Dizziness is a very common symptom that often leads to reduced quality of life, anxiety and emotional distress, loss of fitness, lack of confidence in balance, unsteadiness, and an increased risk of falling. Most dizzy patients are managed in primary care by reassurance and medication to suppress symptoms. Trials have shown that chronic dizziness can be treated effectively in primary care using a self-help booklet to teach patients vestibular rehabilitation exercises that promote neurological adaptation and skill and confidence in balance. However, brief support from a trained nurse was provided in these trials, and this model of managing dizzy patients has not been taken up due to a lack of skills and resources in primary care. The aim of Yardley and colleagues is to evaluate two new alternative models of delivery that may be more feasible and cost-effective. In a single blind two-center pragmatic controlled trial, the investigators will randomize 330 patients from 30 practices to: (a) self-help booklet with telephone support from a vestibular therapist; (b) self-help booklet alone; or (c) routine medical care. Symptoms, disability, handicap, and quality of life will be assessed by validated questionnaires administered by post at baseline, immediately post-treatment (three months), and at one-year follow-up. The study is powered to test the authors’ primary hypothesis that the self-help booklet with telephone support will be more effective than routine care. They will also explore the effectiveness of the booklet without any support, and calculate the costs of treatment in each arm.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that if either trial shows that patients can cost-effectively manage their dizziness in primary care, then it can be easily rolled out to relieve the symptoms of the many patients in primary care who currently have chronic, untreated, disabling dizziness. Treatment in primary care may reduce the development of psychological and physical sequela that cause handicap and require treatment.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: If you experience dizziness, positive results will be of benefit to you in controlling the disorder. How soon the findings will be presented is unknown, however.

L Yardley et al. An evaluation of the cost-effectiveness of booklet-based self-management of dizziness in primary care, with and without expert telephone support. BMC Ear, Nose, & Throat Disorders, 2009;9:13.