Study: Physical therapy reduces risk for falls in patients presenting with dizziness

Key takeaways:

• The reduction in fall risk was greatest 3 to 12 months after physical therapy.
• Primary care physicians may have the greatest opportunity to increase education and awareness of PT.

Timely physical therapy was associated with a significant reduction in the risk for falls in patients presenting with dizziness, a recent study found.

According to Schelomo Marmor, PhD, MPH, an associate professor in the division of surgical oncology at the University of Minnesota Medical School, and colleagues, “among patients with dizziness or balance disorders specifically, physical therapy (PT) interventions have been associated with improved balance and reduced surrogate measures of fall risk.”

“However, direct evidence of actual fall rate reduction associated with vestibular PT is lacking,” they wrote in JAMA Otolaryngology-Head and Neck Surgery.

The researchers aimed to fill literature gaps by assessing receipts of PT and fall incidences in a cohort of 805,454 patients who presented with dizziness from Jan. 1, 2006, through Dec. 31, 2015.

Overall, 6% of patients received PT within 3 months of presenting with dizziness, and 7% experienced a fall that resulted in a medical visit 12 months after presenting with dizziness.

The researchers found varying risk reductions for falls after patients received PT within 3 months of presenting with dizziness. The greatest reduction in fall risk was between 3 to 12 months after receiving PT (adjusted OR = 0.14; 95% CI, 0.14-0.15), followed by 6 to 12 months (aOR = 0.18; 95% CI, 0.18-0.19) and 9 to 12 months (aOR = 0.23; 95% CI, 0.23-0.24.)

Patients least likely to receive PT included:

• women (aOR = 0.8; 95% CI, 0.78-0.81);
• those aged 50 to 59 years (aOR = 0.67; 95% CI, 0.65-0.7) vs. those aged 18 to 39 years; and
• those with comorbidities (aOR = 0.71; 95% CI, 0.7-0.73).

Marmor and colleagues also found PT referral differed by specialty, “and the greatest opportunity to increase awareness and education around the benefits of PT was among primary care clinicians.“

“Development and dissemination of guidelines for the management of dizziness, such as those for [benign paroxysmal positional vertigo] and Ménière disease, may be effective in influencing clinician practice,” they wrote.

Even with fall risk reductions associated with PT, the researchers noted patients presenting with dizziness and comorbidities may require further prevention strategies “including, but not limited to, low-intensity exercise, step training, home safety modifications, and support for caregivers.”

“Medications taken for dizziness, particularly sedatives and vestibular suppressants, may also be associated with an increase in fall risk and their potential interaction with PT should be assessed in future work,” they wrote.