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Implementing vestibular rehabilitation in the emergency department is feasible and may lead to improved patient-reported symptoms of dizziness over time.
A pilot clinical trial suggests that providing vestibular rehabilitation therapy directly in emergency departments (ED) is not only feasible but may offer symptom relief for patients presenting with dizziness. In this nonrandomized clinical trial conducted at a single urban ED, researchers investigated the utility of delivering ED vestibular rehabilitation therapy (ED-VeRT) to those presenting with dizziness. The study also tracked patient-reported outcomes over a 3-month period.
A total of 366 patients were screened, with 125 ultimately enrolled (median age 52 years; 58% female; 49% White). Of those, 63 subjects (50.4%) received ED vestibular therapy delivered by a physical therapist using a structured classification and treatment protocol. Diagnoses were categorized into four types: benign paroxysmal positional vertigo (37.1%), triggered undifferentiated dizziness (22.6%), spontaneous undifferentiated dizziness (22.6%), and unilateral peripheral hypofunction (14.5%).
Feasibility outcomes were promising. Retention in longitudinal follow-up reached 84% over 3 months, suggesting strong patient engagement with the intervention. Moreover, those who received vestibular therapy showed trends toward reduced dizziness-related disability, as measured by improvements in Dizziness Handicap Inventory (DHI; mean difference: −1.68) and Vestibular Activities Avoidance Inventory-9 (VAAI-9) scores (mean difference: −2.27) at the 3-month mark.
These differences did not reach statistical significance, likely due to the small sample size and pilot nature of the study. However, the direction of effect suggests a potential benefit, especially considering the brief and protocolized nature of the intervention. Furthermore, ED-VeRT patients appeared to use fewer sedating medications over time, a clinically meaningful trend that aligns with safer, more targeted treatment goals.
The study’s findings underscore the feasibility and potential clinical value of integrating vestibular therapy into ED workflows. Although not definitive, the results support the launch of a fully powered trial to formally test the usefulness of ED-based vestibular rehabilitation in boosting long-term outcomes for dizziness.
JAMA Network Open
Emergency Department Vestibular Rehabilitation Therapy for Dizziness and Vertigo A Nonrandomized Clinical Trial
Howard S. Kim et al.
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