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An evaluation of the cost-effectiveness of booklet-based self-management of dizziness in primary care, with and without expert telephone support

An evaluation of the cost-effectiveness of booklet-based self-management of dizziness in primary care, with and without expert telephone support
An evaluation of the cost-effectiveness of booklet-based self-management of dizziness in primary care, with and without expert telephone support
Background: dizziness is a very common symptom that often leads to reduced quality of life, anxiety and emotional distress, loss of fitness, lack of confidence in balance, unsteadiness and an increased risk of falling. Most dizzy patients are managed in primary care by reassurance and medication to suppress symptoms. Trials have shown that chronic dizziness can be treated effectively in primary care using a self-help booklet to teach patients vestibular rehabilitation exercises that promote neurological adaptation and skill and confidence in balance. However, brief support from a trained nurse was provided in these trials, and this model of managing dizzy patients has not been taken up due to a lack of skills and resources in primary care. The aim of this trial is to evaluate two new alternative models of delivery that may be more feasible and cost-effective.
Methods/Design: in a single blind two-centre pragmatic controlled trial, we will randomise 330 patients from 30 practices to a) self-help booklet with telephone support from a vestibular therapist, b) self-help booklet alone, c) routine medical care. Symptoms, disability, handicap and quality of life will be assessed by validated questionnaires administered by post at baseline, immediately post-treatment (3 months), and at one year follow-up. The study is powered to test our primary hypothesis, that the self-help booklet with telephone support will be more effective than routine care. We will also explore the effectiveness of the booklet without any support, and calculate the costs of treatment in each arm.
Discussion: if our trial indicates that patients can cost-effectively manage their dizziness in primary care, then it can be easily rolled out to relieve the symptoms of the many patients in primary care who currently have chronic, untreated, disabling dizziness. Treatment in primary care may reduce the development of psychological and physical sequelae that cause handicap and require treatment. There is also the potential to reduce the cost to the NHS of treating dizziness by reducing demand for referral to secondary care for specialist assessment and treatment.
Trial Registration: ClinicalTrials.gov trial registration ID number: NCT00732797
1472-6815
1-12
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Kirby, Sarah
9be57c1b-5ab7-4444-829e-d8e5dbe2370b
Barker, Fiona
531f9acb-d776-4beb-96a7-a9b020b5b11a
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Raftery, James
27c2661d-6c4f-448a-bf36-9a89ec72bd6b
King, Debbie
3045be28-65c3-4286-b512-2d5165a02ec3
Morris, Anna
69230276-48c9-4395-a9c6-725d8054df92
Mullee, Mark
fd3f91c3-5e95-4f56-8d73-260824eeb362
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Kirby, Sarah
9be57c1b-5ab7-4444-829e-d8e5dbe2370b
Barker, Fiona
531f9acb-d776-4beb-96a7-a9b020b5b11a
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Raftery, James
27c2661d-6c4f-448a-bf36-9a89ec72bd6b
King, Debbie
3045be28-65c3-4286-b512-2d5165a02ec3
Morris, Anna
69230276-48c9-4395-a9c6-725d8054df92
Mullee, Mark
fd3f91c3-5e95-4f56-8d73-260824eeb362

Yardley, Lucy, Kirby, Sarah, Barker, Fiona, Little, Paul, Raftery, James, King, Debbie, Morris, Anna and Mullee, Mark (2009) An evaluation of the cost-effectiveness of booklet-based self-management of dizziness in primary care, with and without expert telephone support. BMC Ear, Nose and Throat Disorders, 9 (13), 1-12. (doi:10.1186/1472-6815-9-13).

Record type: Article

Abstract

Background: dizziness is a very common symptom that often leads to reduced quality of life, anxiety and emotional distress, loss of fitness, lack of confidence in balance, unsteadiness and an increased risk of falling. Most dizzy patients are managed in primary care by reassurance and medication to suppress symptoms. Trials have shown that chronic dizziness can be treated effectively in primary care using a self-help booklet to teach patients vestibular rehabilitation exercises that promote neurological adaptation and skill and confidence in balance. However, brief support from a trained nurse was provided in these trials, and this model of managing dizzy patients has not been taken up due to a lack of skills and resources in primary care. The aim of this trial is to evaluate two new alternative models of delivery that may be more feasible and cost-effective.
Methods/Design: in a single blind two-centre pragmatic controlled trial, we will randomise 330 patients from 30 practices to a) self-help booklet with telephone support from a vestibular therapist, b) self-help booklet alone, c) routine medical care. Symptoms, disability, handicap and quality of life will be assessed by validated questionnaires administered by post at baseline, immediately post-treatment (3 months), and at one year follow-up. The study is powered to test our primary hypothesis, that the self-help booklet with telephone support will be more effective than routine care. We will also explore the effectiveness of the booklet without any support, and calculate the costs of treatment in each arm.
Discussion: if our trial indicates that patients can cost-effectively manage their dizziness in primary care, then it can be easily rolled out to relieve the symptoms of the many patients in primary care who currently have chronic, untreated, disabling dizziness. Treatment in primary care may reduce the development of psychological and physical sequelae that cause handicap and require treatment. There is also the potential to reduce the cost to the NHS of treating dizziness by reducing demand for referral to secondary care for specialist assessment and treatment.
Trial Registration: ClinicalTrials.gov trial registration ID number: NCT00732797

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Published date: December 2009

Identifiers

Local EPrints ID: 73448
URI: http://eprints.soton.ac.uk/id/eprint/73448
ISSN: 1472-6815
PURE UUID: 3c1f087c-5096-4f06-b1a5-7d1944fabc54
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X
ORCID for Sarah Kirby: ORCID iD orcid.org/0000-0003-1759-1356
ORCID for Paul Little: ORCID iD orcid.org/0000-0003-3664-1873

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Date deposited: 08 Mar 2010
Last modified: 12 Jul 2024 01:41

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Contributors

Author: Lucy Yardley ORCID iD
Author: Sarah Kirby ORCID iD
Author: Fiona Barker
Author: Paul Little ORCID iD
Author: James Raftery
Author: Debbie King
Author: Anna Morris
Author: Mark Mullee

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