Early Outcomes from the Vestibular Rehabilitation Service Anne McGann, Assoc Prof Keith Hill, Dr...
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Transcript of Early Outcomes from the Vestibular Rehabilitation Service Anne McGann, Assoc Prof Keith Hill, Dr...
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• 34% Falls Clinic clients reported dizziness as a symptom (K. Murray et al, unpublished NARI report 2003)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