Abstract
Objective
To determine the rate of physical therapy (PT) referral and patient and physician
characteristics associated with PT referral for benign paroxysmal positional vertigo
(BPPV) and other peripheral vestibular disorders (PVD) in ambulatory care clinics
in the United States.
Design
Cross-sectional analysis of the National Ambulatory Medical Care Survey 2004-2015
Setting
Ambulatory care clinics in the United States.
Participants
We identified 5.6 million weighted adult visits for BPPV (International Classification of Diseases–9th Revision–Clinical Modifications (ICD-9-CM): 386.11) and 6.6 million weighted visits for other PVDs (ICD-9-CM: 386.1-386.9,
excluding 386.11 and 386.2) made by patients 18 years and older from 2004 through 2015.
Interventions
Not applicable.
Main Outcome Measures
Patient, clinical, and physician characteristics were extracted, and descriptive statistics
were stratified by referral to PT. Two multivariable logistic regression models were
estimated for each diagnostic group (BPPV and other PVDs) to identify predictors of
PT referral.
Results
PT referrals for BPPV increased from 6.2% in the period from 2004 to 2006 to 12.9%
in the period from 2013 to 2015, whereas PT referrals for other PVDs decreased from
3.8% in the period from 2004 to 2006 to 0.5% in the period from 2013 to 2015. Other
insurance coverage (versus private) and neurologists and other specialists (versus
otolaryngologists) were associated with a greater odds of PT referral for BPPV. Visits
made in the Midwest and West (versus the Northeast) and in rural versus metropolitan
areas had greater odds of PT referral for BPPV. Relative to otolaryngologists, primary
care physicians were less likely to refer to PT for other PVDs. Visits made in metropolitan
versus rural areas and visits with 1 or more comorbidities (versus none) had greater
odds of PT referral for other PVDs.
Conclusions
PT referrals remain low for ambulatory care visits for BPPV and other PVDs in the
United States. Referral to PT for BPPV and other PVDs varied by insurance type, physician
specialty, and office location.
Keywords
List of abbreviations:
BPPV (benign paroxysmal positional vertigo), CI (confidence interval), CRM (canalith repositioning maneuver), ICD-9-CM (International Classification of Diseases–9th Revision–Clinical Modifications), NAMCS (National Ambulatory Medical Care Survey), OR (odds ratio), PT (physical therapy), PVD (peripheral vestibular disorder), VR (vestibular rehabilitation)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 19, 2020
Footnotes
This study was supported by a grant awarded through the Health Resources and Services Administration of the United States Department of Health and Human Services under Cooperative Agreement U81HP26495-04-00, Health Workforce Research Centers Program. Aspects of this work have been previously presented at the American Physical Therapy Association Combined Sections Meeting in Washington DC, January 2019.
Disclosure: S.L.W. reports financial relationships with Intelligent automation, Inc, Medbridge, the APTA Board of Directors, the APTA Neurology Academy, and Interacoustics, outside the submitted work. In addition, S.L.W. has a patent pending for an exercise application for people with vestibular disorders. The other authors have nothing to disclose.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
