Authors (including presenting author) :
YEUNG CSS, LEE KWS, CHAN CMA
Affiliation :
Physiotherapy Department, Queen Elizabeth Hospital
Introduction :
Dizziness and vertigo are one of the most common complaints of patients in Emergency Medicine (EM) ward. It is a vague complaint and poses a diagnostic challenge in clinical management. Evidences stated that approximately 24% to 43% of EM ward patients who presented with dizziness and vertigo had vestibular disorders, including Benign Paroxysmal Positional Vertigo (BPPV), vestibular hypofunction, acute vestibular neuritis, etc.
American Academy of Otolaryngology Clinical Practice Guideline on BPPV stated that vestibular physiotherapy was effective in terms of detection of vestibular dysfunction, symptoms control and promotion of functional improvement. Although half of the patients with BPPV could spontaneously recover within 1 to 3 months, the severity of the symptoms and functional impairment significantly disturb the daily lives of the patients. Implementation of early vestibular physiotherapy service in EM ward aimed to provide early physiotherapy assessment and management and to identify suitable cases for further prompt follow-ups in out-patient settings for enhancing symptoms control and functional recovery for patients with BPPV and other vestibular disorders.
Objectives :
(1) To describe the continued physiotherapy care pathway of BPPV patients from EM ward to out-patient physiotherapy setting
(2) To review the clinical improvement of the reviewed patients
Methodology :
A total of 4 patients (3 male and 1 female, aged 58-73 years old) who admitted to EM ward of the Queen Elizabeth Hospital (QEH) with diagnosis of vertigo and referred for physiotherapy were reviewed. Early vestibular physiotherapy was started in EM ward including detailed assessments for screening vestibular pathology and symptoms management was provided. The cases were subsequently arranged for early out-patient physiotherapy appointment for further management. Outcome measures included Visual Analog Scale (VAS) of Dizziness and Vertigo, Dynamic Gait Index (DGI), Berg Balance Scale (BBS) and Numeric Global Rating of Change Scale in terms of symptoms and physical function improvement.
Result & Outcome :
After the detailed screening conducted by experienced physiotherapist in EM ward, the physical diagnosis made were BPPV. Consecutive sessions of in-patient physiotherapy management including particle repositioning maneuver and mobility training were provided with significant symptoms alleviation. All patients were followed up at physiotherapy out-patient clinic within 14 days after the patient discharged from the EM ward. Further particle repositioning maneuver and patient education were provided in out-patient physiotherapy sessions. All patients showed significant improvement and discharged from out-patient physiotherapy treatment in 3-5 sessions. Outcome measures were recorded and compared between the first session in EM ward and the last session in out-patient unit. All outcome measures showed improvement. The severity of dizziness decreased from 6.25 to 0 out of 10 in VAS of Dizziness and Vertigo, DGI score increased from 18.75 to 24 out of 24 and BBS score increased from 53 to 54 out of 56. Our case study demonstrated that early vestibular physiotherapy service was effective in identification and management for patients with BPPV from EM ward to out-patient setting, which resulted in early recovery of symptoms and functions compared with the average spontaneous recovery timeframe of these patients.
