Health care utilization, prognosis and outcomes of vestibular disease in primary care settings: systematic review (original) (raw)
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A systematic review of vertigo in primary care
The British journal of general practice : the journal of the Royal College of General Practitioners, 2001
The symptom of vertigo is usually managed in primary care without further referral. This review examines the evidence on which general practitioners can base clinical diagnosis and management of this relatively common complaint. Research in this area has in the main been from secondary and tertiary centres and has been of variable quality. Indications are that the conditions that present in general practice are most likely to be benign positional vertigo, acute vestibular neuronitis, and Ménière's disease; however, vascular incidents and neurological causes, such as multiple sclerosis, must be kept in mind. An important practice point is that vestibular sedatives are not recommended on a prolonged basis for any type of vertigo. There is a need for basic epidemiological and clinical management research of vertigo in general practice.
Health services utilization of patients with vertigo in primary care: a retrospective cohort study
Journal of Neurology, 2014
Vertigo and dizziness count among the most frequent symptoms in outpatient practices. Although most vestibular disorders are manageable, they are often underand misdiagnosed in primary care. This may result in prolonged absence from work, increased resource use and, potentially, in chronification. Reliable information on health services utilization of patients with vertigo in primary care is scarce. Retrospective cohort study in patients referred to a tertiary care balance clinic. Included patients had a confirmed diagnosis of benign paroxysmal positional vertigo (BPPV), Menière's disease (MD), vestibular paroxysmia (VP), bilateral vestibulopathy (BVP), vestibular migraine (VM), or psychogenic vertigo (PSY). All previous diagnostic and therapeutic measures prior to the first visit to the clinic were recorded. 2,374 patients were included (19.7 % BPPV, 12.7 % MD, 5.8 % VP, 7.2 % BVP, 14.1 % VM, 40.6 % PSY), 61.3 % with more than two consultations. Most frequent diagnostic measures were magnetic resonance imaging (MRI, 76.2 %, 71 % in BPPV) and electrocardiography (53.5 %). Most frequent therapies were medication (61.0 %) and physical therapy (41.3 %). 37.3 % had received homoeopathic medication (39 % in BPPV), and 25.9 % were treated with betahistine (20 % in BPPV). Patients had undergone on average 3.2 (median 3.0, maximum 6) diagnostic measures, had received 1.8 (median 2.0, maximum 8) therapies and 1.8 (median 1.0, maximum 17) different drugs. Diagnostic subgroups differed significantly regarding number of diagnostic measures, therapies and drugs. The results emphasize the need for establishing systematic training to improve oto-neurological skills in primary care services not specialized on the treatment of dizzy patients.
Journal of neurology, 2015
To investigate the long-term outcome of interdisciplinary treatment in a tertiary care neuro-otology institution after 2 years as part of the Dizziness and Vertigo Registry study. Risk factors associated with unfavourable outcome were assessed. 3113 consecutive patients with disorders of vertigo and dizziness were recruited prospectively between March 2010 and February 2012. Patients were clinically assessed and treated according to their diagnosis. Standardized instruments were used at baseline and at 2-year follow-up [Dizziness Handicap Inventory (DHI), Quality of Life Questionnaire, General Depression Scale, Stait-Trait Anxiety Index], as well as a custom health-related questionnaire. The primary outcome variable of this observational study was the change in DHI after 2 years. Patients suffered from phobic postural vertigo (23 %), benign peripheral paroxysmal vertigo (14.4 %), unilateral vestibulopathy (10.5 %), central vestibular disorders (8 %), Menière's disease (9.8 %), v...
2020
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 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.
Current medical research and opinion, 2018
Vertigo and dizziness are highly prevalent symptoms in primary care, frequently misdiagnosed. Based on a thorough need assessment, INDICORE (INform, DIagnose, COmmunicate, REfer), an evidence-based complex intervention has been developed to transfer knowledge of specialized tertiary clinics to primary care providers (PCPs), improve the referral process and, ultimately, improve the functioning and quality of life of patients with vertigo/dizziness. The main objective of the PRIMA-Vertigo pilot study is to examine whether the INDICORE intervention is feasible and sufficiently promising to warrant a larger trial. We plan to perform a single-blind, pragmatic cluster-randomized controlled pilot study with an accompanying process evaluation. PCPs will be the cluster units of randomization. Patients who consult these PCPs because of vertigo/dizziness symptoms will be included consecutively and considered the units of analysis. The intervention will be multi-faceted training on diagnostics ...
Symptoms of vertigo in general practice: a prospective study of diagnosis
The British journal of general practice : the journal of the Royal College of General Practitioners, 2002
There is little published evidence of the general practice experience of the diagnostic outcomes when symptoms of vertigo present. What research there is has been dominated by specialist centres. This gives a skewed view of the prevalence of the causes of such symptoms. To describe the likely diagnosis of symptoms of vertigo. Prospective cohort study Thirteen GPs were recruited and trained to clinically assess and follow up all patients presenting with symptoms of vertigo over a six-month period Age-sex data were simultaneously gathered on those who consulted with non-vertiginous dizziness. The main diagnoses assigned by the GPs in 70 patients were benign positional vertigo, acute vestibular neuronitis and Ménière's disease, which together accounted for 93% (95% confidence interval = 71% to 100%) of patients' symptoms. Ninety-one per cent of patients were managed in general practice and 60% received a prescription for a vestibular sedative. This study suggests that presentat...
