Evaluating the impact of an educational intervention on the management of BPPV: an interrupted time series analysis

Abstract

This study examines the impact of an educational intervention on the use of key diagnostic and treatment maneuvers for Benign Paroxysmal Positional Vertigo (BPPV) and the reduction of unnecessary CT scans in clinical practice. Data were sourced from three healthcare institutions in Ontario, encompassing over 2000 patient records from the pre- and post-intervention periods. The primary diagnostic and treatment outcomes analyzed include Dix-Hallpike, Supine Roll, and Canalith Repositioning Maneuver (CRM), while the secondary focus is on the utilization of CT scans. The analysis employs Interrupted Time Series (ITS) methodology, with segmented regression used to assess changes in the frequency of these procedures. Adjustments were made for potential confounders such as history of BPPV, vomiting, and vertigo. The intervention led to an immediate increase in the appropriate use of Dix-Hallpike and Supine Roll maneuvers, followed by sustained positive trends in their application. Similarly, CRM usage significantly increased post-intervention. However, the intervention had no significant effect on reducing CT scan usage, highlighting the complex challenges of minimizing unnecessary imaging in clinical settings. Nevertheless, after accounting for confounding variables, the post-intervention increases observed previously were no longer statistically significant. This research underscores the importance of targeted educational programs in promoting evidence-based diagnostic and treatment maneuvers for BPPV. While the intervention effectively increased the use of appropriate procedures, its impact on reducing CT scan usage was limited. Future work will focus on extending the follow-up period to assess long-term trends and exploring alternative analytical methods to uncover complex patterns and validate intervention effectiveness.