Vestibular Rehabilitation in the ED: Pilot Study Highlights Potential Benefits for Dizziness and Vertigo

The researchers found that vestibular therapy was successfully administered in the ED to patients with undifferentiated dizziness symptoms. However, they note that among those who received the treatment, the changes in dizziness-related disability over three months were not statistically significant, highlighting the need for a larger randomized clinical trial to assess its effectiveness comprehensively. 

The findings were published online in JAMA Network Open on February 14, 2025. 

The researchers note that dizziness symptoms contribute to nearly 2 million emergency department visits yearly, posing a significant diagnostic challenge for clinicians. While most research in this area has focused on enhancing guideline-based care, there has been limited emphasis on patient-centered interventions for reducing dizziness-related disability. In this context, Howard S. Kim, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, and colleagues aimed to evaluate the feasibility of implementing emergency department vestibular rehabilitation therapy (ED-VeRT). Using a structured diagnostic classification algorithm, the study assessed the delivery of vestibular therapy in the ED and tracked patient-reported outcomes over time to determine its impact on dizziness-related disability.

For this purpose, the researchers conducted a pilot nonrandomized clinical trial at a single urban US emergency department from 2021 to 2023, with three-month outcome collection until May 1, 2023. Patients with dizziness were assigned to ED-VeRT or usual care based on physician discretion. A physical therapist administered ED-VeRT using a structured diagnostic and treatment algorithm. Feasibility outcomes included screening, enrollment, and retention rates, while efficacy was assessed through changes in the Dizziness Handicap Inventory and Vestibular Activities Avoidance Inventory-9 scores over three months.

The study led to the following findings:

• Three-hundred sixty-six patients were screened, and 125 participants were enrolled (median age: 52 years). Among the participants, 73 (58%) were female, and 61 (49%) identified as White.
• Longitudinal data collection retained 84.0% of participants.
• ED vestibular therapy was received by 50.4% of participants.
• Primary diagnostic classifications included benign paroxysmal positional vertigo (37.1% participants), triggered undifferentiated dizziness (22.6% participants), spontaneous undifferentiated dizziness (22.6% participants), and unilateral peripheral hypofunction (14.5% participants).
• Although ED-VeRT participants had higher baseline dizziness-related disability scores, they reported lower dizziness handicap (-1.68) and vestibular activities avoidance (-2.27) at three months, but these differences were not statistically significant.

"The pilot nonrandomized clinical trial explored the feasibility of providing vestibular rehabilitation therapy in the emergency department using a standardized diagnostic system. It also gathered initial data on patient-reported outcomes over three months. The results highlight the need for a larger, fully powered randomized clinical trial to evaluate the effectiveness of ED vestibular therapy," the researchers concluded.

Reference:

Kim HS, Schauer JM, Kan AK, et al. Emergency Department Vestibular Rehabilitation Therapy for Dizziness and Vertigo: A Nonrandomized Clinical Trial. JAMA Netw Open. 2025;8(2):e2459567. doi:10.1001/jamanetworkopen.2024.59567