Key points Is receipt of physical therapy by patients with dizziness associated with a subsequent risk of falling requiring medical attention? Findings In this cross-sectional study of 805,454 patients aged 18 years or older evaluated for dizziness , 7% had a fall resulting in a medical consultation within 12 months of presentation for dizziness. Receiving physical therapy within 3 months of dizziness onset was associated with an 86% reduction in the odds of falling at 12 months. Meaning The findings of this study suggest that timely referral to physiotherapy for dizziness is associated with a reduction in the risk of harmful falls. |
Importance
Among adults presenting for clinical evaluation of dizziness, there is a critical need to identify interventions, such as physical therapy (PT), to mitigate the risk of falls over time.
Aim
The primary objective was to examine the association between receipt of physical therapy (PT) and falls requiring medical attention within 12 months of presentation for dizziness.
Secondary objectives included identification of factors associated with falls requiring medical attention and factors associated with receipt of PT after presentation for dizziness.
Design, environment and participants
This cross-sectional study examined US Medicare Advantage and commercial insurance claims from January 1, 2006 to December 31, 2015. In total, 805,454 patients aged 18 years or older were identified as patients with a new diagnosis of symptomatic or vestibular dizziness. Data was analyzed from October 1, 2021 to February 1, 2023.
Main results and measures
Receipt of physical therapy services and incidence of falls requiring medical attention were measured. The association between receipt of physical therapy (PT) and falls occurring 12 months after presentation for dizziness was estimated after taking into account the setting of presentation (outpatient clinic or emergency department), the Charlson Comorbidity Index ( CCI; higher scores indicate greater morbidity), diagnosis code, and sociodemographic variables.
Results
A total of 805,454 patients presented for dizziness between 2006 and 2015 (median age [range], 52 [18-87] years; 502,055 women [62%]). Of these patients, 45,771 (6%) received physical therapy (PT) within 3 months of presentation for dizziness and 60,060 (7%) experienced a fall resulting in a medical encounter within 12 months of presentation for dizziness. dizziness
In adjusted models, patients least likely to receive physical therapy (PT) were women (adjusted odds ratio [AOR], 0.80; 95% CI, 0.78-0.81), those aged 50 to 59 years (AOR, 0.67 [95% CI, 0.65-0.70] compared with patients aged 18 to 39 years) and those with more comorbidities (AOR, 0.71 [95% CI, 0.70 -0.73] for ICC ≥ 2 vs 0).
Receipt of physical therapy services within 3 months of presenting with dizziness was associated with a reduced risk of falls over the next 12 months.
Conclusions and relevance The results of this cohort study suggest that receiving physical therapy after presentation for dizziness was associated with a reduction in the risk of falls over the following 12 months; therefore, timely referral to a physical therapist for dizziness may be beneficial for these patients. Future research, ideally with a clinical trial design, is needed to explore the independent impact of PT on subsequent falls in adults with dizziness. |
