Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2018 Oct 9;13(10):e0204876.
doi: 10.1371/journal.pone.0204876. eCollection 2018.

Effectiveness of a multifactorial intervention for dizziness in older people in primary care: A cluster randomised controlled trial

Hanneke Stam  1 , Johannes C van der Wouden  1 , Jacqueline G Hugtenburg  2 , Jos W R Twisk  3 , Henriëtte E van der Horst  1 , Otto R Maarsingh  1
Affiliations
Randomized Controlled Trial

Effectiveness of a multifactorial intervention for dizziness in older people in primary care: A cluster randomised controlled trial

Hanneke Stam et al. PLoS One. .

Abstract

Objectives: Dizziness is common in older people. Physicians are often unable to identify a specific cause for dizziness in older people, even after an extensive diagnostic work-up. A prognosis-oriented approach, i.e. treating modifiable risk factors for an unfavourable course of dizziness, may reduce dizziness-related impairment in older people in primary care.

Design: Cluster randomized controlled trial.

Setting: 45 primary care practices in The Netherlands.

Participants: 168 participants aged ≥65y who consulted their general practitioner for dizziness and experienced significant dizziness-related impairment (Dizziness Handicap Inventory (DHI) ≥30). Participants were part of to the intervention group (n = 83) or control group (n = 85), depending on whether they were enlisted in an intervention practice or in a control practice.

Interventions: The multifactorial intervention consisted of: medication adjustment in case of ≥3 prescribed fall-risk-increasing drugs (FRIDs) and/or stepped mental health care in case of anxiety disorder and/or depression and/or exercise therapy in case of impaired functional mobility. The intervention was compared to usual care.

Outcome measures: The primary outcome was dizziness-related impairment. Secondary outcomes were quality of life (QoL), dizziness frequency, fall frequency, anxiety and depression, use of FRIDs.

Results: Intention-to-treat analysis showed no significant intervention effect on dizziness-related impairment (DHI score difference -0.69 [95% CI -5.66;4.28]; p = 0.79). The intervention proved effective in reducing the number of FRIDs (FRID difference -0.48 [95% CI -0.89;-0.06]; p = 0.02). No significant intervention effects were found on other secondary outcomes. The uptake of and adherence to the interventions was significantly lower in patients eligible for ≥2 interventions compared to patients eligible for one intervention (p<0.001).

Conclusions: The multifactorial intervention for dizziness in older patients showed no significant intervention effect on most outcomes and adherence to the multifactorial intervention was low. Although multifactorial treatment for older dizzy people seems promising in theory, we question its feasibility in daily practice. Future research could focus on a sequential treatment for dizziness, e.g. measuring effectiveness of various evidence-based therapies in a stepwise approach.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow of study participants.
Abbreviations: DHI Dizziness Handicap Inventory; pharm fall risk increasing drug medication adjustment; SMHC stepped mental health care; physio exercise therapy. a at risk: usage of ≥ 3 Fall-risk-increasing drugs and/or presence of depressive or anxiety disorder and/or impaired functional mobility. b does not add up to 83: 7 patients did not start any intervention, 8 patients refused 1 intervention but started 1 or 2 other interventions. c does not add up to 76: 61 patients started 1 intervention, 13 patients started 2 interventions, 2 patients started 3 interventions. d does not add up to 17: 5 patients declined 1 intervention, 2 patients declined 2 interventions, 8 patients declined 1 intervention but started ≥1 other interventions.
Fig 2
Fig 2. Uptake of and adherence to the interventions.
Fig 3
Fig 3. Twelve-month course of dizziness-related impairment as measured with the Dizziness Handicap Inventory (DHI).
See this image and copyright information in PMC

References

    1. Maarsingh OR, Dros J, Schellevis FG, van Weert HC, Bindels PJ, van der Horst HE. Dizziness reported by elderly patients in family practice: prevalence, incidence, and clinical characteristics. BMC Fam Pract. 2010;11(2). - PMC - PubMed
    1. Stam H, Harting T, van der Sluijs M, van Marum R, van der Horst HE, van der Wouden JC, et al. Usual care and management of fall risk increasing drugs in older dizzy patients in Dutch general practice. Scand J Prim Health Care. 2016;34(2):165–71. 10.3109/02813432.2016.1160634 - DOI - PMC - PubMed
    1. Aggarwal NT, Bennett DA, Bienias JL, Mendes de Leon CF, Morris MC, Evans DA. The prevalence of dizziness and its association with functional disability in a biracial community population. J Gerontol A Biol Sci Med Sci. 2000;55(5):M288–92. - PubMed
    1. Cigolle CT, Langa KM, Kabeto MU, Tian Z, Blaum CS. Geriatric conditions and disability: The Health and Retirement Study. Ann Intern Med. 2007;147(3):156–64. - PubMed
    1. Kammerlind AS, Håkansson JK, Skogsberg MC. Effects of balance training in elderly people with nonperipheral vertigo and unsteadiness. Clin Rehabil. 2001;15(5):463–70. 10.1191/026921501680425180 - DOI - PubMed

Publication types