Regional differences in patient-reported outcomes as a proxy of healthcare practices for Americans living with vestibular symptoms.

BACKGROUND: Geographical location is known to affect health outcomes; however, evidence regarding whether location affects healthcare for persons suspected to have vestibular dysfunction is lacking. OBJECTIVE: To investigate whether location affects healthcare seeking and outcomes for adults with symptoms of vestibular pathology. METHODS: We assessed for regional disparities associated with demographics, diagnosis, chronological factors, and financial expenditures from Americans who participated in the Vestibular Disorders Association registry (N = 905, 57.4±12.5 years, 82.7% female, 94.8% White, and 8.1% Hispanic or Latino). Respondents were grouped per geographical regions defined by the United States Census Bureau. RESULTS: There were no significant between-region differences for age (p = 0.10), sex (p = 0.78), or ethnicity (p = 0.24). There were more Asian respondents in the West versus the Midwest (p = 0.05) and more Black respondents in the South versus the West (p = 0.05). The time to first seek care was shorter in the Northeast (17.3 [SD = 49.5] weeks) versus the South (42.4 [SD = 83.7] weeks), p = 0.015. The time from the first healthcare visit to receiving a final diagnosis was shorter in the Northeast (46.5 [SD = 75.4] weeks) versus the South (68.9 [SD = 89.7] weeks), p = 0.015. Compared to the Midwest, fewer respondents in the Northeast reported "no" out-of-pocket financial impact, p = 0.039. CONCLUSIONS: Geographical location affects healthcare seeking and outcomes for persons suspected to have vestibular dysfunction.

Patients' Experiences with Management of Benign Paroxysmal Positional Vertigo: Insights from the Vestibular Disorders Association Registry.

Introduction: Benign paroxysmal positional vertigo (BPPV) is the most frequently occurring peripheral vestibular disorder. Clinical practice guidelines (CPG) for BPPV exist; however, little is known about how affected patients perceive their condition is being managed. We aimed to leverage registry data to evaluate how adults who report BPPV are managed. Material and Methods: We retrospectively analyzed of data from 1,262 adults (58.4 ± 12.6 years old, 81.1% female, 91.1% White) who were enrolled in the Vestibular Disorders Association Registry from 2014 to 2020. The following patient-reported outcomes were analyzed by proportions for those who did and did not report BPPV: symptoms experienced, falls reported, diagnostics undertaken, interventions received (eg, canalith repositioning maneuvers [CRMs], medications), and responses to interventions. Results: Of the 1,262 adults included, 26% reported being diagnosed with BPPV. Many adults who reported BPPV (83%) also endorsed receiving additional vestibular diagnoses or may have had atypical BPPV. Those with BPPV underwent magnetic resonance imaging and were prescribed medications more frequently than those without BPPV (76% vs 57% [χ2=36.51, p<0.001] and 85% vs 78% [χ2=5.60, p=0.018], respectively). Falls were experienced by similar proportions of adults with and without BPPV (55% vs 56% [χ2==11.26, p=0.59]). Adults with BPPV received CRMs more often than those without BPPV (86% vs 48%, χ2=127.23, p<0.001). More registrants with BPPV also endorsed benefit from CRMs compared to those without BPPV (51% vs 12% [χ2=105.30, p<0.001]). Discussion: In this registry, BPPV was often reported with other vestibular disorders. Healthcare utilization was higher than would be expected with care based on the CPG. The rates of falls in those with and without BPPV are higher than previously reported. Adults with BPPV reported significant differences in how their care is managed and their overall outcomes compared to those without BPPV. Conclusion: Patient-reported outcomes provide useful information regarding the lived experience of adults with BPPV.

A Systematic Review of Clinical Vestibular Symptom Triage, Tools, and Algorithms.

OBJECTIVE: The evaluation of peripheral vestibular disorders in clinical practice is an especially difficult endeavor, particularly for the inexperienced clinician. The goal of this systematic review is thus to evaluate the design, approaches, and outcomes for clinical vestibular symptom triage and decision support tools reported in contemporary published literature. DATA SOURCES: A comprehensive search of existing literature in August 2020 was conducted using MEDLINE, CINAHL, and EMBASE using terms of desired diagnostic tools such as algorithm, protocol, and questionnaire as well as an exhaustive set of terms to encompass vestibular disorders. REVIEW METHODS: Study characteristics, tool metrics, and performance were extracted using a standardized form. Quality assessment was conducted using a modified version of the Quality of Diagnostic Accuracy Studies 2 (QUADAS-2) assessment tool. RESULTS: A total of 18 articles each reporting a novel tool for the evaluation of vestibular disorders were identified. Tools were organized into 3 discrete categories, including self-administered questionnaires, health care professional administered tools, and decision support systems. Most tools could differentiate between specific vestibular pathologies, with outcome measures including sensitivity, specificity, and accuracy. CONCLUSION: A multitude of tools have been published to aid with the evaluation of vertiginous patients. Our systematic review identified several low-evidence reports of triage and decision support tools for the evaluation of vestibular disorders.