Assessment and treatment of patients with long-term dizziness in primary care

Project summary

Dizziness is common and a troublesome health problem. Dizziness may arise for a variety of reasons, but reports indicate that in around 50 % of those seeking health care for dizziness, it is associated with a vestibular disorder. A vestibular disorder is characterized by an abrupt onset, general malaise, vertigo, visual problems and unsteadiness. In most cases the general condition improves within weeks, but vestibular symptoms may remain in about 30 % of the cases. Long-lasting symptoms is often accompanied by co-morbidities like anxiety/worries and musculoskeletal pain, and increased rates of sickness absence and disability pension.

 

Vestibular Rehabilitation (VR) is considered the most efficient treatment for vestibular hypofunciton. Cognitive behavioral therapy (CBT) alone, or CBT in addition to VR seem to have limited effect. However, in the latter case, CT and VR have been given in a sequential order, not as an integrated model.

 

The main aims of the present study are to investigate an intervention combining VR, body awareness and CBT given in a group format. After a thorough examination, patients undergo a one-time consultation (brief intervention) consisting of information, reassurance and advice regarding the need to stay active before they are randomized to either the group treatment or exercises on their own and follow-up by telephone.

 

It is also of great importance to examine sustaining and exaggerating factors which may prevent recovery. Specifically, we will examine the importance of musculoskeletal problems in this context.

 

Qualitative data will be collected from both patients and health personnel to provide new knowledge about experiences and challenges throughout the project period. 

 

Sub projects

1. Health, function, dizziness symptoms and quality of life in patients with long-lasting dizziness in primary care. A cross sectional study
2. Effect of a group based treatment combining vestibular rehabilitation, body awareness and cognitive behavioral therapy on health, function and dizziness symptoms in patients with long-lasting dizziness. A randomized controlled study
3. A feasibility study on a group based treatment combining vestibular rehabilitation , body awareness and cognitive behavioral therapy and for patients with persistent dizziness – Treatment Protocol and preliminary results 
4. Prognostic factors for improvement after a group based treatment of vestibular rehabilitation, body awareness and cognitive behavioral therapy.
5. Test-retest reliability and clinical important change are examined in a selection of the outcome measures
6. Patients’ perceptions and experiences of participation in a group based treatment of vestibular rehabilitation, body awareness and cognitive behavioral therapy.

 

Method

A multi-center RCT (n=126), including patients with long-term dizziness will be conducted in order to assess the effect of an individually given consultation (brief intervention, BI) and a group based VR+CBT (intervention group), compared to BI alone (control group). Prior to the RCT, a feasibility study will be carried out to examine the feasibility of the separate parts of the study.

Baseline characteristica, and prognostic factors for recovery will be examined. 

Qualitative studies examining patients experiences will be conducted

Test-retest reliability of physical tests will be examined.