Early Outcomes from the Vestibular Rehabilitation Service

Anne McGann, Assoc Prof Keith Hill, Dr Julie Bernhardt, Jeanie Iverson,

Dr Emma Gollings & Joanne Pearce

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• 34% Falls Clinic clients reported dizziness as a symptom (K. Murray et al, unpublished NARI report 2003)

– 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

RMH Vestibular Rehabilitation Service

RMH Royal Park Campus Vestibular Rehabilitation Service (VRS) established in May 2004

• Comprises a multidisciplinary team– 0.2 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)

Outcomes Measured

Initial / Discharge / 3mth Review– Dizziness Handicap Inventory (DHI)

Physical, Functional, Emotional (Jacobson & Newman 1990)

– CTSIB (foam EC)– Functional Reach (FR)– Sharpened Romberg (Eyes Closed)– Step Test– Timed Up & Go (TUG)

Referral Source

Vestibular Specialists 61%NeurologistsENTsNeuro-OpthalmologistsVestibular Services

Other 39%GPsOther Allied HealthMedical Clinics eg Pain Clinic

Results

* Not included in analyses

Initial Assessment (n=45)

Vestibular Rehab Program (n=35, 10 current*)

Discharge (n=26)

3 month Review Appointment (n=13)

Failed to complete program (n=9)*

Therapy Input (n=26)

% patients receiving therapy:

• Physiotherapy 100% (10 session Av)

• Clinical psychology 32%

• Occupational therapy 32%

Results

Population

Age (mean [SD]) 60 [15] years

Females (%) 69

Falls: 1 or more (%) 65

Chronicity of symptoms

> 6 months (%) 92

> 2 years (%) 73

Diagnosis + Anxiety +BPPV Total

Unilateral peripheral 6 4 1 11Bilateral peripheral 2 2Central 1 2 1 4Meniere’s 1 1

Non-specific dizziness 3 3 6BPPV 1 1 2 Total 26

Summary: 42% diagnosed with unilateral peripheral 46% presented with co-existing anxiety

Results

0

10

20

30

40

50

60

Function

al

Emot

ional

Physica

l

Total

AdmissionDischargeM

ean

DH

I S

core

Dizziness Handicap Inventory

** *

*

*p < 0.005

0

10

20

30

40

50

60

Function

al

Emot

ional

Physica

l

Total

AdmissionDischarge

3 month#

Mea

n D

HI

Sco

re

Dizziness Handicap Inventory

#(n=13)

** *

*

*p 0.01

Results – Balance TestsM

ean

Sco

re (

unit

s)

0

5

10

15

20

25

30

35

AdmissionDischarge

*p < 0.005

*

**

SharpRom EC

Foam FT EC

Step Test FunctReach

TUG

Static Dynamic

(secs) (secs)(secs)(no. steps)

(cm)

Mea

n S

core

(un

its)

0

5

10

15

20

25

30

35

AdmissionDischarge3 month #

Results – Balance Tests

SharpRom EC

Foam FT EC

Step Test FunctReach

TUG

Static Dynamic

(secs) (secs)(secs)(no. steps)

(cm)

#(n=13)

Results

• Age, gender and anxiety did not impact on outcomes

• The need for Clinical Psych did influence LOS in program (p< .05) Psych 13 PT sessions (Av) No Psych 8 PT sessions (Av)

In Summary • Most clients present to our Vestibular Rehabilitation

Service with chronic symptoms and falls

• Anxiety is common

• A multidisciplinary VRS can improve patient

outcomes, particularly self-perceived handicap

• Gains were maintained but did not continue at 3

month review

Where To From Here?

• Our waitlist is too long

• Plan– Increase Physiotherapy 0.6EFT

– Increase Clinical Psych 0.3EFT

• Continue evaluation of service

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 Assoc Prof Keith Hill for his role in establishing and

providing ongoing support of our service