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ED-VeRT will enroll up to 125 adult emergency department (ED) patients presenting with a chief complaint of dizziness or vertigo to collect longitudinal outcomes over 3 months of follow-up. This will include 50 patients who were evaluated by an ED physical therapist (ie, vestibular rehabilitation) during their ED visit and 50 patients who received usual care. The aims of this trial are to: (1) obtain initial estimates of participant recruitment and retention, intra-cluster correlation, and between-group outcome differences that will inform sample size calculation for a future randomized clinical trial, and (2) assess feasibility and fidelity of a clinical classification protocol for undifferentiated dizziness among patients receiving ED vestibular rehabilitation.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ED Physical Therapy | Patients in the ED physical therapy group will have been evaluated by an emergency department physical therapist for dizziness/vertigo during their index ED visit. |
| |
| Usual Care | Patients in the usual care group will NOT have received an evaluation by an ED physical therapist for dizziness/vertigo symptoms during their index ED visit. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Vestibular Rehabilitation | Behavioral | Vestibular Rehabilitation refers to the specific interventions that physical therapists provide to patients with dizziness and vertigo symptoms. These interventions can involve repositioning maneuvers, habituation exercises, gaze stabilization, and/or balance training exercises, depending on the specific etiology of dizziness and vertigo per an established clinical protocol utilizing a patient's history and exam findings. Physical therapists instruct patients in how to perform these exercises at home and provide instructions and referral for patients to follow-up with an outpatient physical therapist for further care. |
| Measure | Description | Time Frame |
|---|---|---|
| Dizziness Handicap Inventory (DHI) | The DHI contains 25 items quantifying self-perceived handicapping effects of dizziness symptoms. | Three months after the index ED visit. |
| Measure | Description | Time Frame |
|---|---|---|
| Vestibular Activities Avoidance Instrument (VAAI-9) | The VAAI-9 identifies fear avoidance beliefs in persons with dizziness. The VAAI-9 is the 9-item short form version of the VAAI. | Three months after the index ED visit. |
| ED Diagnostic Imaging Utilization |
| Measure | Description | Time Frame |
|---|---|---|
| Global Rating of Change (GROC) | The GROC is a single-item survey used to evaluate overall recovery from the time that symptoms began until now. Responses are provided on a 15-point Likert scale ranging from "a very great deal worse" to "a very great deal better." | Three months after the index ED visit. |
| Numeric Rating Scale (NRS) |
Inclusion Criteria:
Exclusion Criteria:
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ED patients presenting with a chief complaint relating to dizziness or vertigo.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Northwestern Memorial Hospital | Chicago | Illinois | 60611 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39951266 | Derived | Kim HS, Schauer JM, Kan AK, Alinger JB, Strickland KJ, Garreau A, McCarthy DM, Taylor ZB, Fishman IL, Muschong KM, Roth HR. Emergency Department Vestibular Rehabilitation Therapy for Dizziness and Vertigo: A Nonrandomized Clinical Trial. JAMA Netw Open. 2025 Feb 3;8(2):e2459567. doi: 10.1001/jamanetworkopen.2024.59567. |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| SAP | No | Yes | No | Statistical Analysis Plan | Oct 19, 2022 | Oct 19, 2022 | SAP_000.pdf |
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| ID | Term |
|---|---|
| D004244 | Dizziness |
| D014717 | Vertigo |
| ID | Term |
|---|---|
| D012678 | Sensation Disorders |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| Usual Care | Other | Usual Care refers to any combination of diagnostic testing, medications, and patient education or counseling provided by a patient's treating ED physician. |
|
The proportion of ED visits in which any diagnostic imaging of the brain was performed, including computed tomography and magnetic resonance imaging. |
| Index ED visit (one day) |
| ED Length of Stay | Total length of stay, inclusive of hospitalizations and observation stays. | Index ED visit (up to one week) |
| Patient-Reported Medication Use in Last 24 Hours | Patient-reported medication use for dizziness will be collected using a standardized instrument assess whether participants have taken any dizziness medication in the last 24 hours (binary yes/no). The 24-hour timeframe was selected to maximize accuracy in patient recall. In brief, dizziness medications are listed by brand and generic names; a "yes" response to any medication triggers an additional query asking the participant to specify the medication dose (e.g., meclizine 25mg) and quantity (e.g., one pill). | Three months after the index ED visit. |
The NRS measures intensity of dizziness symptoms from 0 to 10. Participants will report average dizziness intensity over the last 24 hours. |
| Three months after the index ED visit. |
| Advanced Healthcare Utilization | Proportion of participants who utilized any advanced healthcare resources for dizziness after their index ED visit, defined as advanced imaging (e.g., computed tomography, magnetic resonance imaging) or procedures/surgery. | Three months after the index ED visit. |
| Benzodiazepine Prescription Filling | Benzodiazepine prescription filling data will be queried in the state prescription monitoring database. | Three months after the index ED visit |
| Follow-up with Outpatient Physical Therapy | Proportion of participants who reports outpatient physical therapy follow-up for vestibular rehabilitation | Three months after the index ED visit |
| D015837 | Vestibular Diseases |
| D007759 | Labyrinth Diseases |
| D004427 | Ear Diseases |
| D010038 | Otorhinolaryngologic Diseases |
| D009422 | Nervous System Diseases |