Department of Physiotherapy, Gold Coast Hospital and Health Service, Southport, Gold Coast, Qld, Australia.
Department of Speech Pathology and Audiology, Gold Coast Hospital and Health Service, Southport, Gold Coast, Qld, Australia.
BMC Health Serv Res. 2024 Sep 19;24(1):1094. doi: 10.1186/s12913-024-11519-6.
Dizziness and vertigo are common referrals to Ear Nose Throat (ENT) outpatient services however these services have long waitlists for assessment. Primary contact physiotherapy-led vestibular clinics are recognized as improving access to care. This pilot study investigated agreement between physiotherapists and an ENT medical practitioner for diagnostic and management decisions in patients attending a primary contact physiotherapy-led vestibular clinic.
Prospective blinded inter-rater agreement study undertaken in an ENT primary contact physiotherapy-led vestibular clinic. Participants were adults referred to ENT from general practitioners, triaged (Category 2 or 3) to the primary contact physiotherapy-led vestibular clinic with clinical symptoms consistent with vestibular disorder. Primary outcome measures included agreement of diagnoses and management decisions made by an ENT medical practitioner and Physiotherapist based on a vestibular physiotherapy assessment. Adverse events were reviewed 11 months post data collection. Gwet's first order agreement co-efficient (AC1) calculated inter-rater reliability between physiotherapy and ENT.
Fifty-one participants were recruited consecutively from the primary contact physiotherapy-led vestibular clinic. Physiotherapy and ENT had a substantial agreement (AC1 0.613) on diagnosis. AC1 between physiotherapy and ENT for recommending Magnetic resonance imaging (0.810) and computerized tomography (0.935) both indicated near perfect agreement. There was moderate to near-perfect agreement regarding management recommendations between physiotherapy and ENT. Substantial agreement (AC1 0.720) was found for recommendations for ENT input, near perfect agreement (AC1 0.933) for neurology input and moderate agreement (AC1 0.574) for physiotherapy input. There were no adverse events from physiotherapist's management decision, based on final recommendations undertaken 11-months post data collection.
Physiotherapists and ENT medical practitioner made comparable diagnostic and management decisions, based on physiotherapy and audiology hearing assessment, for adults with signs of vestibular dysfunction, within an ENT primary contact physiotherapy-led vestibular clinic. This study provides support for this type of Physiotherapy-led service in managing patients referred to an ENT service with vestibular dysfunction.
头晕和眩晕是耳鼻喉科（ENT）门诊常见的转诊原因，但这些服务的评估等待时间很长。初级接触物理治疗主导的前庭诊所被认为可以改善获得护理的机会。这项试点研究调查了在初级接触物理治疗主导的前庭诊所就诊的患者中，物理治疗师和 ENT 医疗从业者在诊断和管理决策方面的一致性。
在 ENT 初级接触物理治疗主导的前庭诊所进行前瞻性盲法评估者间一致性研究。参与者为从全科医生转诊到 ENT 的成年人，根据临床症状，分诊为初级接触物理治疗主导的前庭诊所，症状符合前庭障碍。主要结局测量包括 ENT 医疗从业者和物理治疗师根据前庭物理治疗评估做出的诊断和管理决策的一致性。回顾了数据采集后 11 个月的不良事件。计算了物理治疗与 ENT 之间的 Gwet 第一顺序一致性系数（AC1）。
从初级接触物理治疗主导的前庭诊所连续招募了 51 名参与者。物理治疗和 ENT 在诊断方面具有实质性的一致性（AC1 0.613）。物理治疗和 ENT 对推荐磁共振成像（0.810）和计算机断层扫描（0.935）的 AC1 均表明接近完美的一致性。物理治疗和 ENT 之间在管理建议方面存在中度至近乎完美的一致性。物理治疗和 ENT 之间在建议 ENT 就诊方面存在实质性的一致性（AC1 0.720），在建议神经病学就诊方面存在近乎完美的一致性（AC1 0.933），在建议物理治疗就诊方面存在中度一致性（AC1 0.574）。根据数据采集后 11 个月进行的最终建议，基于物理治疗师的管理决策，没有出现不良事件。
在 ENT 初级接触物理治疗主导的前庭诊所中，根据物理治疗和听力评估，对于有前庭功能障碍迹象的成年人，物理治疗师和 ENT 医疗从业者在诊断和管理决策方面做出了可比的决策。这项研究为这种物理治疗主导的服务在管理因前庭功能障碍而转介到 ENT 服务的患者方面提供了支持。
