Implementing specialized vestibular physiotherapy in an emergency department: A process evaluation

Abstract

\n Background:Dizziness and vertigo-like symptoms, often caused by common peripheral vestibular disorders such as Benign Paroxysmal Positional Vertigo (BPPV), may have a significant detrimental impact on function and quality of life. The impact of these symptoms often result in Emergency Department (ED) presentations. Evidence based clinical practice guidelines strongly recommend the use of physical assessment and treatment maneuvers for the assessment, diagnosis and treatment of these symptoms. The aim of this study was to evaluate the process of implementing specialized vestibular physiotherapy in an emergency department, from the clinician perspective. Methods:This implementation study utilized a retrospective mixed methods process evaluation to understand how specialized vestibular physiotherapy operated in an Australian emergency department. The PARiHS Framework was embedded within the methodology and analytical approach of the study, to ensure a comprehensive approach which was closely aligned to implementation science. Nine clinicians retrospectively completed the Organizational Readiness for Change Assessment (ORCA), Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM) and Feasibility of Intervention Measure (FIM). Seven clinicians also participate in a focus group or interview. Results: A range of barriers and facilitators to the implementation process were identified by participants, some of which spanned multiple domains of the PARiHS framework. Relationships with service leaders, champions and medical staff were found to be a key facilitator to implementation, along with a generally held perception that specialized vestibular physiotherapy was acceptable and feasible. The main barrier identified was a lack of capacity to deliver and support this innovation, both within the physiotherapy workforce and the broader multidisciplinary team. Conclusions: This study demonstrates the process of implementation of a specialized vestibular physiotherapy team in an ED setting was generally well received by clinicians, but also involved some challenges and barriers. Services looking to implement specialized vestibular physiotherapy in the ED may refer to the recommendations arising from the findings of this study to guide their approach to innovation.