Timely Physical Therapy Reduces Fall Risk Among Patients With Dizziness

People with dizziness who receive timely physical therapy (PT) are at a significantly reduced risk for falls, according to study findings published in JAMA Otolaryngology–Head and Neck Surgery.

As reviewed by researchers, people age 40 and older with dizziness fall at a rate 12 times higher than unaffected people. These falls can lead to fractures, disabilities, and death, underscoring an urgent need for fall-preventive interventions. This can include PT specialized to improve vestibular and balance function. However, previous research has not directly examined whether vestibular PT reduces fall incidence, or number of falls per person with dizziness.

For the current study, the researchers examined claims data from the OptumLabs Data Warehouse for 805,454 patients aged 18 and older who lived across the US. They had been diagnosed with dizziness/giddiness or a vestibular disorder between January 2006, through December 2015. The researchers further examined follow-up data between 3 and 12 months after these patients’ initial presentation, including whether they received PT within that period.

Within 12 months of initial presentation, 7% of those patients followed up reporting a fall. Within the 3–12-month timeframe, they were more likely to fall, regardless of whether they received PT, if they were older than age 40, women, White, or had at least 1 comorbidity included in the Charlson Comorbidity Index (CCI).

A total of 6% of patients with dizziness attended at least 1 PT visit within 3 months of diagnosis. In the 3–12-month timeframe, patients who received PT were more than 7 times less likely than the other patients to fall (adjusted odds ratio [aOR], 0.18; 95% CI, 0.18–0.19). This protective effect was attenuated but remained significant by 9 and 12 months after diagnosis (aOR, 0.23; 95% CI, 0.23–0.24).

Compared with patients who did not receive PT, those who did were more likely to be men, younger than age 40, and non-White, and had at least 1 comorbidity on the CCI. Between 10-13% of patients who saw a specialist (such as a cardiologist or neurologist) during the initial presentation period received PT. By comparison, only 6% of those seen solely by a primary care clinician received PT.

Drawing attention to related research, the researchers noted that, despite the importance of fall-preventive measures, no more than 13% of patients with dizziness, and as few as 0.5% (depending on specific diagnosis), are referred to PT.

The researchers acknowledged that it was not entirely clear whether the decreased likelihood of falling among non-White patients was influenced by disparities in insurance coverage or health care access. Other limitations included potentially incomplete data on severity of dizziness or falls, and lack of information on distinct components of the PT interventions.

The researchers acknowledged that the “Development and dissemination of guidelines for the management of dizziness, such as those for BPPV [benign paroxysmal positional vertigo] and Meniere disease, may be effective in influencing clinician practice.”

Finally, noting that PT did not prevent falls in every treated patient, the researchers recommended that “patients with dizziness and multiple comorbidities may require additional fall prevention strategies, including but not limited to low-intensity exercise, step training, home safety modifications, and support for caregivers.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.