Article
Effectiveness of an evidence-based care pathway to improve mobility and participation in older patients with vertigo, dizziness and balance disorders in primary care – results of the MobilE-PHY2 study
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Authors
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Caren Horstmannshoff
- Technische Universität München, TUM School of Medicine and Health, München, Deutschland; Technische Hochschule Rosenheim, Forschung, Entwicklung und Transfer, Rosenheim, Deutschland
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Peggy Borchers
- Technische Universität Dresden, Bereich Allgemeinmedizin, Medizinische Fakultät am Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
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Petra Bauer
- Technische Hochschule Rosenheim, Forschung, Entwicklung und Transfer, Rosenheim, Deutschland
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Sandy Scheibe
- Technische Universität Dresden, Bereich Allgemeinmedizin, Medizinische Fakultät am Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
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Karen Voigt
- Technische Universität Dresden, Bereich Allgemeinmedizin, Medizinische Fakultät am Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
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Martin Müller
- Ruprecht-Karls-Universität Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung, Medizinische Fakultät am Universitätsklinikum, Heidelberg, Deutschland; Technische Hochschule Rosenheim, Forschung, Entwicklung und Transfer, Rosenheim, Deutschland
| Published: | March 27, 2025 |
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Outline
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Background/research question: Vertigo, dizziness, and balance disorders (VDB) impair mobility and participation of many older adults and are among the most common reasons for visiting a general practitioner. Diagnosis and treatment are challenging for health professionals due to multifactorial causes. Therefore, an evidence-based interprofessional care pathway was developed and piloted as a complex intervention in accordance with the UK Medical Research Council guideline, and is now being evaluated for effectiveness.
Methods: The multicentre, cluster-randomized controlled trial included patients aged 60 and older with acute or chronic VDB. Randomization was conducted in a 1:1 ratio at cluster level (general practice). The care pathway included a decision aid for general practitioners and a decision tree for physiotherapists, along with associated training. The control group received optimized standard care from their general practitioner. The primary outcome was the improvement in patients’ mobility and participation after six months (t2), using the Dizziness Handicap Inventory (DHI). Secondary outcomes included physical activity, balance, falls, and fear of falling. A linear mixed model (LMM) was used to analyse changes between baseline and t2 in the intervention and control groups, as well as between clusters and centres. Treatment group, time points, and their interaction were defined as fixed effects.
Results: Sixteen general practices participated (n=9 intervention group; n=7 control group), along with 99 patients (82.5% of the calculated sample size; n=56 intervention group; n=43 control group) and nine physiotherapy practices. The LMM showed a significant difference between groups for the DHI (11.6; [–20.25– –2.98]; p=0.008; C=2.66). However, no significant effects were found for time (–0.4; [–5.21–4.4], p=0.9; C=–0.02) or the interaction between group and time (0.5; [–2.65–3.75]; p=0.7; C=0.02). There were no significant differences (p>0.05) regarding the secondary endpoints between the intervention and control groups, or in clusters and centres.
Conclusion: The care pathway had no significant effect on mobility, participation, physical activity, balance, falls, and fear of falling in older adults with VDB. When interpreting the results, it is important to note that due to COVID-19, the study did not meet its recruitment target and was underpowered with 82 patients instead of 93 at t2. Furthermore, the LMM indicated a significant difference between the intervention and control groups in the DHI at t0.
Competing interests: No conflicts of interest are declared.