The Burden and Impact of Vertigo: Findings from the REVERT Patient Registry
Frontiers in Neurology, 2013
Objective: Despite the high prevalence of vertigo globally and an acknowledged, but underreported, effect on an individual's wellbeing, few studies have evaluated the burden on healthcare systems and society. This study was aimed to quantitatively determine the impact of vertigo on healthcare resource use and work productivity. Methods: The economic burden of vertigo was assessed through a multi-country, noninterventional, observational registry of vertigo patients: the Registry to Evaluate the Burden of Disease in Vertigo. Patients included were those with a new diagnosis of Meniere's disease, benign paroxysmal positional vertigo, other vertigo of peripheral vestibular origin, or peripheral vestibular vertigo of unknown origin. Results: A total of 4,294 patients at 618 centers in 13 countries were included during the registry. Of the 4,105 patients analyzed, only half were in employment. Among this working patient population, 69.8% had reduced their workload, 63.3% had lost working days, and 4.6% had changed and 5.7% had quit their jobs, due to vertigo symptoms. Use of healthcare services among patients was high. In the 3 months preceding Visit 1, patients used emergency services 0.4 ± 0.9 times, primary care consultations 1.6 ± 1.8 times, and specialist consultations 1.4 ± 2.0 times (all mean ± SD). A mean of 2.0 ± 5.4 days/patient was also spent in hospital due to vertigo. Conclusion: In addition to the negative impact on the patient from a humanistic perspective, vertigo has considerable impact on work productivity and healthcare resource use.
Kulak burun boğaz ihtisas dergisi : KBB = Journal of ear, nose, and throat, 2015
This study aims to establish a "Vertigo Council Diagnosis Questionnaire" for patients with chronic vestibular dysfunction and show the reliability of this questionnaire. A "Vertigo Council Diagnosis Questionnaire" consisting of 10 questions was prepared by 15 specialist physicians and analyzed for reliability using the "translation-back-translation" method. When all the items of our questionnaire were evaluated, the content validity ratio ranged from 0.6 to 0.87, and the content validity index was 0.676. The conformity ratio between the real diagnosis and the diagnosis based on the questionnaire was 63.19%, and the kappa was 0.441 (moderate). No significant difference was found between the first and second responses to any of the questions (p>0.05). There was no significant difference between question conformity (conformity between the first and second responses) and diagnostic conformity (conformity between the real diagnosis and the diagnosis based...
The European Journal of Public Health, 2013
Background: Complaints of vertigo and dizziness are common in primary care in the aged. They can be caused by distinct vestibular disorders, but can also be a symptom in other conditions like non-vestibular sensory loss, vascular encephalopathy or anxiety. The aim of this study was to investigate the specific contribution of vertigo and dizziness to the total burden of disability in aged persons when controlling for the presence of other health conditions. Methods: Data originate from the MONICA/KORA study, a population-based cohort. Survivors of the original cohorts who were 65 years and older were examined by telephone interview in 2009. Disability was assessed with the Health Assessment Questionnaire. Logistic regression was used to adjust for potential confounders and additive regression to estimate the contribution of vertigo and dizziness to disability prevalence. Results: Adjusted for age, sex and other chronic conditions, vertigo and dizziness were associated with disability (odds ratio 1.66, 95% confidence intervals 1.40-1.98). In both men and women between 65 and 79 years, vertigo and dizziness were among the strongest contributors to the burden of disability with a prevalence of 10.5% (6.6 to 15.1) in men and 9.0% (5.7 to 13.0) in women. In men, this effect is stable across all age-groups, whereas it decreases with age in women. Conclusions: Vertigo and dizziness independently and relevantly contribute to population-attributable disability in the aged. They are not inevitable consequences of ageing but arise from distinct disease entities. Careful management of vertigo and dizziness might increase population health and reduce disability.
Outcome evaluation of the dizziness handicap inventory in an outpatient vestibular clinic
Journal of Vestibular Research, 2017
BACKGROUND: The DHI is a widely used questionnaire for the evaluation of the self-reported disability in patients with dizziness and balance problems. OBJECTIVE: To investigate the relationship between the DHI scores and demographic, symptomatic and diagnostic parameters. METHODS: Retrospective study in 568 patients with balance problems. RESULTS: We observed a total of 61.3% of patients with moderate (DHI total score between 30 and 59) to severe (DHI total score between 60 and 100) disability. Patients with long-standing complaints (lasting longer than 3 months) experience their self-reported disability to a greater extent than patients with new onset pathology (illness duration of one month and less). Moreover, patients suffering from continuous complaints have a larger DHI score than patients with shorter symptom duration. The first effect (new onset vs. long-standing pathology) is primarily caused by emotional factors, the latter effect (symptom duration) is attributable to functional and physical factors, not to emotional aspects. Patients with daily and weekly complaints have larger DHI scores than patients who reported only one episode. Female patients reported larger DHI scores than males. We found no effect of age, diagnostic group (no diagnosis, episodic, acute or chronic vestibular syndrome) or reported symptoms on the DHI scores. CONCLUSIONS: The information retrieved from the DHI questionnaire is complementary to the information obtained from clinical investigation and diagnostic tests and therefore is an essential tool in a vestibular clinic.