Prevalence av BPPV Among Elderly in Primary Care

Screening for Benign Paroxysmal Positional Vertigo in Primary Care Among Elderly Presenting With Dizziness, Imbalance, and Increased Tendency to Fall

This study aims to investigate whether positional tests should be routinely performed on all elderly patients (65 years and older) presenting to primary care with symptoms of acute, episodic, or chronic dizziness or vertigo, unsteadiness, imbalance, and/or an increased tendency to fall in the past 12 months. Study aims to investigate whether diagnostic maneuvers should be performed regardless of the presence of conventional positional vertigo presentation associated with classical cases of benign paroxysmal positional vertigo (BPPV). Specifically, the study aims to identify "hidden" cases of BPPV and assess the potential benefits of clinical screening and initial treatment of BPPV in primary care setting thus improving the BPPV-related quality of life and reducing the risk of falls in the elderly population.

Study Overview

• Status: Recruiting
• Conditions: Benign Paroxysmal Positional Vertigo (BPPV)

• Study Type: Observational
• Enrollment (Estimated): 115

Contacts and Locations

• Study Contact: Name: Emilija Rackauskaite; Phone Number: +46723965492; Email: emilija.rackauskaite@regionstockholm.se

Study Locations

• Sweden
  • Stockholm
    • Saltsjö-Boo, Stockholm, Sweden, 13230
      • Recruiting
      • Boo health center
      • Contact: Maria Ahlmark, Operations manager; Phone Number: + 46812338228; Email: maria.ahlmark@regionstockholm.se
      • Principal Investigator: Emilija Rackauskaite

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Eligible participants are elderly patients aged 65 years and older who present to the primary care clinic with acute, episodic, or chronic dizziness or vertigo, unsteadiness, imbalance, and/or an increased tendency to fall by exhibiting unintentional loss of balance resulting in a fall one or more times in the past 12 months.

Description

Inclusion Criteria:

Patients aged 65 years or older and present to the primary care clinic with one or several of the following:

1. Acute, episodic, or chronic sensation of dizziness/vertigo.
2. Subjective or objective imbalance during stance or movements.
3. Presented with increased tendency of falls by exhibiting unintentional loss of balance resulting in a fall one or more times in the past 12 months.

Exclusion Criteria:

1. Patients not meeting the above epidemiological and medical criteria described under "Inclusion Criteria".
2. Patients presenting with pathologies in which head and neck movements/manipulations are contraindicated, including (but not limited to): cervical instability, acute head and neck trauma, known cervical disk prolapse, Arnold-Chiari malformation, vascular pathologies such as carotid sinus syncope, vascular dissection and vertebrobasilarinsufficiency, including patients with paralysis as well as those with reduced mobility, in whom diagnostic maneuvers cannot be correctly performed.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
What is the overall prevalence of BPPV among elderly patients (65 years and older) presenting with symptoms of dizziness, vertigo, unsteadiness, imbalance, or an increased tendency to fall in primary care setting?	From enrollment to the follow-up visit 2 weeks later in BPPV positive cases (only one visit for negative cases).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
What is the prevalence of benign paroxysmal positional vertigo among elderly patients seeking primary care for dizziness, unsteadiness, balance problems and/or an increased tendency to fall but not reporting conventional BPPV symptoms?	Outcome aims to identify prevalence of so-called hidden cases of BPPV.	From enrollment to the follow-up visit 2 weeks later in BPPV positive cases (only one visit for negative cases).
What is the prevalence of benign paroxysmal positional vertigo among elderly patients seeking primary care for clear and well defined positional vertigo associated with conventional BPPV presentation?	Outcome aims to identify prevalence of so-called classical cases of BPPV.	From enrollment to the follow-up visit 2 weeks later in BPPV positive cases (only one visit for negative cases).
What are the differences in demographic, clinical and life-quality results between BPPV-positive and BPPV-negative groups?	This outcome aims to evaluate differences between the two following patient groups: patients who present with symptoms but have no BPPV and patients who test positive for BPPV. Metrics that are analysed are: demographic information; current and previous diseases; current medications; frailty; Downtown fall risk index; fall risk according to "World guidelines for falls prevention and management for older adults: a global initiative", DHI-scores, TUG-test results, Dix-Hallpike-test result. Above mentioned metrics are not analysed between each other, instead the analysis is done for each metric between the two patient groups.	From enrollment to the follow-up visit 2 weeks later in BPPV positive cases (only one visit for negative cases).
What are the differences in clinical and life-quality outcomes between so-called "classical" BPPV-cases and "hidden" BPPV-cases before and after treatment?	This outcome aims to evaluate differences in following patient groups: patients who present with conventional BPPV-related symptoms and test positive for BPPV and patients who present with more diffuse symptoms and experience imbalance in during stance or movements or have fallen in the past year and do not report the conventional BPPV symptoms but test positive for BPPV. Metrics that are analysed are: demographic information; current and previous diseases; current medications; frailty; Downtown fall risk index; fall risk according to "World guidelines for falls prevention and management for older adults: a global initiative", DHI-scores upon first visit and follow-up visit, TUG-test results, Dix-Hallpike-test result upon upon first visit and follow-up visit; referral status. Above mentioned metrics are not analysed between each other, instead the analysis is done for each metric between the two mentioned patient groups.	From enrollment to the follow-up visit 2 weeks later in BPPV positive cases (only one visit for negative cases).

Collaborators and Investigators

• Sponsor: Region Stockholm
• Collaborators: Karolinska Institutet
• Investigators: Study Director: Luca Verrecchia, PhD, Karolinska Institutet

Study record dates

Study Major Dates

• Study Start (Actual): October 16, 2024
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): December 1, 2026

Study Registration Dates

• First Submitted: October 13, 2024
• First Submitted That Met QC Criteria: October 13, 2024
• First Posted (Actual): October 16, 2024

Study Record Updates

• Last Update Posted (Actual): October 28, 2024
• Last Update Submitted That Met QC Criteria: October 24, 2024
• Last Verified: October 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Otorhinolaryngologic Diseases; Sensation Disorders; Ear Diseases; Labyrinth Diseases; Vestibular Diseases; Vertigo; Benign Paroxysmal Positional Vertigo; Dizziness
• Other Study ID Numbers: SLSO 2024-2982; 2024-05079-01 (Other Identifier: Swedish Ethical Review Authority (Etikprövningsmyndigheten))

Drug and device information, study documents

• product manufactured in and exported from the U.S.: No