Vestibular Physiotherapy Patients May Require Medical Assessment: Results of Vertigo Audit in Hutt Hospital

Results of a vertigo audit in Hutt Hospital

  • Shyh Poh Teo Mail Department of Internal Medicine, Geriatrics and Palliative Unit, RIPAS Hospital, Brunei Darussalam.
Keywords:
Vestibular physiotherapy, Vertigo, Dizziness; Benign paroxysmal positional vertigo

Abstract

Introduction: To identify the type of referrals received by vestibular physiotherapists for vertigo and assess whether medical review for these patients would be appropriate.
Materials and Methods: We performed a retrospective review of referral forms, vestibular assessment forms, and vertigo clinic letters of patients referred for vertigo or vestibular physiotherapy input between July 1, 2013, to December 31, 2013.
Results: We studied 29 patients with a median age of 63 years. A diagnosis was provided in 65.5% of the referrals. Of 14 patients with possible benign paroxysmal positional vertigo (BPPV), Dix-Hallpike had been performed only for 4 patients. Almost half were seen for the medical review in the Vertigo Clinic due to the concerns of possible alternative non-vestibular diagnosis, medication issues, or syncope. Alternative diagnoses identified medically included orthostatic hypotension, stroke, vestibular migraine, medication-induced bradycardia, and phobic postural vertigo. Medication changes in vertigo clinic included treatment for heart failure, migraine, and medication optimization.
Conclusion: Medical review is appropriate for some patients referred for vestibular physiotherapy. A medical opinion should be sought by vestibular physiotherapists if there is uncertainty or concerns that the referred patients did not have straightforward vestibular problems, or there were possible alternative diagnoses, concerns with medications, or syncope.

References

1. Kwong ECK, Pimlott NJG. Assessment of dizziness among older patients at a family practice clinic: A chart audit study. BMC Family Practice. 2005; 6(1):2. [DOI:10.1186/1471-2296-6-2] [PMID] [PMCID]
2. Bird JC, Beynon GJ, Prevost AT, Baguley DM. An analysis of referral patterns for dizziness in the primary care setting. British Journal of General Practice. 1998; 48(437):1828-32. [PMID] [PMCID]
3. Hanley K, O’Dowd T, Considine N. A systematic review of vertigo in primary care. British Journal of General Practice. 2001; 51(469):666-71. [PMID] [PMCID]
4. Kroneke K, Lucas CA, Rosenberg ML, Scherokman B, Herbers Jr JE, Wehrle PA, et al. Causes of persistent dizziness. A prospective study of 100 patients in ambulatory care. Annals of Internal Medicine. 1992; 117(11):898-904. [DOI:10.7326/0003-4819-117-11-898] [PMID]
5. Brandt T, Strupp M. General vestibular testing. Clinical Neurophysiology. 2005; 116(2):406-26. [DOI:10.1016/j.clinph.2004.08.009] [PMID]
6. Halmagyi GM, Cremer PD. Assessment and treatment of dizziness. Journal of Neurology, Neurosurgery & Psychiatry. 2000; 68(2):129-36. [DOI:10.1136/jnnp.68.2.129] [PMID] [PMCID]
7. Luxon LM. Evaluation and management of the dizzy patient. Journal of Neurology Neurosurgery and Psychiatry. 2004; 75(Suppl 4):iv45-iv52. [DOI:10.1136/jnnp.2004.055285] [PMID] [PMCID]
8. Labuguen RH. Initial evaluation of vertigo. American Family Physician. 2006; 73(2):244-51. [PMID]
9. Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S, et al. Clinical practice guideline: Benign paroxysmal positional vertigo. Otolaryngology-Head and Neck Surgery. 2008; 139(Suppl 5):47-81. [DOI:10.1016/j.otohns.2008.08.022] [PMID]
10. Kaski D, Seemungal BM. The bedside assessment of vertigo. Clinical Medicine. 2010; 10(4):402-5. [DOI:10.7861/clinmedicine.10-4-402] [PMID] [PMCID]
Published
2020-08-01
How to Cite
1.
Teo SP. Vestibular Physiotherapy Patients May Require Medical Assessment: Results of Vertigo Audit in Hutt Hospital. jmr. 14(2):89-96.
Section
Original Article(s)