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Early Outcomes from the Vestibular Rehabilitation Service

Early Outcomes from the Vestibular Rehabilitation Service. Anne McGann , Assoc Prof Keith Hill, Dr Julie Bernhardt, Jeanie Iverson, Dr Emma Gollings & Joanne Pearce . Background.

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Early Outcomes from the Vestibular Rehabilitation Service

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  1. Early Outcomes from the Vestibular Rehabilitation Service Anne McGann, Assoc Prof Keith Hill, Dr Julie Bernhardt, Jeanie Iverson, Dr Emma Gollings & Joanne Pearce

  2. 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medical assistance (Sloane & Dallara 1999) • 34% Falls Clinic clients reported dizziness as a symptom (K. Murray et al, unpublished NARI report 2003) • 28% have vestibular dysfunction at initial assessment • A standardised approach to clinical screening and improved knowledge and skills in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

  3. 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

  4. Patient Flow Through Service Initial Assessment (Physio) OT Clin Psych Vestibular Rehab Program (Physio & home exercise program) Discharge 3 month Review Appointment (Physio)

  5. 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)

  6. Referral Source Vestibular Specialists 61% Neurologists ENTs Neuro-Opthalmologists Vestibular Services Other 39% GPs Other Allied Health Medical Clinics eg Pain Clinic

  7. 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)* Results * Not included in analyses

  8. Therapy Input (n=26) % patients receiving therapy: • Physiotherapy 100% (10 session Av) • Clinical psychology 32% • Occupational therapy 32%

  9. Results Population Age (mean [SD]) 60 [15] years Females (%) 69 Falls: 1 or more (%) 65 Chronicity of symptoms > 6 months (%) 92 > 2 years (%) 73

  10. Results Diagnosis+ Anxiety+BPPVTotal Unilateral peripheral 6 4 1 11 Bilateral peripheral 2 2 Central 1 2 1 4 Meniere’s 1 1 Non-specific dizziness 3 3 6 BPPV 1 1 2 Total 26 Summary: 42% diagnosed with unilateral peripheral 46% presented with co-existing anxiety

  11. Dizziness Handicap Inventory 60 * 50 40 Mean DHI Score 30 Admission * Discharge * * 20 10 0 Total Physical Emotional Functional *p < 0.005

  12. Dizziness Handicap Inventory 60 * 50 40 Mean DHI Score * 30 * Admission * Discharge 20 3 month# 10 0 #(n=13) Total Physical Emotional Functional *p 0.01

  13. Results – Balance Tests Sharp Foam Step Test Funct TUG (secs) (no. steps) Rom EC FT EC Reach (secs) (secs) (cm) Static Dynamic 35 30 * 25 Mean Score (units) 20 * Admission * Discharge 15 10 5 0 *p < 0.005

  14. Results – Balance Tests Sharp Foam Step Test Funct TUG (secs) (no. steps) Rom EC FT EC Reach (secs) (secs) (cm) Static Dynamic 35 30 25 Mean Score (units) 20 Admission Discharge 15 3 month # 10 5 0 #(n=13)

  15. 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)

  16. 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

  17. Where To From Here? • Our waitlist is too long • Plan • Increase Physiotherapy 0.6EFT • Increase Clinical Psych 0.3EFT • Continue evaluation of service

  18. 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

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