A Multi-Site Feasibility Trial to Support Implementation of Vestibular Rehabilitation Therapy for Dizziness and Vertigo in the Emergency Department

PROJECT SUMMARY Dizziness is a common problem affecting nearly 37 million U.S. individuals annually and accounting for 2 million emergency department (ED) visits per year. Dizziness presents a substantial diagnostic challenge for clinicians because of its broad differential spanning both benign and serious diagnoses; dizziness-related language is also frequently used by patients to describe symptoms from non-balance related conditions. Thus, ED visits for dizziness commonly result in low value diagnostic testing (e.g., computed tomography, magnetic resonance imaging) and unnecessary hospital admission, which in turn contributes to escalating healthcare costs. Patients suffering from dizziness report reduced quality of life, anxiety, and depression, in addition to a substantial number of lost working days and time spent seeking healthcare. Fortunately, vestibular rehabilitation therapy delivered by physical therapists in the outpatient setting has been shown to improve dizziness symptoms for a number of balanced-related conditions. Whether vestibular rehabilitation therapy can be delivered by physical therapists in the emergency care setting – where patients have received little to no prior medical evaluation – is currently unknown but represents vast potential for benefit. This multi-site feasibility trial will evaluate the feasibility of emergency department vestibular rehabilitation therapy for patients with undifferentiated dizziness in two diverse health systems in Chicago, IL and Salt Lake City, UT. We will also gather qualitative data on contextual implementation determinants and preferred implementation strategies among stakeholders at multiple levels in preparation for a future multi-site hybrid effectiveness- implementation trial.