’s
Non-specific dizziness
BPPV
Central & Peripheral
+ Anxiety
10
1
2
18
4
4
4
4
1
5
3
3
+BPPV
3
2
1
Total
Total
31
5
8
1
9
7
4
65
Summary: 48% diagnosed with unilateral peripheral
57% presented with co-existing anxiety
Dizziness Handicap Inventory
60
50
***
40
30
***
20
***
***
10
0
Functional
Physical
Initial
*** p<0.001
Emotional
Post Program
Total
Dizziness Handicap Inventory
3 month follow-up
60
***
***
50
40
30
20
***
***
***
***
***
***
10
0
Functional
Initial
*** p<0.001
Physical
Emotional
Post Program
3 month f/up
Total
Results – Balance tests
STATIC BALANCE
35
30
DYNAMIC BALANCE
***
***
25
**
20
***
***
15
10
5
0
Foam FT
EC (secs)
Sharpened Single Limb
Rom EC Stance EO
(secs)
(secs)
Initial
** p<0.01; *** p<0.001
Step Test
(steps
/15sec)
Post Program
Functional Timed Up
Reach (cm) & Go (sec)
Results – Balance tests
40
STATIC BALANCE
DYNAMIC BALANCE
35
30
25
**
***
**
***
**
20
***
***
*
***
***
15
10
5
0
Foam FT
EC (secs)
Sharpened Single Limb
Rom EC Stance EO
(secs)
(secs)
Initial
* p<0.05; ** p<0.01; *** p<0.001
Step Test
(steps
/15sec)
Post Program
Functional Timed Up
Reach (cms) & Go (sec)
3 month f/up
Results
There were no significant differences in
clinical outcomes or LOS based on:
age (<55yrs; 56 – 70yrs; 70yrs+ )
gender
anxiety (present vs absent)
diagnosis
chronicity of symptoms
CALD
In Summary
A new Vestibular Rehabilitation Service was
implemented based on EBP 3 years ago
RMH VRS was one of the first established Public
Health Vestibular Rehabilitation Services in Vic
Majority of clients present to our Vestibular
Rehabilitation Service with chronic symptoms and
falls
Anxiety is common
A multidisciplinary exercise based VRS can improve
patient outcomes, particularly self-perceived
handicap and balance
In addition
Improved access to post graduate training in
Vestibular Rehabilitation
APA Introduction to Vestibular Rehabilitation x 2-3
yearly
Atlanta Competency Based Vestibular
Rehabilitation course held in Melbourne Nov 06
Increasing number of Vestibular
Rehabilitation Services and skilled
physiotherapists in Vic….and Australia – wide
Acknowledgements
Investigation of overseas VR models
Anne McGann was supported by the Winston
Churchill Memorial Trust prior to start up of our
own VRS
Establishment of RMH VRS
Thanks to Professor Keith Hill for his role in
establishing and providing ongoing support of
our service