Evaluation of Vestibular Rehabilitation programme of physiotherapy in Tuen Mun Hospital

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Authors (including presenting author) :
Li KW (1); Li KH(1); MOK YC(1); Mak MY(1); LEE TH(2); YEUNG KW(2)
Affiliation :
(1)Physiotherapy Department, TMH (2)Department of Ear, Nose & Throat, TMH
Introduction :
The vestibular system in our body is a sensory system which contributes to sensory of balance, spatial orientation and coordination movement with body balance. However, this system can be affected by ageing, injury or vestibular disorder resulted in vestibular hypo-function and caused symptoms such as vertigo, dizziness, imbalance and visual disturbance. All these symptoms affected the Quality of Life of patient significantly. Vestibular rehabilitation is an exercise-based treatment program designed to enhance gaze stability, to improve postural stability, to reduce vertigo and the impact on activities of daily living via vestibular adaptation, habituation and substitution mechanism.
Objectives :
To determine the effectiveness of Vestibular Rehabilitation programme of physiotherapy in improving symptoms, balance and functional performance of patients with dizziness and vestibular weakness.
Methodology :
This was a retrospective study. Patients who were referred to physiotherapy service for vestibular rehabilitation since April 2018 and discharged after completing a course of training were recruited for data analysis. The outcome measures were: (1) composite score of Sensory Organisation Test (SOT) of computerised dynamic posturography, considered as a standardised test for measuring balance performance. (2) The Dizziness Handicap Inventory (DHI) Questionnaire, to evaluate the impact of dizziness on physical function, social activity and emotion (3) The Clinical Test for the Sensory Interaction of Balance (CTSIB), to assess balance. (4) 4-items Dynamic Gait Index, to measure the impact of dizziness on walking (5) The dizziness score charted by visual analogue scale (VAS). (6) The average number of treatment sessions. Paired T-test was used to compare pre and post treatment data of outcomes 1,2 & 5. Wilcoxon Signed Ranks Test was used to compare data of outcomes 3 & 4.
Result & Outcome :
From April to Oct 2018, 29 subjects with completed training were included for data analysis. The mean number of treatment sessions was 8.8. Paired T-test showed significant improvement in composite score of SOT (from mean of 62.9 ± 9.2 to 74.7 ± 6.6 with P< 0.001), Dizziness score in VAS (from mean of 4.7 ± 1.7 to 1.1 ± 1.0 with P< 0.001) and DHI questionnaire (from mean of 36.8 ± 15.7 to 28.0 ± 15.2 with P=0.013). Wilcoxon Signed Ranks Test showed that the post-rehabilitation performance in condition 3 & 4 of CTSIB were statistically significantly better than the pre-rehabilitation performance (P< 0.05). The comparison of pre and post training result in 4-items Dynamic Gait Index was insignificant with P=0.059 Our study showed that the current vestibular rehabilitation program provided by physiotherapists was effective in improving balance performance, reducing symptoms severity and lowering the impact on psychosocial aspect of daily life of our clients.

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