title: Interdisciplinary treatment for vestibular dysfunction: the effectiveness of mindfulness, cognitive-behavioral techniques, and vestibular rehabilitation.
abstract: OBJECTIVE
  To investigate whether an interdisciplinary program for vestibular patients improved health outcomes and health care utilization.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Outpatient neurotology clinic.
  
  
  METHODS
  Patients (N = 167) with dizziness attended an interdisciplinary neurotology clinic; 129 were offered group treatment. After an introductory session, group treatment included 5 sessions incorporating mindfulness, cognitive-behavioral techniques, and vestibular rehabilitation. Physical and emotional functioning, depression,anxiety, dizziness, impairment, coping, skill use, and patient satisfaction were measured with rating scales pre- and post-group treatment. Data from 51 patients (male/female = 14/37; age range, 25-82 years) were analyzed with paired t tests or nonparametric tests. Logistic regression analyzed predictors of outcome and utilization for 116 patients (male/female = 81/35; age range, 11-86 years) attending the interdisciplinary clinic, introductory session, and/or group.
  
  
  RESULTS
  After group treatment, patients reported better mood (P = .0482); better physical (P = .0006) and mental (P = .0183) health; better functionality, coping, and skill use (Ps< .0001); less impairment (P < .0001); and fewer limitations from dizziness (P < .0001). Higher pretreatment levels of depression (P = .0216), poorer initial mental (P = .0164) or physical (P = .0059) health, and peripheral diagnosis (P = .0220) predicted better outcome. Group treatment decreased utilization more than the interdisciplinary clinic with (P = .0183) or without (P = .0196) the introductory session; 78% of patients with any level of participation showed less utilization. Clinic patients had fewer radiology procedures than group patients (P = .0365). Patients were highly satisfied with the program and found it more effective than previous treatment.
  
  
  CONCLUSIONS
  Interdisciplinary treatment improves patient coping, functionality, and satisfaction and decreases overall health care utilization in vestibular patients.
authors.affiliation: Department of Neurology, Kaiser Permanente, Santa Rosa, California USA. Christine.Naber@kp.org
authors.forename: Christine M
authors.initials: CM
authors.lastname: Naber
authors.forename: Omay
authors.initials: O
authors.lastname: Water-Schmeder
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Bohrer
authors.forename: Kathy
authors.initials: K
authors.lastname: Matonak
authors.forename: Allan L
authors.initials: AL
authors.lastname: Bernstein
authors.forename: Maqdooda A
authors.initials: MA
authors.lastname: Merchant
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000523:psychology / Q000534:rehabilitation; D002648:Child; D015928:Cognitive Behavioral Therapy; D003299:Cooperative Behavior; D003863:Depression / Q000523:psychology / Q000534:rehabilitation; D005260:Female; D006801:Humans; D055809:Illness Behavior; D033183:Interdisciplinary Communication; D008297:Male; D019122:Meditation; D008575:Meniere Disease / Q000523:psychology / Q000534:rehabilitation*; D008875:Middle Aged; D010348:Patient Care Team / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D010555:Personality Inventory; D012189:Retrospective Studies; D014600:Utilization Review / Q000706:statistics & numerical data; D055815:Young Adult