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Alhakami BA, Almarwani MM. Assessment of Saudi Physicians and Physical Therapists' Adherence to the Updated Clinical Practice Guideline for Benign Paroxysmal Positional Vertigo: A Cross-Sectional Study. Int Arch Otorhinolaryngol 2022; 27:e67-e76. [PMID: 36714907 PMCID: PMC9879653 DOI: 10.1055/s-0042-1742775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/14/2021] [Indexed: 02/01/2023] Open
Abstract
Introduction Variations in clinical practice regarding the management of benign paroxysmal positional vertigo (BPPV) among clinicians have been noted in previous studies. Such variations might be related to the different adherence to clinical practice guidelines. Objective To evaluate clinicians' adherence to BPPV guidelines and investigate the variations in the adherence between different specialties and qualifications. Methods This is a cross-sectional study with a vignettes-based survey conducted between June and August, 2020. We included clinicians engaged in managing BPPV that had at least one year of clinical experience. We excluded students, and clinicians who were not involved in the management of individuals with BPPV. Participants were asked to make their management choices based on four hypothetical patient vignettes. The sample ranged from 77 participants for the first vignette to 45 participants for the last vignette. Results We included 77 clinicians in the study, with the majority being Otolaryngologists (31.2%). The respondents' mean adherence to the guideline was of 63.3%. Result showed that Otolaryngologists' adherence was higher than that of clinicians from different specialties ( p = 0.006, d = 0.72). Furthermore, clinicians with a postgraduate degree were more likely to adhere than those with a bachelor's degree only ( p = 0.014, d = 0.58) and participants who were aware of the guideline were more likely to adhere to it ( p < 0.001, d = 1.05). Lastly, regression analysis exhibited that adherence was affected by postgraduate degree and guideline awareness. Conclusion Otolaryngologists were more likely to adhere to the guideline than other specialties. Among all specialties, higher adherence was associated with guideline awareness and postgraduate degrees.
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Affiliation(s)
- Bushra Ahmad Alhakami
- Department of Physical Therapy, Prince Sultan Military Medical City, Riyadh, Saudi Arabia,Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia,Address for correspondence Bushra Ahmad Alhakami, MSc Department of Physical Therapy, Prince Sultan Military Medical CityMakkah Al Mukarramah Rd, As Sulimaniyah, PO Box 7897, Riyadh 11159Saudi Arabia
| | - Maha Mohammed Almarwani
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Gurumukhani JK, Patel DM, Shah SV, Patel MV, Patel MM, Patel AV. Negative Impact of Vestibular Suppressant Drugs on Provocative Positional Tests of BPPV: A Study from the Western Part of India. Ann Indian Acad Neurol 2021; 24:367-371. [PMID: 34446999 PMCID: PMC8370151 DOI: 10.4103/aian.aian_413_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/15/2020] [Accepted: 06/02/2020] [Indexed: 11/21/2022] Open
Abstract
Aims: To study the impact of vestibular suppressant drugs (VSD) on provocative positional tests (PPT) in patients with benign paroxysmal positional vertigo (BPPV). Settings and Design: A prospective case-control observational study. Materials and Methods: Patients with a history suggestive of BPPV were tested for PPT. Patients with vertiginous symptoms and with nystagmus on PPT were classified as objective BPPV (O-BPPV, control group), while those without nystagmus with no alternate diagnosis were classified as subjective BPPV (S-BPPV, case group). Details of VSD treatment were noted in all the patients. In both groups, patients were instructed to discontinue VSD and were further assigned as the VSD and non-VSD subgroups. Patients were followed for 2 months with PPT every week. PPT positive patients were treated by vestibular rehabilitation maneuvers. Statistics: Student t-test with two-tailed, unpaired, was used for continuous scale and Chi-square test for categorical differences between the two groups. Results: 295 consecutive BPPV patients were enrolled in the study, 55 in the S-BPPV group and 240 in the O-BPPV group. Significantly higher proportion of patients in the S-BPPV group were on VSD at presentation, 80.00% vs. 53.75% (OR 2.52; 95% CI: 1.30–4.86), P = 0.006. In an unadjusted analysis of the S-BPPV group following discontinuation of VSD, PPT became positive in 79.54% of patients as compared to 18.19% in the non-VSD group (OR 35.0; 95% CI: 6.2–197.3), P < 0.001. Conclusion: A higher proportion of S-BPPV patients were receiving VSD in comparison to O-BPPV at the initial visit. The PPT converted positive four times higher after ceasing the VSD in S-BPPV patients. Study Design: Prospective case-control observational study.
