Vertigo

Vertigo and Dizziness Research

W2II-1: Epidemiology and health services research in vertigo
“Implementing pragmatic management of vertigo in the community”

Principle Investigator: Prof. Dr. Eva Grill, MPH

Funded by: Federal Ministry for Education and Research (BMBF), Project number: 01EO1401

Period: 01.11.2014 - 31.10.2019

Background
Epidemiological research is faced with several challenges when it comes to dizziness and balance disorders. These include, for example, insufficient case definition, lack of established knowledge about diagnostic and therapeutic algorithms, diversity of data collection methods, and the lack of standardization of routines. In addition, vertigo disorders often inadequately diagnosed and treated incorrectly in routine care, although most dizziness symptoms can be well diagnosed and treated.

Objectives

1. PREVALENCE AND DETERMINANTS: To examine prevalence and specific determinants of vertigo in the community
2. HEALTH SERVICES UTILIZATION: To examine current diagnostic, therapeutic and referral behavior of the healthcare providers
3. IMPLEMENTATION: To develop an intervention for the implementation of pragmatic diagnostic and therapeutic management strategies for vertigo in primary care and to examine its cost-effectiveness.

Project Descriptions

1. Community-Based Cohort Study: This study is conducted on patients who are being treated for vertigo or dizziness symptoms in the primary care setting. We will analyze typical diagnostic and treatment pathways and the impact of vertigo or dizziness on quality of life and participation.
2. Reviews: Systematic reviews of the effectiveness and cost of policy implementation and implementation strategies will be carried out to collect the theoretical knowledge base for an intervention.
   1. Guideline implementation strategies in primary care – a systematic review and meta-analysis
   2. Facilitators and barriers of guideline adherence in primary care setting: systematic review of the primary care providers' opinion
3. Interviews: Based on the results of the systematic reviews, we will conduct semi-qualitative interviews with general practitioners. The transcripts of the interviews are subject to a structured content analysis in order, for example, to elaborate on barriers and facilitators for a successful implementation of guidelines. In addition, expert interviews with members of the DSGZ will be conducted to determine meaningful intervention components.
4. Expert workshop: Based on the results of the systematic review and the interviews, potentially successful intervention components will be developed at a workshop. Participants in the workshop will be national experts on dizziness and experts in program implementation, as well as general practitioners representing the main intervention group.
5. Pilot study: As preparation for a randomized study, the implementation of the intervention will be tested in a pilot study in the primary care setting. The feasibility of the recruitment strategy, the acceptance of the various components of the intervention, and the performance of various outcome instruments will be tested. The study is also designed to assess the variability of patient-related outcomes within and between general practitioners and to assess whether the intervention could be successful enough to justify a larger clinical trial.
6. Cluster randomized trial: Depending on the results of the pilot study, a clinical trial for the implementation of the intervention will be carried out. Because of the complexity of the intervention and the need to develop and, if necessary, modify an implementation strategy, this study can only be planned and started after completion of the pilot study. The study will be funded separately.

Contact:
Dr. med. Eva Kovacs, Dipl.-Psych.