Does training therapists to manage benign paroxysmal positional vertigo in patients with acute traumatic brain injury reduce vestibular neurology referrals?

Marroney, Natalie; Beattie, Jenna; Hildebrand, Natalie; Flint, Thomas P.; Smith, Rebecca

doi:10.1080/02699052.2022.2034955

Cited by 2 publications

(6 citation statements)

References 19 publications

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“… 62 There is a precedent for physiotherapists taking on vestibular roles, however few occupational therapists appear to practice in this area in the UK. 20 This trend is not limited to TBI, as a majority of physiotherapists work with vestibular patients in other although mainly outpatient areas. 49 63 However, the roles physiotherapists and occupational therapists undertake can and do overlap, as noted by studies of inpatient stroke rehabilitation, where such overlap was found to benefit patient care.…”

Section: Discussionmentioning

confidence: 99%

“…Such strategies have been found to be effective in other areas 62. There is a precedent for physiotherapists taking on vestibular roles, however few occupational therapists appear to practice in this area in the UK 20. This trend is not limited to TBI, as a majority of physiotherapists work with vestibular patients in other although mainly outpatient areas 49 63.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies noted long delays to diagnosis and treatment, 8 and large discrepancies in assessment and treatment practices between trauma centres. 20 Potential explanations for a lack of routine vestibular management in aTBI include: (1) limited wardbased vestibular expertise, (2) absence of recommendations for vestibular assessment or treatment in national early management of head injury guidelines 21 and (3) a newly described but common clinical phenomenon called vestibular agnosia (blunting of vestibular perception in patients with moderate-severe aTBI). 22 The lack of vestibular expertise on major trauma wards is perhaps not surprising since the complexity of vestibular dysfunction has only recently been elucidated, 4 5 22 and vestibular neurologists/specialists do not appear in the current list of recommended trauma wardbased healthcare professionals.…”

Section: Open Accessmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Why are patients with acute traumatic brain injury not routinely assessed or treated for vestibular dysfunction in the UK? A qualitative study

et al. 2023

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ObjectivesVestibular dysfunction is common in patients with acute traumatic brain injury (aTBI). Persisting vestibular symptoms (ie, dizziness and imbalance) are linked to poor physical, psychological and socioeconomic outcomes. However, routine management of vestibular dysfunction in aTBI is not always standard practice. We aimed to identify and explore any healthcare professional barriers or facilitators to managing vestibular dysfunction in aTBI.DesignA qualitative approach was used. Data were collected using face to face, semi-structured interviews and analysed using the Framework approach.SettingTwo major trauma centres in London, UK.Participants28 healthcare professionals participated: 11 occupational therapists, 8 physiotherapists and 9 surgical/trauma doctors.ResultsVestibular assessment and treatment were not routinely undertaken by trauma ward staff. Uncertainty regarding responsibility for vestibular management on the trauma ward was perceived to lead to gaps in patient care. Interestingly, the term dizziness was sometimes perceived as an ‘invisible’ and vague phenomenon, leading to difficulties identifying or ‘proving’ dizziness and a tendency for making non-specific diagnoses. Barriers to routine assessment and treatment included limited knowledge and skills, a lack of local or national guidelines, insufficient training and concerns regarding the practical aspects of managing vestibular dysfunction. Of current trauma ward staff, therapists were identified as appropriate healthcare professionals to adopt new behaviours regarding management of a common form of vestibular dysfunction (benign paroxysmal positional vertigo). Strategies to support this behaviour change include heightened clarity around role, implementation of local or national guidelines, improved access to training and multidisciplinary support from experts in vestibular dysfunction.ConclusionsThis study has highlighted that role and knowledge barriers exist to multidisciplinary management of vestibular dysfunction in aTBI. Trauma ward therapists were identified as the most appropriate healthcare professionals to adopt new behaviours. Several strategies are proposed to facilitate such behaviour change.Trial registration numberISRCTN91943864.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Open Accessmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Why are patients with acute traumatic brain injury not routinely assessed or treated for vestibular dysfunction in the UK? A qualitative study

et al. 2023

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“…Further details regarding the training delivered to ward therapists have been documented previously. 23 …”

Section: Design and Methodsmentioning

confidence: 99%

Treating benign paroxysmal positional vertigo in acute traumatic brain injury: a prospective, randomised clinical trial assessing safety, feasibility, and efficacy

Smith,

Burgess,

Beattie

et al. 2024

BMJ Neurol Open

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BackgroundBenign paroxysmal positional vertigo (BPPV) affects approximately half of acute, moderate-severe traumatic brain injury (TBI) patients. To date, there have been no rigorous studies of BPPV assessment or treatment in this cohort. We aimed to determine the safety, practicability, and efficacy of therapist-led BPPV management in acute TBI and the feasibility of a larger effectiveness trial.MethodsThis was a multi-centre, three-arm, parallel-groups, randomised, feasibility trial. Recruitment was via convenience sampling. The main inclusion criteria were age over 18 years and a confirmed, non-penetrating, acute TBI. BPPV-positive patients were randomly allocated to one of three interventions (repositioning manoeuvres, Brandt–Daroff exercises or advice) using minimisation criteria. Outcome assessors were blinded to the intervention.ResultsOf 2014 patients screened for inclusion, 180 were assessed for BPPV. Of those assessed, 34% (62/180) had BPPV, and 58 patients received an intervention. Therapist-led interventions were delivered safely and accurately according to intervention monitoring criteria. Resolution of BPPV was observed in 35/58 (60%) patients. The resolution rate was highest following repositioning manoeuvres (78%), followed by the advice (53%) and Brandt–Daroff interventions (42%). 10 patients experienced recurrence. This was observed more frequently in those with skull fractures and bilateral or mixed BPPV.ConclusionsOverall, the results provide strong evidence for the feasibility of a future trial. Therapist-led management of BPPV in acute TBI was safe and practicable. Repositioning manoeuvres seemingly yielded a superior treatment effect. However, given the high recurrence rate of post-traumatic BPPV, the optimal time to treat according to patients’ specific recurrence risk requires further investigation.Trial registrationISRCTN91943864,https://doi.org/10.1186/ISRCTN91943864.

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Does training therapists to manage benign paroxysmal positional vertigo in patients with acute traumatic brain injury reduce vestibular neurology referrals?

Cited by 2 publications

References 19 publications

Why are patients with acute traumatic brain injury not routinely assessed or treated for vestibular dysfunction in the UK? A qualitative study

Why are patients with acute traumatic brain injury not routinely assessed or treated for vestibular dysfunction in the UK? A qualitative study

Treating benign paroxysmal positional vertigo in acute traumatic brain injury: a prospective, randomised clinical trial assessing safety, feasibility, and efficacy

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