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Independent prescriber physiotherapist led balance clinic: the Southport and Ormskirk pathway

Published online by Cambridge University Press:  16 February 2017

L Burrows ,
T H Lesser ,
A V Kasbekar ,
N Roland  and
M Billing
L Burrows*
Affiliation:
Department of Physiotherapy, Southport and Ormskirk NHS Trust, Southport, UK
T H Lesser
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Aintree University Hospital, Liverpool, UK
A V Kasbekar
Affiliation:
Department of Otology and Hearing Implantation, Cambridge University Hospitals, UK
N Roland
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Aintree University Hospital, Liverpool, UK
M Billing
Affiliation:
Department of Audiology, Southport and Ormskirk NHS Trust, Southport, UK
*
Address for correspondence: Ms Lisa Burrows, Dept of Physiotherapy, Southport and Ormskirk NHS Trust, Town Lane, Southport, UK Fax: +44 01704 385061 E-mail: [email protected]
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Abstract

Objective:

To report the introduction and impact of non-medical prescribing, initiated to improve patient pathways for those presenting with dizziness and balance disorders.

Methods:

The Southport and Ormskirk physiotherapy-led vestibular clinic sees and treats all patients with dizziness and balance disorders referred to the ENT department. Letters are triaged by an audiologist, who also performs an otological examination and hearing test; this is followed by an assessment with the independent prescriber physiotherapist. An ENT consultant is nearby if joint consultation is needed. Diagnoses, treatments and patient satisfaction were studied, with an analysis of the impact of medication management (stopping or starting medicines) on patients and service.

Results:

In 12 months, 413 new patients with dizziness and balance disorders had appointments. The most common diagnoses were benign paroxysmal positional vertigo and vestibular migraine. Eighty-four per cent of patients required self-management strategies, 50 per cent exercise therapy, 48 per cent medication management and 24 per cent a particle repositioning manoeuvre. Patient satisfaction was high (99 per cent).

Conclusion:

Having an independent prescriber physiotherapist leading the balance clinic has reduced the number of hospital visits and onward referrals. Nearly half of all patients required medication management as part of their dizziness or balance treatment.

Keywords

Balance ClinicPostural BalanceDizzinessPhysiotherapistIndependent PrescriberNon-Medical Prescribing
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 5 , May 2017 , pp. 417 - 424
Copyright
Copyright © JLO (1984) Limited 2017 

