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Clinical and cost-effectiveness of booklet based vestibular rehabilitation for chronic dizziness in primary care: single blind, parallel group, pragmatic, randomised controlled trial

Clinical and cost-effectiveness of booklet based vestibular rehabilitation for chronic dizziness in primary care: single blind, parallel group, pragmatic, randomised controlled trial
Clinical and cost-effectiveness of booklet based vestibular rehabilitation for chronic dizziness in primary care: single blind, parallel group, pragmatic, randomised controlled trial
OBJECTIVE: To determine the clinical and cost effectiveness of booklet based vestibular rehabilitation with and without telephone support for chronic dizziness, compared with routine care.

DESIGN: Single blind, parallel group, pragmatic, randomised controlled trial.

SETTING: 35 general practices across southern England between October 2008 and January 2011.

PARTICIPANTS: Patients aged 18 years or over with chronic dizziness (mean duration >five years) not attributable to non-vestibular causes (confirmed by general practitioner) and that could be aggravated by head movement (confirmed by patient).

INTERVENTIONS: Participants randomly allocated to receive routine medical care, booklet based vestibular rehabilitation only, or booklet based vestibular rehabilitation with telephone support. For the booklet approach, participants received self management booklets providing comprehensive advice on undertaking vestibular rehabilitation exercises at home daily for up to 12 weeks and using cognitive behavioural techniques to promote positive beliefs and treatment adherence. Participants receiving telephone support were offered up to three brief sessions of structured support from a vestibular therapist.

MAIN OUTCOME MEASURES: Vertigo symptom scale-short form and total healthcare costs related to dizziness per quality adjusted life year (QALY).

RESULTS: Of 337 randomised participants, 276 (82%) completed all clinical measures at the primary endpoint, 12 weeks, and 263 (78%) at one year follow-up. We analysed clinical effectiveness by intention to treat, using analysis of covariance to compare groups after intervention, controlling for baseline symptom scores. At 12 weeks, scores on the vertigo symptom scale in the telephone support group did not differ significantly from those in the routine care group (adjusted mean difference -1.79 (95% confidence interval -3.69 to 0.11), P=0.064). At one year, both intervention groups improved significantly relative to routine care (telephone support -2.52 (-4.52 to -0.51), P=0.014; booklet only -2.43 (-4.27 to -0.60), P=0.010). Analysis of cost effectiveness acceptability curves showed that both interventions were highly cost effective; at very low QALY values, the booklet only approach was most likely to be cost effective, but the approach with additional telephone support was most likely to be cost effective at QALY values more than £1200 (€1488; $1932). Using the booklet approach with telephone support, five (three to 12) patients would need to be treated for one patient to report subjective improvement at one year.

CONCLUSIONS: Booklet based vestibular rehabilitation for chronic dizziness is a simple and cost effective means of improving patient reported outcomes in primary care.
0959-8138
e2237-[14pp]
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Barker, Fiona
531f9acb-d776-4beb-96a7-a9b020b5b11a
Muller, Ingrid
2569bf42-51bd-40da-bbfd-dd4dbbd62cad
Turner, David
39dc4dc8-88b4-4950-8bbd-c647ff110ec9
Kirby, Sarah
9be57c1b-5ab7-4444-829e-d8e5dbe2370b
Mullee, Mark
fd3f91c3-5e95-4f56-8d73-260824eeb362
Morris, Anna
69230276-48c9-4395-a9c6-725d8054df92
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Barker, Fiona
531f9acb-d776-4beb-96a7-a9b020b5b11a
Muller, Ingrid
2569bf42-51bd-40da-bbfd-dd4dbbd62cad
Turner, David
39dc4dc8-88b4-4950-8bbd-c647ff110ec9
Kirby, Sarah
9be57c1b-5ab7-4444-829e-d8e5dbe2370b
Mullee, Mark
fd3f91c3-5e95-4f56-8d73-260824eeb362
Morris, Anna
69230276-48c9-4395-a9c6-725d8054df92
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777

