Routine benign paroxysmal positional vertigo (BPPV) physiotherapy management: a feasibility study

Abstract

Background Benign paroxysmal positional vertigo (BPPV) is common in older adults with a falls history. The feasibility of routine physiotherapy management in subacute inpatients is not known. Objective Examine the feasibility of implementing routine BPPV physiotherapy management in older subacute inpatients and ascertain the proportion BPPV positive. Methods Subacute inpatients aged ≥50 years sustaining a fall within six months were assessed for BPPV. Feasibility was defined as >75% of eligible patients able to be assessed for BPPV. Implementation was also evaluated through surveys completed by study physiotherapists. Demographic, falls, medical history, frailty, functional mobility information and modified dizziness handicap inventory (DHI) versions were also collected. Results Overall, 67% of 447 eligible patients underwent BPPV assessment; 301 completed ≥ one BPPV assessment, 146 could not be assessed, most commonly due to physical limitation, cognition precluding assessment, declining assessment or discharged prior. Physiotherapists perceived BPPV management to be acceptable (88%), appropriate (90%) and feasible (76%) however constrained by patient-factors, time required and environmental barriers. BPPV was found in 6% of those assessed, with 35% reporting current dizziness or unsteadiness. Modified DHI scores were significantly higher in those BPPV positive (5-item P ≤ .001; 8-item P = .001). Conclusion BPPV management was not feasible in this population predominantly due to physical limitations and cognitive impairment. Physiotherapists perceive BPPV management as important but difficult amongst these patient-factors and competing clinical priorities. Subjective symptoms may not indicate BPPV risk, however, the 5-item DHI may identify need for individual assessment.