Influence of Vestibular Diagnosis and Management on Recommended Discharge Environment for Hospitalized Inpatients
Authors: Lammers Kerry , Kumble Sowyma , Sperle Christina , McCarty John Bradley , Steinhorn Gabrielle 
Published: December 2019

Purpose:
Despite the prevalence of dizziness and vertigo, evidence examining the impact of acute vestibular physical therapy evaluation and intervention for patients reporting these symptoms in the acute care setting is limited. Recent evidence indicates that patients may present with vestibular impairments without obvious symptoms; however, physical therapists are not routinely evaluating for vestibular dysfunction in hospitalized adults. The primary purpose of this study was to determine the influence and feasibility of vestibular physical therapy evaluation and treatment on recommended discharge environment for hospitalized inpatients.

Methods:
A retrospective chart review was conducted of patients who were referred for vestibular physical therapy evaluation and treatment after not responding to conventional balance intervention during hospitalization. Primary outcome measures included change in recommended discharge environment and time in minutes for the vestibular encounter. Secondary outcomes included the Activity Measure for Post-Acute Care (AM-PAC) Basic Mobility Score and the Johns Hopkins Highest Level of Mobility (JH-HLM) Scale from prior to vestibular encounter and upon discharge.

Results:
Twenty-two patients who met inclusion criteria were included for analysis. Of the patients evaluated for vestibular impairment, less than 5% had been admitted for symptoms of dizziness. A statistically significant change in recommended discharge environment after the vestibular physical therapy encounter was found (χ2 = 64.86, P < .001), with an associated 54.5% reduction in the number of patients requiring inpatient rehabilitation. Average session duration for all vestibular encounters was—mean (SD) [range]—57.59 (21.19) [30-120] minutes. Significant differences in functional mobility from prior to the vestibular encounter to discharge were found for both the JH-HLM (P = .003) and the AM-PAC (P = .050).

Discussion:
This study demonstrates that identifying and treating hospitalized patients with vestibular impairments regardless of having a primary admitting diagnosis of vestibular impairment may influence the recommended discharge environment resulting in higher levels of mobility during and after hospitalization. While a higher overall treatment time was required to address vestibular impairments during hospitalization, the significant reduction in patients recommended for inpatient rehabilitation suggests potential for significant health care dollar savings for both the patient and the institution. Further exploration is needed to investigate vestibular intervention and overall reduction in length of stay.

Conclusion:
By providing a more comprehensive approach to evaluation and assessment, acute care physical therapists can have a profound impact in early identification of vestibular impairments in hospitalized inpatients, thus providing more focused therapy interventions, promoting more rapid improvements in functional mobility, and facilitating discharge to the most appropriate destination.