Implementing specialised vestibular physiotherapy in an emergency department: A process evaluation

Background: Dizziness and vertigo-like symptoms, often caused by common peripheral vestibular disorders such
as benign paroxysmal positional vertigo (BPPV), may signifcantly impact function and quality of life. These symptoms often result in emergency department (ED) presentations. Evidence-based clinical practice guidelines strongly recommend using physical assessment and treatment manoeuvres for the assessment, diagnosis and treatment of these symptoms. This study aimed to evaluate the process of implementing specialised vestibular physiotherapy (SPV) in an emergency department from the clinician’s perspective.
Methods: This implementation study utilised a retrospective mixed-methods process evaluation to understand how SVP operated in an Australian emergency department. The i-PARiHS framework was embedded within the methodology and analytical approach of the study to ensure a comprehensive approach closely aligned to implementation
science. Nine clinicians retrospectively completed the Organisational Readiness for Change Assessment (ORCA), Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM) and Feasibility of Intervention Measure (FIM). Seven clinicians also participated in a focus group or interview.
Results: A range of barriers and facilitators to the implementation process were identifed by participants, some of which spanned multiple domains of the i-PARiHS framework. Relationships with service leaders, champions and medical staf were pivotal facilitators to implementation, along with a generally held perception that SVP was acceptable and feasible. The main barrier identifed was a lack of capacity to deliver and facilitate this innovation within the physiotherapy workforce and the broader multidisciplinary recipients.
Conclusions: This study demonstrates that the process of implementing an SVP service in an ED context was generally well-received by clinicians but also involved some challenges and barriers. Services looking to implement SVP in the ED should aim to build stakeholder relationships; develop a shared vision with clear goals and intended outcomes; embed the innovation in organisation processes, procedures and policies; and increase workforce capacity to deliver and facilitate SVP to guide their approach to this innovation.