Department of Neurology, Kaiser Permanente, Santa Rosa, California USA.
Otolaryngol Head Neck Surg. 2011 Jul;145(1):117-24. doi: 10.1177/0194599811399371.
To investigate whether an interdisciplinary program for vestibular patients improved health outcomes and health care utilization.
Case series with chart review.
Outpatient neurotology clinic.
Patients (N = 167) with dizziness attended an interdisciplinary neurotology clinic; 129 were offered group treatment. After an introductory session, group treatment included 5 sessions incorporating mindfulness, cognitive-behavioral techniques, and vestibular rehabilitation. Physical and emotional functioning, depression,anxiety, dizziness, impairment, coping, skill use, and patient satisfaction were measured with rating scales pre- and post-group treatment. Data from 51 patients (male/female = 14/37; age range, 25-82 years) were analyzed with paired t tests or nonparametric tests. Logistic regression analyzed predictors of outcome and utilization for 116 patients (male/female = 81/35; age range, 11-86 years) attending the interdisciplinary clinic, introductory session, and/or group.
After group treatment, patients reported better mood (P = .0482); better physical (P = .0006) and mental (P = .0183) health; better functionality, coping, and skill use (Ps< .0001); less impairment (P < .0001); and fewer limitations from dizziness (P < .0001). Higher pretreatment levels of depression (P = .0216), poorer initial mental (P = .0164) or physical (P = .0059) health, and peripheral diagnosis (P = .0220) predicted better outcome. Group treatment decreased utilization more than the interdisciplinary clinic with (P = .0183) or without (P = .0196) the introductory session; 78% of patients with any level of participation showed less utilization. Clinic patients had fewer radiology procedures than group patients (P = .0365). Patients were highly satisfied with the program and found it more effective than previous treatment.
Interdisciplinary treatment improves patient coping, functionality, and satisfaction and decreases overall health care utilization in vestibular patients.
研究前庭疾病患者的跨学科治疗方案是否能改善健康结果和医疗保健的利用情况。
病例系列研究，结合图表回顾。
门诊神经耳科诊所。
167 例头晕患者参加了跨学科神经耳科诊所；129 例患者接受了小组治疗。在介绍性会议之后，小组治疗包括 5 次会议，整合了正念、认知行为技术和前庭康复。在小组治疗前后，使用评定量表评估身体和情绪功能、抑郁、焦虑、头晕、障碍、应对、技能使用和患者满意度。对 51 例患者（男/女=14/37；年龄 25-82 岁）的数据进行配对 t 检验或非参数检验分析。对 116 例（男/女=81/35；年龄 11-86 岁）参加跨学科诊所、介绍性会议和/或小组治疗的患者进行逻辑回归分析，以预测结果和利用情况。
小组治疗后，患者的情绪（P=0.0482）、身体（P=0.0006）和精神健康（P=0.0183）均有改善；功能、应对和技能使用（P<0.0001）情况更好；障碍程度（P<0.0001）和头晕限制（P<0.0001）更少。较高的治疗前抑郁水平（P=0.0216）、较差的初始精神（P=0.0164）或身体健康（P=0.0059）和周围性诊断（P=0.0220）预测了更好的结果。小组治疗比跨学科诊所（P=0.0183）或无介绍性会议（P=0.0196）更能减少利用，78%的参与患者的利用率较低。诊所患者的影像学检查程序比小组患者少（P=0.0365）。患者对该方案非常满意，认为其比以往的治疗更有效。
跨学科治疗可改善前庭疾病患者的应对、功能和满意度，并降低整体医疗保健的利用。
