Cargando…
Implementation of evidence-based practice for benign paroxysmal positional vertigo: DIZZTINCT– A study protocol for an exploratory stepped-wedge randomized trial
BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, and accounts for 8% of individuals with moderate or severe dizziness. BPPV patients experience substantial inconveniences and disabilities during symptomatic periods. BPPV therapeutic processes...
Autores principales: | , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6303863/ https://www.ncbi.nlm.nih.gov/pubmed/30577834 http://dx.doi.org/10.1186/s13063-018-3099-0 |
_version_ | 1783382243788455936 |
---|---|
author | Meurer, William J. Beck, Kathryn E. Rowell, Brigid Brown, Devin Tsodikov, Alexander Fagerlin, Angela Telian, Steven A. Damschroder, Laura An, Lawrence C. Morgenstern, Lewis B. Ujhely, Misty Loudermilk, Laura Vijan, Sandeep Kerber, Kevin A. |
author_facet | Meurer, William J. Beck, Kathryn E. Rowell, Brigid Brown, Devin Tsodikov, Alexander Fagerlin, Angela Telian, Steven A. Damschroder, Laura An, Lawrence C. Morgenstern, Lewis B. Ujhely, Misty Loudermilk, Laura Vijan, Sandeep Kerber, Kevin A. |
author_sort | Meurer, William J. |
collection | PubMed |
description | BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, and accounts for 8% of individuals with moderate or severe dizziness. BPPV patients experience substantial inconveniences and disabilities during symptomatic periods. BPPV therapeutic processes – the Dix-Hallpike Test (DHT) and the Canalith Repositioning Maneuver (CRM) – have an evidence base that is at the clinical practice guideline level. The most commonly used CRM is the modified Epley maneuver. The DHT is the gold standard test for BPPV and the CRM is supported by numerous randomized controlled trials and systematic reviews. Despite this, BPPV care processes are underutilized. METHODS/DESIGN: This is a stepped-wedge, randomized clinical trial of a multi-faceted educational and care-process-based intervention designed to improve the guideline-concordant care of patients with BPPV presenting to the emergency department (ED) with dizziness. The unit of randomization and target of intervention is the hospital. After an initial observation period, the six hospitals will undergo the intervention in five waves (two closely integrated hospitals will be paired). The order will be randomized. The primary endpoint is measured at the individual patient level, and is the presence of documentation of either the Dix-Hallpike Test or CRM. The secondary endpoints are referral to a health care provider qualified to treat dizziness for CRM and 90-day stroke rates following an ED dizziness visit. Formative evaluations are also performed to monitor and identify potential and actual influences on the progress and effectiveness of the implementation efforts. DISCUSSION: If this study safely increases documentation of the DHT/CRM, this will be an important step in implementing the use of these evidenced-based processes of care. Positive results will support conducting larger-scale follow-up studies that assess patient outcomes. The data collection also enables evaluation of potential and actual influences on the progress and effectiveness of the implementation efforts. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02809599. The record was first available to the public on 22 June 2016 prior to the enrollment of the first patients in October 2016. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13063-018-3099-0) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6303863 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-63038632018-12-31 Implementation of evidence-based practice for benign paroxysmal positional vertigo: DIZZTINCT– A study protocol for an exploratory stepped-wedge randomized trial Meurer, William J. Beck, Kathryn E. Rowell, Brigid Brown, Devin Tsodikov, Alexander Fagerlin, Angela Telian, Steven A. Damschroder, Laura An, Lawrence C. Morgenstern, Lewis B. Ujhely, Misty Loudermilk, Laura Vijan, Sandeep Kerber, Kevin A. Trials Study Protocol BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, and accounts for 8% of individuals with moderate or severe dizziness. BPPV patients experience substantial inconveniences and disabilities during symptomatic periods. BPPV therapeutic processes – the Dix-Hallpike Test (DHT) and the Canalith Repositioning Maneuver (CRM) – have an evidence base that is at the clinical practice guideline level. The most commonly used CRM is the modified Epley maneuver. The DHT is the gold standard test for BPPV and the CRM is supported by numerous randomized controlled trials and systematic reviews. Despite this, BPPV care processes are underutilized. METHODS/DESIGN: This is a stepped-wedge, randomized clinical trial of a multi-faceted educational and care-process-based intervention designed to improve the guideline-concordant care of patients with BPPV presenting to the emergency department (ED) with dizziness. The unit of randomization and target of intervention is the hospital. After an initial observation period, the six hospitals will undergo the intervention in five waves (two closely integrated hospitals will be paired). The order will be randomized. The primary