Vestibular Therapy in ED Shows Promise for Dizziness

TOPLINE:

Emergency department vestibular rehabilitation therapy (ED-VeRT) was feasible and reduced symptoms and vestibular activity in patients who presented with dizziness in the ED, a new study reported.

METHODOLOGY:

• This nonrandomized clinical trial enrolled participants (median age, 52 years; 58% women; 49% White) presenting with dizziness or vertigo at an ED in Chicago from 2021 to 2023.
• Participants received either ED-VeRT (n = 55), delivered by physical therapists using a protocolized diagnostic classification algorithm, or usual care (n = 51), as determined by the treating physician.
• The primary outcome was the change in the Dizziness Handicap Inventory (DHI) score, and secondary outcomes were the change in the Vestibular Activities Avoidance Inventory-9 (VAAI-9) score, patient-reported medication use in the past 24 hours, and ED visit characteristics over 3 months of follow-up.

TAKEAWAY:

• Among the 366 patients screened, 125 were enrolled, with 105 (84%) retained in longitudinal data collection, highlighting the feasibility of ED-VeRT.
• Among the participants receiving ED-VeRT, diagnostic classifications included benign paroxysmal positional vertigo (37.1%), triggered undifferentiated dizziness (22.6%), spontaneous undifferentiated dizziness (22.6%), and unilateral peripheral hypofunction (14.5%).
• At 3 months, participants receiving ED-VeRT had lower DHI scores (mean difference, −1.68; 95% CI, −11.30 to 7.90) and VAAI-9 scores (mean difference, −2.27; 95% CI, −8.40 to 3.86) than those receiving usual care.
• Compared with participants receiving usual care, those receiving ED-VeRT had higher rates of discharge (66% vs 75%) and lower diagnostic imaging use (CT brain: 71% vs 56%).

IN PRACTICE:

“This present study represents a notable departure from the extant dizziness literature as it focuses on the patient-oriented outcome of dizziness-related disability,” the authors wrote. “The data generated from this pilot study may subsequently inform the design and sample size calculations of a multisite randomized clinical trial of ED vestibular therapy for dizziness and vertigo,” they added.

SOURCE:

The study was led by Howard S. Kim, MD, MS, Northwestern University Feinberg School of Medicine, Chicago. It was published online on February 14, 2025, in JAMA Network Open.

LIMITATIONS:

The study was limited by its nonrandomized design and unmeasured variables that were not accounted for in the analysis. Participants receiving ED-VeRT reported higher baseline symptom scores than those receiving usual care. The sample size was small, and analyses were potentially underpowered. Additionally, a single physical therapist performed most vestibular evaluations, potentially limiting the generalizability of the findings.

DISCLOSURES:

The study received support from the Davee Foundation and the Agency for Healthcare Research and Quality (grant R01HS027426). Howard S. Kim, MD, MS, reported receiving a stipend from the American Medical Association as a deputy editor for JAMA Network Open, outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.