Authors (including presenting author) :
Chung SFJ, Lee YKW, WONG SWE, LAM SLR
Affiliation :
Physiotherapy Department, United Christian Hospital
Introduction :
Patients diagnosed “Dizziness” were used to be referred physiotherapy for vestibular rehabilitation in United Christian Hospital (UCH). Physiotherapists analysed the clinical picture and conducted specific physical examination to formulate the management plan, which was found helpful in most of the cases. Further investigation by ENT Specialists and Audiologists was indicated on cases with atypical presentation, however both were not being timely accessed. The mean waiting time for an ENT consultation and Audiology assessment afterward was two years in 2019 which was absolutely undesirable.
Objectives :
This case study aimed to reveal the keys for success of a new multidisciplinary collaborative model for Vestibular Rehabilitation in UCH, which was highly related to:
1. Timely communication for fast tract consultations between ENT Specialists, Audiologists and Physiotherapists
2. Accurate patient screening for indication on additional vestibular assessment and laboratory testing and
3. Effective vestibular rehab program by physiotherapists
Methodology :
A patient whose occupation was cleansing worker being diagnosed Benign Paroxysmal Positional Vertigo and presenting with unilateral vestibular weakness was reviewed. Patient initially received 3 sessions of physiotherapy including vertigo maneuver and habituation exercises, some progress was noted. However due to having residual dizziness which was very atypical, she could not resume duty. Direct communication with ENT surgeon was activated. ENT consultation was advanced immediately and vestibular laboratory assessment was also referred straight away to Audiologist. The fast tract consultation and assessment revealed patient was suffering from bilateral vestibular weakness which was uncommon but could be benefited from further habituation exercises and balance training through the vestibular rehabilitation service.
Apart from waiting time, outcomes were also measured to demonstrate the program effectiveness.
Result & Outcome :
Waiting time for ENT consultation was shortened from 6.5 months to 1.5 months, for vestibular laboratory assessment it was 2 weeks. Timely communication and referral between the three professionals for “Early Consultation, Assessment and Intervention” were obviously demonstrated as key successful factors on this new patient care model.
Patient reported 90% improvement and was able to resume duty after receiving total 7 sessions of physiotherapy. The dizziness score reduced from 4/10 to 1/10, Dizziness Handicap Inventory score dropped from 80/100 to 8/100, and Activities Specific Balance Confidence scale improved from 23.6% to 98.1%. Her balance tested in Dynamic Gait Index also improved from 19 to 24.