Yardley, Lucy, Barker, Fiona, Muller, Ingrid, Turner, David, Kirby, Sarah, Mullee, Mark, Morris, Anna and Little, Paul (2012) Clinical and cost-effectiveness of booklet based vestibular rehabilitation for chronic dizziness in primary care: single blind, parallel group, pragmatic, randomised controlled trial. BMJ, 344 (e2237), e2237-[14pp]. (doi:10.1136/bmj.e2237). (PMID:22674920)

Record type: Article

Abstract

OBJECTIVE: To determine the clinical and cost effectiveness of booklet based vestibular rehabilitation with and without telephone support for chronic dizziness, compared with routine care.

DESIGN: Single blind, parallel group, pragmatic, randomised controlled trial.

SETTING: 35 general practices across southern England between October 2008 and January 2011.

PARTICIPANTS: Patients aged 18 years or over with chronic dizziness (mean duration >five years) not attributable to non-vestibular causes (confirmed by general practitioner) and that could be aggravated by head movement (confirmed by patient).

INTERVENTIONS: Participants randomly allocated to receive routine medical care, booklet based vestibular rehabilitation only, or booklet based vestibular rehabilitation with telephone support. For the booklet approach, participants received self management booklets providing comprehensive advice on undertaking vestibular rehabilitation exercises at home daily for up to 12 weeks and using cognitive behavioural techniques to promote positive beliefs and treatment adherence. Participants receiving telephone support were offered up to three brief sessions of structured support from a vestibular therapist.

MAIN OUTCOME MEASURES: Vertigo symptom scale-short form and total healthcare costs related to dizziness per quality adjusted life year (QALY).

RESULTS: Of 337 randomised participants, 276 (82%) completed all clinical measures at the primary endpoint, 12 weeks, and 263 (78%) at one year follow-up. We analysed clinical effectiveness by intention to treat, using analysis of covariance to compare groups after intervention, controlling for baseline symptom scores. At 12 weeks, scores on the vertigo symptom scale in the telephone support group did not differ significantly from those in the routine care group (adjusted mean difference -1.79 (95% confidence interval -3.69 to 0.11), P=0.064). At one year, both intervention groups improved significantly relative to routine care (telephone support -2.52 (-4.52 to -0.51), P=0.014; booklet only -2.43 (-4.27 to -0.60), P=0.010). Analysis of cost effectiveness acceptability curves showed that both interventions were highly cost effective; at very low QALY values, the booklet only approach was most likely to be cost effective, but the approach with additional telephone support was most likely to be cost effective at QALY values more than £1200 (€1488; $1932). Using the booklet approach with telephone support, five (three to 12) patients would need to be treated for one patient to report subjective improvement at one year.

CONCLUSIONS: Booklet based vestibular rehabilitation for chronic dizziness is a simple and cost effective means of improving patient reported outcomes in primary care.

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More information

Published date: 6 June 2012
Organisations: Primary Care & Population Sciences, Psychology

Identifiers

Local EPrints ID: 338432
URI: http://eprints.soton.ac.uk/id/eprint/338432
ISSN: 0959-8138
PURE UUID: ae8f9145-5fa5-4b01-838e-e263124d073e
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X
ORCID for Ingrid Muller: ORCID iD orcid.org/0000-0001-9341-6133
ORCID for Sarah Kirby: ORCID iD orcid.org/0000-0003-1759-1356

Catalogue record

Date deposited: 17 May 2012 08:07
Last modified: 26 Nov 2021 02:54

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Contributors

Author: Lucy Yardley ORCID iD
Author: Fiona Barker
Author: Ingrid Muller ORCID iD
Author: David Turner
Author: Sarah Kirby ORCID iD
Author: Mark Mullee
Author: Anna Morris
Author: Paul Little

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