Development of a BPPV Algorithm for Earlier Physical Therapy Consultation in the Acute Care Setting

Abstract

Purpose: Diagnosing and managing individuals with dizziness, imbalance, and vertigo are a challenge in health care. Benign paroxysmal positional vertigo is a common source of these symptoms. Individuals are often misdiagnosed or undiagnosed, causing overuse of medical testing or hospitalizations, suboptimal care, and increased costs. Physical therapists (PTs) are often overlooked in the consultation process until medical testing is completed. Practice pattern differences among the medical and rehabilitation communities and a lack of established interdisciplinary guidelines exist. This case report highlights the potential for resolution of these problems. Methods: An individual with symptoms of dizziness, vertigo, shoulder and neck pain, and imbalance was admitted to an acute care hospital for a 5-day length of stay. PT was not consulted until admission day 3 after medical workup and when left posterior canalithiasis was suspected. This led to the development of a benign paroxysmal positional vertigo consultant algorithm the medical and PT staff could use as a screen in determining if PT consultation was necessary. The medical and PT staff were given an in-service. Results: Symptoms were successfully alleviated with PT intervention, including a canalith repositioning maneuver and education. Conclusion: Barriers, including clinical competency and delayed consultation, resulted in an increased length of stay and costs. Internal education and algorithm development for PT referral were generated. Earlier PT consultation in collaboration with medical workup may decrease health care costs and improve quality of care.