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(K. Murray et al, unpublished NARI report 2003)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