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References

1 Royal College of Physicians. Hearing and Balance Disorders: Achieving Excellence in Diagnosis and Management. Report of a Working Party. London: Royal College of Physicians of London, 2007 Google Scholar
2 Kroenke, K, Price, RK. Symptoms in the community: prevalence, classification, and psychiatric comorbidity. Arch Intern Med 1993;153:2474–80Google Scholar
3 Yardley, L, Owen, N, Nazareth, I, Luxon, L. Prevalence and presentation of dizziness in a general practice community sample of working age people. Br J Gen Pract 1998;48:1131–5Google Scholar
4 Davis, A, Moorjani, P. The epidemiology of hearing and balance disorders. In: Luxon, L. Textbook of Audiological Medicine. London: Martin Dunitz, 2003 Google Scholar
5 Jonsson, R, Sixt, E, Landahl, S, Rosenhall, U. Prevalence of dizziness and vertigo in an urban elderly population. J Vestib Res 2004;14:47–52 Google Scholar
6 BAO-HNS. Balance 2008. Excellence in Practice – The Provision of Adult Balance Services by Otolaryngologists. London: BAO-HNS, 2008 Google Scholar
7 Lee, A, Jones, G, Corcoran, J, Premachandra, P, Morrison, GA. A UK hospital based multidisciplinary balance clinic run by Allied Health Professionals: first year results. J Laryngol Otol 2011;7:661–7Google Scholar
8 Kasbekar, AV, Mullin, N, Morrow, C, Youssef, AM, Kay, T, Lesser, TH. Development of a physiotherapy-led balance clinic: the Aintree model. J Laryngol Otol 2014;128:966–71CrossRefGoogle ScholarPubMed
9 Chew-Graham, CA, Hunter, C, Langer, S, Stenhoff, A, Drinkwater, J, Guthrie, EA et al. How QOF is shaping primary care review consultations: a longitudinal qualitative study. BMC Fam Pract 2013;14:103 Google Scholar
10 Leong, AC, Barker, F, Bleach, NR. Primary assessment of the vertiginous patient at a pre-ENT balance clinic. J Laryngol Otol 2008;2:132–8Google Scholar
11 Gov.uk. Productivity in NHS hospitals. In: https://www.gov.uk/government/publications/productivity-in-nhs-hospitals [22 June 2016]Google Scholar
12 Department of Health. The NHS Plan: A Plan for Investment: A Plan for Reform. Norwich: Stationery Office, 2000 Google Scholar
13 NHS Health Education North West. Non-Medical Prescribing (NMP). An Economic Evaluation. London: i5health, 2015 Google Scholar
14 Kaski, D, Bronstein, AM. Epley and beyond: an update on treating positional vertigo. Pract Neurol 2014;25:210–21Google Scholar
15 Adrion, C, Fischer, CS, Wagner, J, Gürkov, R, Mansmann, U, Strupp, M. Efficacy and safety of betahistine treatment in patients with Meniere's disease: primary results of a long term, multicentre, double blind, randomised, placebo controlled, dose defining trial (BEMED trial). BMJ 2016;352:6816 CrossRefGoogle ScholarPubMed
16 National Institute for Health and Care Excellence. Diagnosis and Management of Headache in Young People and Adults, CG150. London: NICE, 2012 Google Scholar
17 NICE. Vestibular neuronitis. Scenario: Management. In: http://cks.nice.org.uk/vestibular-neuronitis#!scenario [10 June 2016]Google Scholar
18 Gingerich, WJ, Peterson, LT. Effectiveness of solution-focused brief therapy: a systematic qualitative review of controlled outcome studies. Res Soc Work Pract 2013;3:266–83Google Scholar
19 Lystad, RP, Bell, G, Bonnevie-Svendsen, M, Carter, CV. Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: a systematic review. Chiropr Man Therap 2011;19:21 Google Scholar
20 Herdman, SJ, Clendaniel, R. Vestibular Rehabilitation. Philadelphia: FA Davis, 2014 Google Scholar
21 Lamb, S. 033 Interventions for preventing falls in older people living in the community: findings from the recently updated Cochrane review. Parkinsonism & Related Disorders 2010;16:S9 Google Scholar
22 Chartered Society of Physiotherapy. Practice Guidance for Physiotherapist Supplementary and/or Independent Prescribers in the Safe Use of Medicines, 2nd edn. London: Chartered Society of Physiotherapy, 2013 Google Scholar
23 Weiss, J, Parham, K. Drug-induced vertigo. In: Dispenza, F, De Stefano, A, eds. Textbook of Vertigo: Diagnosis and Management. Mumbai: Jaypee Brothers Medical Publishers, 2013;179Google Scholar
24 Sirven, JI, Fife, TD, Wingerchuk, DM, Drazkowski, JF. Second-generation antiepileptic drugs' impact on balance: a meta-analysis. Mayo Clin Proc 2007;82:40–7Google Scholar
25 Black, FO, Pesznecker, S, Stallings, V. Permanent gentamicin vestibulotoxicity. Otol Neurotol 2004;25:559–69Google Scholar
26 Lempert, T, Olesen, J, Furman, J, Waterston, J, Seemungal, B, Carey, J et al. Vestibular migraine: diagnostic criteria. J Vestib Res 2012;22:167–72Google Scholar
27 Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013;33:629–808 Google Scholar
28 Gazzola, JM, Ganança, FF, Aratani, MC, Perracini, MR, Ganança, MM. Clinical evaluation of elderly people with chronic vestibular disorder. Braz J Otorhinolaryngol 2006;72:515–22Google Scholar
29 da Silva, CN, de Figueiredo Ribeiro, KM, de Medeiros Freitas, RV, Ferreira, LM, Guerra, RO. Vertiginous symptoms and objective measures of postural balance in elderly people with benign paroxysmal positional vertigo submitted to the Epley maneuver. Int Arch Otorhinolaryngol 2016;20:61–8Google Scholar
30 De Stefano, A, Dispenza, F, Suarez, H, Perez-Fernandez, N, Manrique-Huarte, R, Ban, JH et al. A multicenter observational study on the role of comorbidities in the recurrent episodes of benign paroxysmal positional vertigo. Auris Nasus Larynx 2014;41:31–6Google Scholar
31 Fernández, L, Breinbauer, HA, Delano, PH. Vertigo and dizziness in the elderly. Front Neurol 2015;6:144 Google Scholar
32 Kasse, CA, Santana, GG, Branco-Barreiro, FC, Scharlach, RC, Gazzola, JM, Ganança, FF et al. Postural control in older patients with benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2012;146:809–15CrossRefGoogle ScholarPubMed
33 Kerber, KA, Newman-Toker, DE. Misdiagnosing dizzy patients: common pitfalls in clinical practice. Neurol Clin 2015;33:565–75CrossRefGoogle ScholarPubMed