A substantial opportunity to deliver effective and efficient care for patients with a common and disabling disorder is being squandered. Currently, patients diagnosed with Benign Paroxysmal Positional Vertigo (BPPV) are more likely to undergo unnecessary and expensive tests and to be treated with potentially harmful medications than they are to receive an evidence-based, highly effective, and simple treatment called the canalith repositioning maneuver (CRM). In this project we aim to develop a patient-oriented intervention regarding BPPV and to demonstrate the potential future value of it. BPPV is among the most common causes of dizziness and results in disabling symptoms. The disorder stems from free-floating particles that enter a semi-circular canal (canaliths) of the inner ear. BPPV is diagnosed based on the clinical history and a simple bedside test, the Dix-Hallpike test (DHT), and then treated with the CRM in minutes at the bedside. BPPV patients randomized to the CRM have a cure rate of 80% at 24 hours compared with only 10% of patients randomized to a sham maneuver. These evidence-based processes are supported by two independently generated society guideline statements (American Academy of Otolaryngology-Head and Neck Survey and the American Academy of Neurology). Despite this, the underuse of these processes has been shown in several different settings. A population-based study of emergency departments (ED) found that among patients diagnosed with BPPV by the treating physician, 78% did not have the DHT and 96.1% did not have a CRM. In fact, other tests (e.g., head CT scans) and treatments (e.g., medicines) are more commonly utilized in ED patients diagnosed with BPPV - a finding that highlights inefficiencies. Recent and preliminary research demonstrates substantial patient demand for online BPPV tools based on a systematic review of YouTube videos and Google keyword searches. Significant shortcomings of the current YouTube videos have also been uncovered, including lack of diagnostic information and errors in the demonstration. In preparation for future trials, we first need to develop the intervention and demonstrate the potential value of it. The current project aims to develop an intervention for the diagnosis and treatment of BPPV from the patient's perspective and then to demonstrate that it has appropriate discriminatory characteristics, that patients using the intervention can perform the positional movements accurately, and that a representative sample of the US population scores measures of behavioral intent favorable to its use. Rigorous methods, incorporating quantitative and qualitative data collection and analysis, will be used to develop the intervention and demonstrate its potential value. These are critical first steps toward our long-term goal to improve the outcomes of patients with BPPV and simultaneously reduce healthcare inefficiencies. For this project, an outstanding trans-disciplinary team has been assembled including expertise in neurology, otolaryngology, physical therapy, patient decision aids, and video production.
Benign Paroxysmal Positional Vertigo (BPPV) is common and causes disabling symptoms. Guideline- supported, evidence-based, effective practices exist, but the processes are substantially underused, resulting in missed opportunities to deliver effective and efficient care. This project aims to develop an intervention for the diagnosis/treatment of BPPV from the patient perspective and to demonstrate key aspects of its potential value.
|Saber Tehrani, Ali S; Kattah, Jorge C; Kerber, Kevin A et al. (2018) Diagnosing Stroke in Acute Dizziness and Vertigo: Pitfalls and Pearls. Stroke 49:788-795|
|Callaghan, Brian C; Burke, James F; Skolarus, Lesli E et al. (2016) Medicare's Reimbursement Reduction for Nerve Conduction Studies: Effect on Use and Payments. JAMA Intern Med 176:697-9|
|Callaghan, Brian; Kerber, Kevin; Langa, Kenneth M et al. (2015) Longitudinal patient-oriented outcomes in neuropathy: Importance of early detection and falls. Neurology 85:71-9|
|Kerber, Kevin A; Meurer, William J; Brown, Devin L et al. (2015) Stroke risk stratification in acute dizziness presentations: A prospective imaging-based study. Neurology 85:1869-78|