United Christian Hospital (Audiology, ENT & Physiotherapy Departments) Presented by Ms. Becky Lam (PT)
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1 Fast-track Assessment, Screening & Treatment pathway for Enhanced vestibular Rehabilitation United Christian Hospital (Audiology, ENT & Physiotherapy Departments) Presented by Ms. Becky Lam (PT)
2 Uncompensated Peripheral Vestibular Hypofunction Dizziness Activity level Functional independence Social interaction QOL Vertigo Dysequilibrium Oscillopsia
3 Conventional Model GP/ GOPC consultation: refer ENT ~ 6 months 1 st ENT specialist consultation ~ 16 months Vestibular diagnostic Ax by audiologist (ENG) ENT Fu with vestibulo-suppressant prescription Allow time for self compensation
4 Long Waiting Time
5 No Way Out
6 Dragging in Health Care System Health Care System
7 FASTER The Solution GP/ GOPC consultation: refer ENT New Triage System 1 st ENT specialist consultation Preliminary VNG Ax by PT Advanced vestibular diagnostic Ax Physiotherapy Vestibular Rehabilitation
8 New Triage System ENT specialists triage patients with possible vestibular hypofunction from routine waiting list 1st ENT consultation: 6 months 1 month
9 Advanced Vestibular Diagnostic Ax Videonystagmography (VNG) by Physiotherapist Diagnostic test: 16 months 2 months Vestibular Rehab for indicated cases
10 Physiotherapy Vestibular Rehabilitation Comprehensive Assessment Vestibular symptoms Functional limitation QOL Oculomotor function Balance
11 Physiotherapy Vestibular Rehabilitation Specific & individualized training Adaptation, Gaze Stabilization, & Substitution Gaze stabilization: Focus, Head Turn Adaptation: Optokinetic Taining Substitution : Trampoline Walk
12 Physiotherapy Vestibular Rehabilitation Balance Training & Reconditioning Balance Training: Tandam walk, Balance Beam Reconditioning KT II, Semi Lunge
13
14 Conventional Vs FASTER GP/ GOPC consultation: refer ENT ~ 6 month GP/ GOPC consultation: refer ENT ~ 1 month 1 st ENT specialist consultation ~ 16 months ENG by audiologist Advanced 1 st ENT consultation with triage system ~ 2 months Advanced VNG Ax by PT ENT Fu for medication Allow time for self compensation Physiotherapy Vestibular Rehabilitation
15 Time to obtain a confirmed Dx of vestibular hypofunction = 22 months = 3 months
16 Results of Physiotherapy Vestibular Rehabilitation March 29 to March 21 No of Patient 46 Mean Age Duration of symptoms 56 years old 63.6 months (~ 5 yrs) No. of PT session 5.2
17 NGRCS Score Outcome Measures Significant positive effects were shown in all 4 outcome measures Numeric Global Rating of Change Scale (NGRCS) *P <. Visual Analogue Scale (VAS) *P <. 2 *P <. 1 VAS Score Dizzinesss Handicap Inventory Score Avarge Single Leg Stand Duration Total Score *P < Duration (seconds) *P <
18 Outcome Measures Numeric Global Rating of Change Scale (NGRCS) - Overall improvement with Rx NGRCS Score Numeric Global Rating of Change Scale (NGRCS) *P <. *P < VAS Score Visual Analogue Scale (VAS) *P < Dizzinesss Handicap Inventory Score Avarge Single Leg Stand Duration Total Score *P < Duration (seconds) *P <
19 Outcome Measures Visual Analogue Scale - Symptoms severity measurement NGRCS Score Numeric Global Rating of Change Scale (NGRCS) *P <. *P < VAS Score Visual Analogue Scale (VAS) *P < Dizzinesss Handicap Inventory Score Avarge Single Leg Stand Duration Total Score *P < Duration (seconds) *P <
20 Outcome Measures Chinese Version of Dizziness Handicap Inventory - QOL (chronic dizziness) measurement - High total score indicate fall risk NGRCS Score Numeric Global Rating of Change Scale (NGRCS) *P <. Visual Analogue Scale (VAS) *P <. 2 *P <. 1 VAS Score Dizzinesss Handicap Inventory Score Avarge Single Leg Stand Duration Total Score *P < Duration (seconds) *P <
21 Outcome Measures Average Single Leg Stand Duration - Balance ability measurement (Max. 3s) NGRCS Score Numeric Global Rating of Change Scale (NGRCS) *P <. Visual Analogue Scale (VAS) *P <. 2 *P <. 1 VAS Score Dizzinesss Handicap Inventory Score Avarge Single Leg Stand Duration Total Score *P < Duration (seconds) *P <
22 Amazing Change with FASTER Shorten Long Waiting Time Advanced ENT SOPD ENT SOPD (6/12) (1/12) Advanced Diagnostic Diagnostic Ax (16/12) Ax (2/12) PT Vestibular Symptomatic Rehabilitation to Enhance Control Physical Only Recovery & QOL Facilitate Discharge SOPD Fu from ENT SOPD
23 Dr. Luk Harriet Lo Becky Lam Mrs. E Chan Dr. Wendy Kwan Betty Tsui Yvonne Lam
24
25 Acknowledgements ENT Department Dr. Victor Abdullah (COS) Dr. Wendy Kwan (AC) Dr. Alex Lee (Specialist) Audiology Department Ms. Betty Tsui (DM) Physiotherapy Department Mrs. Eleanor Chan (DM) Ms. Harriet Lo (SPT)
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