Use of Physical Therapy and Subsequent Falls Among Patients With Dizziness in the US

Abstract

ImportanceAmong adults who present for clinical evaluation of dizziness, there is a critical need to identify interventions, such as physical therapy (PT), to mitigate the risk of falls over time.ObjectiveThe primary objective was to examine the association between receipt of PT and falls requiring medical care within 12 months of presentation for dizziness. Secondary objectives included identification of factors associated with falls requiring medical care and factors associated with receipt of PT after presentation for dizziness.Design, Setting, and ParticipantsThis cross-sectional study examined US commercial insurance and Medicare Advantage claims from January 1, 2006, through December 31, 2015. In all, 805 454 patients 18 years or older with a new diagnosis of symptomatic dizziness or vestibular disorders were identified. Data were analyzed from October 1, 2021, to February 1, 2023.Main Outcomes and MeasuresReceipt of PT services and the incidence of falls requiring medical care were measured. The association between receipt of PT and falls that occurred 12 months after presentation for dizziness was estimated after accounting for presentation setting (outpatient clinic or emergency department), Charlson Comorbidity Index (CCI; with higher scores indicating greater morbidity), diagnosis code, and sociodemographic characteristics.ResultsA total of 805 454 patients presented for dizziness from 2006 through 2015 (median [range] age, 52 [18-87] years; 502 055 females [62%]). Of these patients, 45 771 (6%) received PT within 3 months of presentation for dizziness and 60 060 (7%) experienced a fall resulting in a medical encounter within 12 months after presentation for dizziness. In adjusted models, patients least likely to receive PT were female (adjusted odds ratio [AOR], 0.80; 95% CI, 0.78-0.81), those aged 50 to 59 years (AOR, 0.67 [95% CI, 0.65-0.70] compared with patients aged 18-39 years), and those with more comorbidities (AOR, 0.71 [95% CI, 0.70-0.73] for CCI ≥ 2 vs 0). Receipt of PT services within 3 months of presentation for dizziness was associated with a reduced risk of falls over the subsequent 12 months, with the greatest risk reduction found within 3 months after PT (AOR, 0.14 [95% CI, 0.14-0.15] at 3-12 months vs 0.18 [95% CI, 0.18-0.19] at 6-12 months and 0.23 [95% CI, 0.23-0.24] at 9-12 months).Conclusions and RelevanceResults of this cohort study suggest that receipt of PT after presentation for dizziness was associated with a reduction in fall risk during the subsequent 12 months; thus, timely PT referral for dizziness may be beneficial for these patients. Future research, ideally with a clinical trial design, is needed to explore the independent impact of PT on subsequent falls for adults with dizziness.

Tooth Extraction and Osteoradionecrosis

“…We appreciate the suggestion to consider waiting for 10 to 14 days after TE as a reasonable approach to reduce the risk of ORN, a suggestion that is supported by the findings of our study. 1 We did not, however, conclude that a 2-week waiting period be recommended between TE and RT. This recommendation, when applied uniformly, would have resulted in a delay to starting RT in 78% of the patients included in the study.…”

“…Erkan Topkan, MD Efsun Somay, PhD Ugur Selek, PhD In Reply We thank Topkan et al for their thoughtful and insightful comments on our recent publication titled "Dental Extractions Before Radiation Therapy and the Risk of Osteoradionecrosis in Patients With Head and Neck Cancer." 1 We appreciate their engagement with our work and welcome the opportunity to address the concerns raised.…”

Physical Therapy and Risk of Falls Among Patients With Dizziness

“…Third, the study defines individuals who sought PT assistance within 3 months of their initial medical consultation for dizziness as those who received PT. It is important to acknowledge that several variables could potentially affect the effectiveness of the treatment, including the timing of rehabilitation initiation, frequency of sessions, duration of therapy, and whether patients engaged practice in home .…”

“…Despite the useful information provided by Marmor et al, we raised some concerns about potential confounding factors such as frailty, general balance, and course of PT. We believe further clarification of commonly used definitions of comorbidity associated with falls can help enhance the credibility of the study.…”

Physical Therapy And Risk of Falls Among Patients With Dizziness—Reply

“…Despite these imperfections, the CCI remains the most widely used comorbidity index, boasting more than 10 000 citations. Its appeal, especially in administrative studies like ours, lies in its utility and generalizability for large cohorts and its adaptability for use with administrative data …”