The aim of this subgroup analysis was to investigate whether the physiotherapy intervention as part of the care pathway improves the subjectively perceived impairment of mobility and participation among older individuals with VDB in the intervention group (IG).
Following a training programme, general practitioners in the IG could prescribe physiotherapy within three months. The physiotherapists also received training and an algorithmic decision tree. Impairment was assessed using the Dizziness Handicap Inventory (DHI) at three time points: prior to the intervention (t0), four months later (t1) and six months later (t2). For the analysis, t-tests with effect size calculation, a linear regression to investigate the influence of physiotherapy on the DHI, and a two-way ANOVA with repeated measures to analyse the effects over time and between the groups were performed.
The IG (N=56) was divided into two groups: those with physiotherapy (n=23) and those without physiotherapy (n=33). The mean difference in DHI scores at t1 was -15.36 points (95% CI: [-28.16; -2.55]), and at t2, it was -14.15 points (95% CI: [-27.85; -0.44]). The observed differences exceed the minimal clinically important difference of 12 points. At both time points, the t-tests demonstrated statistically significant differences in favour of physiotherapy, with a medium effect size (t1: p=0.02, t=2.38, Cohen's d=-0.68; t2: p=0.045, t=2.06, Cohen's d=-0.60). The regression analysis yielded significant results at both time points, with p-values of t1: p=0.003 and t2: p=0.045 for the physiotherapy group, and regression coefficients of -14.85 (t1) and -14.15 (t2) points. Nevertheless, the models explained less than 10% of the variance. The assumptions of normal distribution, homogeneity of variance and sphericity were met. The ANOVA revealed a significant effect for physiotherapy (F=9.58, p=0.002), but no significant effect of time (F=0.21, p=0.8) or interaction between time and physiotherapy (F=0.51, p=0.6). This is in contrast to the previous analyses, which indicated a change over time.
The physiotherapy intervention, as part of the care pathway, has a positive, clinically relevant effect on the subjectively perceived impairment of mobility and participation in individuals with VDB. However, other influencing factors must be identified on the basis of the accompanying process evaluation. Furthermore, the small sample size must be taken into account when interpreting the results. An implementation study with a larger sample size is planned.
The study indicates that physiotherapy can be a valuable component in treating older individuals with VDB. For a broader implementation into practice, general practitioners should be familiarised with it so that patients can benefit from collaboration in primary care in the future.
care-pathway
RCT
