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A survey of current management of Benign Paroxysmal Positional Vertigo (BPPV) by physiotherapists’ interested in vestibular rehabilitation in the UK

  • A.J. Male
    Correspondence
    Corresponding author at: Therapy Services, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, United Kingdom.
    Affiliations
    Faculty of Health Social Care and Education, Kingston University and St. George’s University of London, Cranmer Terrace, London SW17 0RE, United Kingdom

    Therapy Services, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, United Kingdom
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  • G.M. Ramdharry
    Affiliations
    Faculty of Health Social Care and Education, Kingston University and St. George’s University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
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  • R. Grant
    Affiliations
    Faculty of Health Social Care and Education, Kingston University and St. George’s University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
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  • R.A. Davies
    Affiliations
    Department of Neuro-Otology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, United Kingdom
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  • I.D. Beith
    Affiliations
    Faculty of Health Social Care and Education, Kingston University and St. George’s University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
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Published:September 05, 2018DOI:https://doi.org/10.1016/j.physio.2018.08.007

      Abstract

      Objectives

      Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of dizziness. Extensive research has identified the best assessment and treatment manoeuvres for each subtype of BPPV. Education in vestibular rehabilitation (VR) is inconsistent. It is unclear if the evidence has been adopted by UK physiotherapists in clinical practice and no research has investigated this specifically.

      Design

      An online survey with closed- and open-text answers.

      Participants

      A purposive sample of physiotherapists interested in VR. A response rate of 67% (100/150) was obtained, from which 20 responses were excluded.

      Results

      Participants had good evidence-based awareness in assessment (79/80, 99%) and treatment (72/80, 90%) of posterior BPPV. Horizontal BPPV assessment awareness was lower than treatment (37/80, 46% vs 60/80, 75%). Differential diagnosis was poor in subjective (20/80, 25%) and objective stages of assessment (34/80, 43%). Thirty six percent (29/80) were able to list ≥3 test precautions with all three nystagmus characteristics described by 29% (23/80). Eighty one percent (65/80) encourage activity restrictions post-treatment. Only 28% (22/80) were aware of practice guidelines or Cochrane reviews in BPPV.
      External courses were rated the top method for learning how to manage BPPV. Lack of peer support (26/77, 34%) was the main challenge faced whilst learning. Recommendations for improving BPPV education included more external courses (23/87, 26%) and competency guidelines (13/87, 15%).

      Conclusions

      Good awareness of research evidence was observed in some aspects of BPPV management but many areas require development. Translation and implementation of evidence remains poor and suggests changes in education and knowledge dissemination are warranted.

      Keywords

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