Survey of Physical Therapists' Views on and Referral Processes for Objective Vestibular Testing

Background: Referral pathways for the “dizzy” patient are complex and vary depending on presenting symptoms. There are currently no guidelines for referring a patient with vestibular symptoms from physical therapy to vestibular audiology for formal vestibular testing.Purpose: The purpose of this study was to survey physical therapists (PTs) to (1) provide insight into the referral process between the PT and the vestibular audiologist, (2) identify trends among PTs regarding their familiarity with objective vestibular testing, and (3) assess how formal vestibular testing can help provide a targeted treatment plan.Research Design: A mixed-methods approach was used to evaluate responses to an electronically sent survey to PTs of six different associations.Study Sample: There were 109 responses received, with 75 vestibular rehabilitation–certified respondents.Data Collection and Analysis: The collected data were analyzed using descriptive statistics and qualitative analysis to derive themes from open-ended responses.Results: Primary triggers necessitating referral for further medical consultation and objective vestibular testing included (1) central indications, (2) no improvement in symptoms after the treatment period, (3) inconsistencies on physical therapy evaluation, and (4) a history of vestibulotoxic medications. Of the respondents, 35 percent (38/109) reported performing three to five physical therapy sessions before referral. The videonystagmography and Video Head Impulse Test were the most useful vestibular tests, 84 percent (91/109) and 69 percent (75/109), respectively. Most PTs (95/109 [87.2 percent]) were familiar with formal vestibular testing, and 74 of 109 (67.9 percent) felt comfortable interpreting the vestibular test results. About 72 of 109 (66.1 percent) PTs use vestibular tests to guide their treatment plan, and 64 of 109 (58.7 percent) PTs use the results when treatment plans have been unsuccessful. Interestingly, only 21 percent (23/109) stated that treatment plans differ after an individual received vestibular testing.Conclusions: The results demonstrate PTs’ awareness and understanding of vestibular testing, but barriers to collaborative care include a lack of clear referral guidelines (i.e., number of treatment sessions before referral). Further support is needed to help navigate the care of patients with dizziness, including better access to formal vestibular testing.Clinical Relevance Statement: The work of this study highlights the need for better access to vestibular audiologists, increased communication between providers, and more multidisciplinary clinics for patients with vestibular symptoms. In addition, it encourages value of the vestibular test battery from the opinion of PTs who specialize in vestibular rehabilitation. Future work from this study may focus on creating a specific guideline criterion for the vestibular PTs and vestibular audiologists.