Evaluating diagnostic and management agreement between physiotherapists and ear, nose and throat specialist in a primary contact physiotherapy-led vestibular clinic: A prospective blinded inter-rater agreement study

Abstract

Abstract Background: Dizziness and vertigo are common referrals to Ear Nose Throat (ENT) outpatient services however these services have long waitlists for assessment. While a primary contact physiotherapy-led vestibular clinics is recognized at improving access to care, no published literature has reported on the safety and diagnostic accuracy of such a service. This study investigates diagnostic and management agreement between physiotherapists and ENT specialist for patients attending a primary contact physiotherapy-led vestibular clinic. Methods: Prospective blinded inter-rater agreement study undertaken in an ENT primary contact physiotherapy-led vestibular clinic. Participants included adults referred to ENT from general practitioners, triaged (Category 2 or 3) to the primary contact physiotherapy-led vestibular clinic with clinical symptoms consistent with vestibular disorder. Primary outcome measures included diagnoses and management decisions (imaging, ENT/ neurology/ physiotherapy management). Adverse events were reviewed 11 months post data collection. Percentage agreement and Gwet’s first order agreement co-efficient (AC1) calculated inter-rater reliability between physiotherapy and ENT. Results: Fifty-one participants were recruited consecutively from the primary contact physiotherapy-led vestibular clinic. Physiotherapy and ENT had a 78% agreement on categorised diagnosis. Agreements between physiotherapy and ENT for recommending Magnetic resonance imaging was 86%, and 94% for computorised tomography. There was moderate to near-perfect agreement regarding management recommendations between physiotherapy and ENT. An 82% agreement was found for recommendations to ENT, 94% for neurology and 73% for physiotherapy. There were no adverse events from physiotherapist’s management decision, based on final recommendations undertaken 11-months post data collection. Conclusions: Physiotherapists and ENT made comparable diagnostic and management decisions, based on physiotherapy assessment, for adults with signs of vestibular dysfunction, within an ENT primary contact physiotherapy-led vestibular clinic. This provides reassurance about the competency and safety of vestibular physiotherapists in the management of patients with dizziness.