Assessment and treatment of dizzy patients in primary health care

Sammanfattning: Dizziness is a common reason for visits to primary health care, especially among elderly patients. From a physiotherapeutic perspective, this thesis aims to study the assessment and treatment of dizzy patients in primary health care. Interventions in papers I, III and IV comprised a vestibular rehabilitation programme.

In paper I, patients with multisensory dizziness were randomized to intervention group or control group. At follow-up after six weeks and three months, the intervention group had improved their postural control while the control group had deteriorated. In paper II, the diagnostic panorama at a primary health care centre was studied, as well as balance measures and self-perceived handicap because of dizziness. Patients with multisensory dizziness performed more poorly on the balance measures than the other groups. Subjects 66 years or older had more disturbances in balance, but lower level of self-perceived handicap. The level of self-perceived handicap did not correlate with any of the balance measures. In paper III, patients with dizziness caused by whiplash associated disorder were randomized to intervention group or control group. At follow-up after six weeks and three months, the intervention group had improved in both balance measures and self-perceived handicap. In paper IV, patients with multisensory dizziness were studied. An intervention group was compared to a control group regarding balance measures, self-perceived handicap and the proportions of patients who fell. At the follow-up after three months, the intervention group had improved in two balance measures. There were no differences between the two groups in the proportions of patients who fell.

This thesis indicates vestibular rehabilitation as a feasible treatment for dizzy patients in primary health care. Since primary health care is considered the appropriate level of medical care for the majority of dizzy patients, this is also where vestibular rehabilitation is best provided, preferably by a trained physiotherapist.