Emergency Department Vestibular Rehabilitation Therapy for Dizziness and Vertigo

Study Overview
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Brief Summary
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ED-VeRT will enroll up to 125 adult emergency department (ED) patients presenting with a chief complaint of dizziness or vertigo to collect longitudinal outcomes over 3 months of follow-up. This will include 50 patients who were evaluated by an ED physical therapist (ie, vestibular rehabilitation) during their ED visit and 50 patients who received usual care. The aims of this trial are to: (1) obtain initial estimates of participant recruitment and retention, intra-cluster correlation, and between-group outcome differences that will inform sample size calculation for a future randomized clinical trial, and (2) assess feasibility and fidelity of a clinical classification protocol for undifferentiated dizziness among patients receiving ED vestibular rehabilitation.

Official Title
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A Pilot Feasibility Trial of Emergency Department Vestibular Rehabilitation Therapy for Dizziness and Vertigo

Conditions
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Dizziness, Vertigo

Intervention / Treatment
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* Behavioral: Vestibular Rehabilitation
* Other: Usual Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Chief complaint relating to dizziness or vertigo Ability to complete follow-up data collection electronically or by telephone English-speaking Exclusion Criteria: Severe neurologic deficit concerning for ischemic or hemorrhagic stroke Known pregnancy, under police custody, unable to consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| ED Physical Therapy<br>Patients in the ED physical therapy group will have been evaluated by an emergency department physical therapist for dizziness/vertigo during their index ED visit. | Behavioral: Vestibular Rehabilitation<br>* Vestibular Rehabilitation refers to the specific interventions that physical therapists provide to patients with dizziness and vertigo symptoms. These interventions can involve repositioning maneuvers, habituation exercises, gaze stabilization, and/or balance training exercises, depending on the specific etiology of dizziness and vertigo per an established clinical protocol utilizing a patient's history and exam findings. Physical therapists instruct patients in how to perform these exercises at home and provide instructions and referral for patients to follow-up with an outpatient physical therapist for further care.<br>|
| Usual Care<br>Patients in the usual care group will NOT have received an evaluation by an ED physical therapist for dizziness/vertigo symptoms during their index ED visit. | Other: Usual Care<br>* Usual Care refers to any combination of diagnostic testing, medications, and patient education or counseling provided by a patient's treating ED physician.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Dizziness Handicap Inventory (DHI) | The DHI contains 25 items quantifying self-perceived handicapping effects of dizziness symptoms. | Three months after the index ED visit. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Vestibular Activities Avoidance Instrument (VAAI-9) | The VAAI-9 identifies fear avoidance beliefs in persons with dizziness. The VAAI-9 is the 9-item short form version of the VAAI. | Three months after the index ED visit. | 
| ED Diagnostic Imaging Utilization | The proportion of ED visits in which any diagnostic imaging of the brain was performed, including computed tomography and magnetic resonance imaging. | Index ED visit (one day) | 
| ED Length of Stay | Total length of stay, inclusive of hospitalizations and observation stays. | Index ED visit (up to one week) | 
| Patient-Reported Medication Use in Last 24 Hours | Patient-reported medication use for dizziness will be collected using a standardized instrument assess whether participants have taken any dizziness medication in the last 24 hours (binary yes/no). The 24-hour timeframe was selected to maximize accuracy in patient recall. In brief, dizziness medications are listed by brand and generic names; a yes response to any medication triggers an additional query asking the participant to specify the medication dose (e.g., meclizine 25mg) and quantity (e.g., one pill). | Three months after the index ED visit. |