Dizziness, Vertigo
Conditions
Brief summary
ED-VeRT will enroll up to 125 adult emergency department (ED) patients presenting with a chief complaint of dizziness or vertigo to collect longitudinal outcomes over 3 months of follow-up. This will include 50 patients who were evaluated by an ED physical therapist (ie, vestibular rehabilitation) during their ED visit and 50 patients who received usual care. The aims of this trial are to: (1) obtain initial estimates of participant recruitment and retention, intra-cluster correlation, and between-group outcome differences that will inform sample size calculation for a future randomized clinical trial, and (2) assess feasibility and fidelity of a clinical classification protocol for undifferentiated dizziness among patients receiving ED vestibular rehabilitation.
Interventions
BEHAVIORALVestibular Rehabilitation
Vestibular Rehabilitation refers to the specific interventions that physical therapists provide to patients with dizziness and vertigo symptoms. These interventions can involve repositioning maneuvers, habituation exercises, gaze stabilization, and/or balance training exercises, depending on the specific etiology of dizziness and vertigo per an established clinical protocol utilizing a patient's history and exam findings. Physical therapists instruct patients in how to perform these exercises at home and provide instructions and referral for patients to follow-up with an outpatient physical therapist for further care.
OTHERUsual Care
Usual Care refers to any combination of diagnostic testing, medications, and patient education or counseling provided by a patient's treating ED physician.
Sponsors
Northwestern University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Chief complaint relating to dizziness or vertigo * Ability to complete follow-up data collection electronically or by telephone * English-speaking
Exclusion criteria
* Severe neurologic deficit concerning for ischemic or hemorrhagic stroke * Known pregnancy, under police custody, unable to consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Dizziness Handicap Inventory (DHI) | Three months after the index ED visit. | The DHI contains 25 items quantifying self-perceived handicapping effects of dizziness symptoms. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Vestibular Activities Avoidance Instrument (VAAI-9) | Three months after the index ED visit. | The VAAI-9 identifies fear avoidance beliefs in persons with dizziness. The VAAI-9 is the 9-item short form version of the VAAI. |
| ED Diagnostic Imaging Utilization | Index ED visit (one day) | The proportion of ED visits in which any diagnostic imaging of the brain was performed, including computed tomography and magnetic resonance imaging. |
| ED Length of Stay | Index ED visit (up to one week) | Total length of stay, inclusive of hospitalizations and observation stays. |
| Patient-Reported Medication Use in Last 24 Hours | Three months after the index ED visit. | Patient-reported medication use for dizziness will be collected using a standardized instrument assess whether participants have taken any dizziness medication in the last 24 hours (binary yes/no). The 24-hour timeframe was selected to maximize accuracy in patient recall. In brief, dizziness medications are listed by brand and generic names; a yes response to any medication triggers an additional query asking the participant to specify the medication dose (e.g., meclizine 25mg) and quantity (e.g., one pill). |
Other
| Measure | Time frame | Description |
|---|---|---|
| Global Rating of Change (GROC) | Three months after the index ED visit. | The GROC is a single-item survey used to evaluate overall recovery from the time that symptoms began until now. Responses are provided on a 15-point Likert scale ranging from a very great deal worse to a very great deal better. |
| Numeric Rating Scale (NRS) | Three months after the index ED visit. | The NRS measures intensity of dizziness symptoms from 0 to 10. Participants will report average dizziness intensity over the last 24 hours. |
| Advanced Healthcare Utilization | Three months after the index ED visit. | Proportion of participants who utilized any advanced healthcare resources for dizziness after their index ED visit, defined as advanced imaging (e.g., computed tomography, magnetic resonance imaging) or procedures/surgery. |
| Benzodiazepine Prescription Filling | Three months after the index ED visit | Benzodiazepine prescription filling data will be queried in the state prescription monitoring database. |
| Follow-up with Outpatient Physical Therapy | Three months after the index ED visit | Proportion of participants who reports outpatient physical therapy follow-up for vestibular rehabilitation |
Countries
United States
Outcome results
None listed