Evaluating diagnostic and management agreement between physiotherapists and ear, nose and throat specialist in a primary contact physiotherapy-led vestibular clinic: A prospective blinded inter-rater agreement study

Abstract

Background: Dizziness and vertigo are common referrals to Ear Nose Throat (ENT) outpatient services however these services have long waitlists for assessment. While a primary contact physiotherapy-led vestibular clinics is recognized at improving access to care, no published literature has reported on the safety and diagnostic accuracy of such a service. This study investigates diagnostic and management agreement between physiotherapists and ENT specialist for patients attending a primary contact physiotherapy-led vestibular clinic. Methods: Prospective blinded inter-rater agreement study undertaken in an ENT primary contact physiotherapy-led vestibular clinic. Participants included adults referred to ENT from general practitioners, triaged (Category 2 or 3) to the primary contact physiotherapy-led vestibular clinic with clinical symptoms consistent with vestibular disorder. Primary outcome measures included diagnoses and management decisions (imaging, ENT/ neurology/ physiotherapy management). Adverse events were reviewed 11 months post data collection. Percentage agreement and Gwet’s first order agreement co-efficient (AC1) calculated inter-rater reliability between physiotherapy and ENT. Results: Fifty-one participants were recruited consecutively from the primary contact physiotherapy-led vestibular clinic. Physiotherapy and ENT had a 78% agreement on categorised diagnosis. Agreements between physiotherapy and ENT for recommending Magnetic resonance imaging was 86%, and 94% for computorised tomography. There was moderate to near-perfect agreement regarding management recommendations between physiotherapy and ENT. An 82% agreement was found for recommendations to ENT, 94% for neurology and 73% for physiotherapy. There were no adverse events from physiotherapist’s management decision, based on final recommendations undertaken 11-months post data collection. Conclusions: Physiotherapists and ENT made comparable diagnostic and management decisions, based on physiotherapy assessment, for adults with signs of vestibular dysfunction, within an ENT primary contact physiotherapy-led vestibular clinic. This provides reassurance about the competency and safety of vestibular physiotherapists in the management of patients with dizziness.

Pitfalls, patience and patients: developing a physiotherapy-led balance clinic

“…The process of developing this clinic has been challenging, but ultimately rewarding. Despite having confidence in the validity and effectiveness of the model, as previously detailed, [12][13][14][15] the local commissioning requirement for data from a local pilot took a significant amount of time. Unfortunately, this seems a familiar story across the National Health Service (NHS), which likely stops many projects in their tracks, despite significant evidence already being out there.…”

“…Training was undertaken to provide parity between the diagnosis and management processes between the lead physiotherapists and ENT medics. 15 A six-month pilot was agreed, providing two physiotherapy-led balance clinics a week. Patient referrals to ENT were triaged by ENT consultants.…”