endpoint is measured at the individual patient level, and is the presence of documentation of either the Dix-Hallpike Test or CRM. The secondary endpoints are referral to a health care provider qualified to treat dizziness for CRM and 90-day stroke rates following an ED dizziness visit. Formative evaluations are also performed to monitor and identify potential and actual influences on the progress and effectiveness of the implementation efforts. DISCUSSION: If this study safely increases documentation of the DHT/CRM, this will be an important step in implementing the use of these evidenced-based processes of care. Positive results will support conducting larger-scale follow-up studies that assess patient outcomes. The data collection also enables evaluation of potential and actual influences on the progress and effectiveness of the implementation efforts. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02809599. The record was first available to the public on 22 June 2016 prior to the enrollment of the first patients in October 2016. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13063-018-3099-0) contains supplementary material, which is available to authorized users. BioMed Central 2018-12-22 /pmc/articles/PMC6303863/ /pubmed/30577834 http://dx.doi.org/10.1186/s13063-018-3099-0 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Study Protocol Meurer, William J. Beck, Kathryn E. Rowell, Brigid Brown, Devin Tsodikov, Alexander Fagerlin, Angela Telian, Steven A. Damschroder, Laura An, Lawrence C. Morgenstern, Lewis B. Ujhely, Misty Loudermilk, Laura Vijan, Sandeep Kerber, Kevin A. Implementation of evidence-based practice for benign paroxysmal positional vertigo: DIZZTINCT– A study protocol for an exploratory stepped-wedge randomized trial |
title | Implementation of evidence-based practice for benign paroxysmal positional vertigo: DIZZTINCT– A study protocol for an exploratory stepped-wedge randomized trial |
title_full | Implementation of evidence-based practice for benign paroxysmal positional vertigo: DIZZTINCT– A study protocol for an exploratory stepped-wedge randomized trial |
title_fullStr | Implementation of evidence-based practice for benign paroxysmal positional vertigo: DIZZTINCT– A study protocol for an exploratory stepped-wedge randomized trial |
title_full_unstemmed | Implementation of evidence-based practice for benign paroxysmal positional vertigo: DIZZTINCT– A study protocol for an exploratory stepped-wedge randomized trial |
title_short | Implementation of evidence-based practice for benign paroxysmal positional vertigo: DIZZTINCT– A study protocol for an exploratory stepped-wedge randomized trial |
title_sort | implementation of evidence-based practice for benign paroxysmal positional vertigo: dizztinct– a study protocol for an exploratory stepped-wedge randomized trial |
topic | Study Protocol |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6303863/ https://www.ncbi.nlm.nih.gov/pubmed/30577834 http://dx.doi.org/10.1186/s13063-018-3099-0 |
work_keys_str_mv | AT meurerwilliamj implementationofevidencebasedpracticeforbenignparoxysmalpositionalvertigodizztinctastudyprotocolforanexploratorysteppedwedgerandomizedtrial AT beckkathryne implementationofevidencebasedpracticeforbenignparoxysmalpositionalvertigodizztinctastudyprotocolforanexploratorysteppedwedgerandomizedtrial AT rowellbrigid implementationofevidencebasedpracticeforbenignparoxysmalpositionalvertigodizztinctastudyprotocolforanexploratorysteppedwedgerandomizedtrial AT browndevin implementationofevidencebasedpracticeforbenignparoxysmalpositionalvertigodizztinctastudyprotocolforanexploratorysteppedwedgerandomizedtrial AT tsodikovalexander implementationofevidencebasedpracticeforbenignparoxysmalpositionalvertigodizztinctastudyprotocolforanexploratorysteppedwedgerandomizedtrial AT fagerlinangela implementationofevidencebasedpracticeforbenignparoxysmalpositionalvertigodizztinctastudyprotocolforanexploratorysteppedwedgerandomizedtrial AT telianstevena implementationofevidencebasedpracticeforbenignparoxysmalpositionalvertigodizztinctastudyprotocolforanexploratorysteppedwedgerandomizedtrial AT damschroderlaura implementationofevidencebasedpracticeforbenignparoxysmalpositionalvertigodizztinctastudyprotocolforanexploratorysteppedwedgerandomizedtrial AT anlawrencec implementationofevidencebasedpracticeforbenignparoxysmalpositionalvertigodizztinctastudyprotocolforanexploratorysteppedwedgerandomizedtrial AT morgensternlewisb implementationofevidencebasedpracticeforbenignparoxysmalpositionalvertigodizztinctastudyprotocolforanexploratorysteppedwedgerandomizedtrial AT ujhelymisty implementationofevidencebasedpracticeforbenignparoxysmalpositionalvertigodizztinctastudyprotocolforanexploratorysteppedwedgerandomizedtrial AT loudermilklaura implementationofevidencebasedpracticeforbenignparoxysmalpositionalvertigodizztinctastudyprotocolforanexploratorysteppedwedgerandomizedtrial AT vijansandeep implementationofevidencebasedpracticeforbenignparoxysmalpositionalvertigodizztinctastudyprotocolforanexploratorysteppedwedgerandomizedtrial AT kerberkevina implementationofevidencebasedpracticeforbenignparoxysmalpositionalvertigodizztinctastudyprotocolforanexploratorysteppedwedgerandomizedtrial |