Authors (including presenting author) :
Cheung WL(1), Kwan MWF(1), Ip MW(2), Kwan KCP(2), Yung CMJ(2), Tam DCM(3), Yip EW(3), Lo RLS(3), Chan EMF(1), Kwong SSF(1)
Affiliation :
(1)Physiotherapy Department, Ruttonjee and Tang Siu Kin Hospitals, (2)Department of Ear Nose & Throat, Pamela Youde Nethersole Eastern Hospital, (3)Physiotherapy Department, Pamela Youde Nethersole Eastern Hospital
Introduction :
Dizziness or vertigo affects 15-20% adults annually and severely affects daily life. Common causes included Benign Paroxysmal Positional Vertigo(BPPV) and Vestibular Hypofunction(VH). Vestibular rehabilitation(VR) is an exercise-based treatment designed to enhance gaze and postural stability, to reduce vertigo and its impact on daily living. With Computerized Dynamic Posturography (CDP) installed in 2020, its comprehensive assessment could direct doctors and physiotherapists for targeted intervention.
Objectives :
- To evaluate the structured vestibular physiotherapy intervention
- To facilitate treatment planning with CDP assessment
Methodology :
Patients referred to physiotherapy in RTSKH for dizziness or vertigo were recruited. Those with BPPV were treated with specific maneuver such as Canalith Repositioning Procedure, followed with home exercises. For patients with VH, progressive training with adaption, substitution and habituation treatment approach were adopted. CDP was arranged to evaluate dysfunction in vestibular, visual and proprioceptive system as indicated.
Result & Outcome :
From Dec 2020 to Nov 2021, 105 patients attended with 88 patients completed the program. Case-mix included BPPV (n=58;66%), VH (n=15;17%) and other diagnosis, such as Meniere's disease, vertebrobasilar insufficiency and cervicogenic headache (n=15;17%). CDP was performed for 21 patients (24%) with reports communicated with ENT Doctors via e-documentation. The mean number of treatment sessions were 3.4. The mean waiting time was 9 weeks.
For BPPV subgroup, the mean dizziness intensity measured in Visual Analogue Scale (VAS) was significantly decreased from 4.9 to 0.5 (p<0.005). Self-perceived impact of dizziness on daily life measured by Dizziness Handicap Inventory (DHI) was decreased from 34.0 to 12.1 (p<0.005). Subjective overall improvement was 90%.
For VH subgroup, VAS in dizziness was significantly reduced from 4.8 to 2.9 (p=0.009). Static balance improved significantly as represented by Single Leg Stand Test improved from 15.6 to 20.7 (p=0.04) and Sharpened Romberg Test with eye closed improved from 15.4 to 18.9 seconds (p=0.04). DHI score and Dynamic balance measured by Dynamic Gait Index showed improving trend. Subjective overall improvement was 40%.
Conclusion:
The Vestibular Physiotherapy program was effective for patients with dizziness or vertigo. CDP assessment can guide tailor-made intervention for Doctors and Physiotherapist along patient’s journey.
