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Effectiveness of an evidence-based care pathway to improve mobility and participation in older patients with vertigo and balance disorders in primary care (MobilE-PHY2): study protocol for a multicentre cluster-randomised controlled trial

  • Background Vertigo, dizziness or balance disorders (VDB) are common leading symptoms in older people, which can have a negative impact on their mobility and participation in daily live, yet, diagnosis is challenging and specific treatment is often insufficient. An evidence-based, multidisciplinary care pathway (CPW) in primary care was developed and pilot tested in a previous study. The aim of the present study is to evaluate the effectiveness and safety of the CPW in terms of improving mobility and participation in community-dwelling older people with VDB in primary care. Methods For this multicentre cluster randomised controlled clinic trial, general practitioners (GP) will be recruited in two regions of Germany. A total of 120 patients over 60 years old with VDB will be included. The intervention is an algorithmized CPW. GPs receive a checklist for standardise clinical decision making regarding diagnostic screening and treatment of VDB. Physiotherapists (PT) receive a decision tree for evidence-based physiotherapeutic clinical reasoning and treatment of VDB. Implementation strategies comprises educational trainings as well as a workshop to give a platform for exchange for the GPs and PTs, an information meeting and a pocket card for home care nurses and informal caregivers and telephone peer counselling to give all participants the capability, opportunity and the motivation to apply the intervention. In order to ensure an optimised usual care in the control group, GPs get an information meeting addressing the national guideline. The primary outcome is the impact of VDB on participation and mobility of patients after 6 month follow-up, assessed using the Dizziness Handicap Inventory (DHI) questionnaire. Secondary outcomes are physical activity, static and dynamic balance, falls and fear of falling as well as quality of life. We will also evaluate safety and health economic aspects of the intervention. Behavioural changes of the participants as well as barriers, facilitating factors and mechanisms of impact of the implementation will be investigated with a comprehensive process evaluation in a mixed-methods design. Discussion With our results, we aim to improve evidence-based health care of community-dwelling older people with VDB in primary care.
Metadaten
Author:Caren HorstmannshoffORCiD, Stefanie Skudlik, Jenny Petermann, Theresia Kiesel, Tobias Döringer, Alexander Crispin, Joachim Hermsdörfer, Juliane Köberlein‑Neu, Klaus Jahn, Stefan Schädler, Petra Bauer, Karen Voigt, Martin Müller
URL:https://doi.org/10.1186/s13063-022-07017-x
Parent Title (English):BMC Trials
Document Type:Article (peer reviewed)
Language:English
Publication Year:2023
Tag:Balance disorder; Care pathway; Complex intervention; Dizziness; Mobility; Multicentre cluster randomised controlled trial; Physiotherapy; Primary care; Vertigo
Volume:24
First Page:91
Project Title:MobilE-PHY2
Funding Agency:Bundesministerium für Bildung und Forschung
Grant Number:01GY19131C
faculties / departments:Zentrum für Forschung, Entwicklung und Transfer
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit