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

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medical assistance (Sloane & Dallara 1999) 34% Falls Clinic clients reported dizziness as a symptom (K. Murray et al, unpublished NARI report 2003) –28% have vestibular dysfunction at initial assessment –A standardised approach to clinical screening and improved knowledge and skills in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

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

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

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)

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

Results * Not included in analyses 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)*

Therapy Input (n=26) % patients receiving therapy: Physiotherapy100%(10 session Av) Clinical psychology 32% Occupational therapy 32%

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

Diagnosis + Anxiety +BPPV Total Unilateral peripheral Bilateral peripheral 2 2 Central Meniere’s 1 1 Non-specific dizziness 33 6 BPPV 11 2 Total 26 Summary: 42% diagnosed with unilateral peripheral 46% presented with co-existing anxiety Results

Functional Emotional Physical Total Admission Discharge Mean DHI Score Dizziness Handicap Inventory * * * * *p < 0.005

Functional Emotional Physical Total Admission Discharge 3 month # Mean DHI Score Dizziness Handicap Inventory # (n=13) * * * * *p  0.01

Results – Balance Tests Mean Score (units) Admission Discharge *p < * * * Sharp Rom EC Foam FT EC Step TestFunct Reach TUG StaticDynamic (secs) (no. steps) (cm)

Mean Score (units) Admission Discharge 3 month # Results – Balance Tests Sharp Rom EC Foam FT EC Step TestFunct Reach TUG StaticDynamic (secs) (no. steps) (cm) # (n=13)

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)

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

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

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