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Affiliation(s)
- Jayanti K Gurumukhani
- Consultant Neurologist, Jay Neurology and Physiotherapy Clinic, Bhavnagar, Gujarat, India
| | - Dhruvkumar M Patel
- Junior Resident in Medicine, Zydus Medical College and Hospital, Ahmedabad, Gujarat, India
| | - Sudhir V Shah
- Professor and Head, Department of Neurology, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Mukundkumar V Patel
- Associate Professor of Medicine, Zydus Medical College and Hospital, Dahod, Gujarat, India
| | - Maitri M Patel
- GCS Medical College, Research Center and Hospital, Ahmedabad, Gujarat, India
| | - Anand V Patel
- Assistant Professor of Neurology, University of Texas Medical Branch, Galveston, Texas, USA
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Patel DM, Gurumukhani JK, Patel MV, Patel MM, Patel C, Patel HD, Patel MV. Short Term Efficacy of Modified Epley’s Maneuvre Assisted by Visual Aid Dynamic Device Versus Unassisted Maneuvre for the Treatment of Posterior Canal BPPV. CURRENT DRUG THERAPY 2020. [DOI: 10.2174/1574885515999200706013308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction:
Modified Epley’s maneuver is the recommended treatment for the Posterior
Canal (PC) BPPV. To enhance the efficacy of this maneuver, an easy to perform visual aid
device (DizzyFIX) guided modified Epley’s maneuver was studied.
Material and Methods:
This prospective, double-blind, randomized study included consecutive
patients with PC-BPPV based on clinical history, neuro-otological examination, and positive Dix-
Hallpike (DHP) test from January 2018 to March 2019 at a neurology clinic of western India. Patients
were randomly assigned treatment with either visual aid device assisted modified Epley’s
maneuver, which constituted the case group or by a placebo device guided modified Epley’s maneuver,
which constituted the control group. DizzyFIX was used as a visual aid device in the case
group. Patients were followed up at one hour and 24 hours with DHP by the blinded examiners to
observe for remission.
Results:
Out of 280 patients (140 patients in each group), 6 from the case, and 2 from the controls
were lost from the follow-up. Overall, 134 cases were compared to 138 controls. The success rate of
remission in the case and the control group at one-hour was 79.19% vs. 48.30%, respectively, with
a p-value of 0.003. Similarly, the success rate in the case and control group at 24 hours was 95.27%
vs. 80.62%, respectively, with a p-value of 0.011. At 1 hour, unadjusted Odd Ratio (OR) was 4.13,
(C.I. 95% 2.02- 8.46) and at 24 hours, it was 4.37, (C.I. 95% 1.39-13.77), which was significant
even after adjustment of co-variables (OR 4.02, C.I. 95% 2.34- 8.26) and (OR 4.11, C.I. 95% 2.30-
14.26), respectively.
Conclusion:
For short term treatment of PC-BPPV, DizzyFIX assisted modified Epley’s maneuver
is more efficacious than unassisted modified Epley’s maneuver.
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Affiliation(s)
- Dhruvkumar M. Patel
- Zydus Medical College and Hospital, Dahod, India, DM, Jay Neurocare and Physiotherapy Clinic, Bhavnagar, India
| | - Jayanti K. Gurumukhani
- Zydus Medical College and Hospital, Dahod, India, DM, Jay Neurocare and Physiotherapy Clinic, Bhavnagar, India
| | - Mukundkumar V. Patel
- Zydus Medical College and Hospital, Dahod, India, DM, Jay Neurocare and Physiotherapy Clinic, Bhavnagar, India
| | | | - Chilvana Patel
- University of Texas Medical Branch, Galveston, TX, United States
| | | | - Maurvi V. Patel
- Intern Doctor, B. J. Medical College, Ahmedabad, India; Jay Neurocare and Physiotherapy Clinic, Bhavnagar, India
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Olajide T, Adegbiji W, Olubi O, Olajuyin O, Aluko A. Clinicoepidemiology of benign paroxysmal positional vertigo in Nigerian. J Family Med Prim Care 2019; 8:3220-3224. [PMID: 31742145 PMCID: PMC6857368 DOI: 10.4103/jfmpc.jfmpc_555_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/22/2019] [Accepted: 09/24/2019] [Indexed: 11/19/2022] Open
Abstract
Objective: Benign paroxysmal positional vertigo (BPPV) is poorly reported in developing countries. This study aimed at determining the prevalence, aetiology, and comorbid illnesses of benign paroxysmal positional vertigo in our center. Materials and Methods: This was a prevalence hospital-based study of all patients with the diagnosis of benign paroxysmal positional vertigo (BPPV). Pretested interviewer assisted questionnaire was administered to obtain data. Otoscopic examination, otoneurologic review, followed by mandatory Dix Hallpike maneuver and supine roll test was performed on all patients to diagnose posterior, lateral or anterior canal benign paroxysmal positional vertigo. All the data obtained were collated and analyzed by using SPSS version 16.0. Results: Prevalence was 1.9%. Peak prevalence of 37.0% was at age group 41–50 years. Male accounted for 46.1% with male to female ratio of 1:1.2. Benign paroxysmal positional vertigo accounted for 62.3% urban dwellers, 33.1% postsecondary education, 39.6% Civil servant and 33.8% married. There were 99.4% unilateral and 64.3% right benign paroxysmal positional vertigo. Idiopathic was 70.1% while trauma, migraine, and inner ear disorder were 20.8%, 7.1%, and 1.9%, respectively. Benign paroxysmal positional vertigo was 66.2% posterior semicircular canal followed by 24.7% lateral semicircular canal and 0.6% anterior semicircular canal. Commonly associated comorbid illnesses were visual disorder, hypertension, arthritis, and diabetes mellitus in 27.9%, 23.4%, 22.1%, and 2.6%, respectively. Conclusion: Benign paroxysmal positional vertigo is common otologic disorder. It is associated with significant comorbid illnesses. Early detection will reduce morbidity and mortality. Improvement in the level of health care at primary level and health education to create awareness among the populace is to be encouraged.
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Efficacy of SRM-IV Vestibular Function Diagnosis and Treatment System in Treating Benign Paroxysmal Positional Vertigo. IRANIAN JOURNAL OF PUBLIC HEALTH 2018; 47:641-647. [PMID: 29922605 PMCID: PMC6005989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND We determined the diagnostic and therapeutic effects of SRM-IV vestibular function diagnosis and treatment system on benign paroxysmal positional vertigo (BPPV). METHODS Overall, 120 patients with BPPV diagnosed in the outpatient and in-patient departments of the Vertigo Treatment Center of the First People's Hospital of Xuzhou from January 2013 to December 2015 were selected for this study. They were randomly divided into three groups. Automatic repositioning procedure was conducted for 40 patients in the equipment repositioning group by SRM-IV vestibular function diagnosis and treatment system, conventional manual repositioning procedure was used for 40 patients in the manual repositioning group, and combination of treatment drugs (alprostadil and safflower injection) with acclimatization training was adopted in 40 patients in the drug therapy group. RESULTS After 1 week of treatment, the cure rate and total effective rate in the equipment repositioning group and the manual repositioning group were significantly higher than those in drug therapy group (P<0.05). The total effective rate was 100.0% in the equipment-repositioning group and 92.5% in manual repositioning group; the difference between the two groups was not statistically significant. The success rate of one-time treatment of anterior semicircular canal BPPV, posterior semicircular canal BPPV and lateral semicircular canal BPPV in the equipment-repositioning group were higher than those in the manual repositioning group were. CONCLUSION The SRM-IV vestibular function diagnosis and treatment system are helpful in achieving effective and standard diagnosis and treatment of BPPV.
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Saeed BMN, Omari AF. Climatic variations and benign paroxysmal positional vertigo. J Otol 2016; 11:33-37. [PMID: 29937808 PMCID: PMC6002593 DOI: 10.1016/j.joto.2016.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 11/30/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is probably the most common diagnosis at vertigo clinics. Seasonal cycles of several human illnesses could be attributed variously to changes in atmospheric or weather conditions. In this retrospective study, patients with BPPV from January 2010 to December 2012 were studied, and their charts were reviewed. Statistical analysis revealed a statistically significant difference in patients' numbers among different months of the year. Also there is a significant statistical correlation between the numbers of patients with climatic variations especially the temperature. The present paper discusses the possible explanations for these results which confirms the seasonal variations in BPPV, together with a review of literature to view the possible associations with other disorders that causes such seasonality.
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Affiliation(s)
- Basil M N Saeed
- Department of Surgery, College of Medicine, Mosul University, Duhok, Kurdistan, Iraq
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Repositioning chairs in benign paroxysmal positional vertigo: implications and clinical outcome. Eur Arch Otorhinolaryngol 2015; 273:573-80. [DOI: 10.1007/s00405-015-3583-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
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Kraeling M. Proposed treatment for geriatric vestibular disease in dogs. Top Companion Anim Med 2014; 29:6-9. [PMID: 25103883 DOI: 10.1053/j.tcam.2014.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 04/08/2014] [Indexed: 11/11/2022]
Abstract
Sudden-onset vestibular dysfunction in the canine is a commonly seen condition in veterinary practice, with some veterinarians reporting several cases each month. However, traditional veterinary medicine has little to offer these patients other than symptomatic relief for the severe nausea that accompanies the vertigo and supportive advice for the owners. Owners of affected dogs are informed that these symptoms usually resolve within a few days. As physical therapists, we often see cases of benign paroxysmal positional vertigo in our human practice clinics, and effective protocols for diagnosis and treatment of the condition have been developed for this condition. A modified testing and repositioning postural maneuver used successfully on 12 canine patients in our canine rehabilitation clinic (The Canine Fitness Centre, Calgary, Alberta, Canada) is hereby described.
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