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Table 3 Underlying conditions diagnosed and indicated interventions

From: Tailored multifactorial intervention to improve dizziness symptoms and quality of life, balance and gait in dizziness sufferers aged over 50 years: protocol for a randomised controlled trial

Underlying condition Intervention
Benign Paroxysmal Positional Vertigo Epley’s manoeuvre [22]: repositioning manoeuvre performed on the patient by a physiotherapist to remove vestibular debris from the semi-circular canals.
Peripheral vestibular conditions 1. Vestibular rehabilitation [22] administered by a vestibular physiotherapist. 2. Referral to an ear-nose-throat specialist or neurologist as indicated.
Central vestibular conditions 1. Onward referral to neurologist, magnetic resonance imaging scan/other scans as indicated. 2. Review at Falls Clinic by Consultant Geriatrician for management of any co-morbidities and medication review.
Anxiety/depression/low falls efficacy 1. Online or booklet-based Cognitive Behavioural Therapy (CBT) with telephone support to a clinical psychologist; the program will be focusing on management of anxiety, depression and fear of falling. The booklet will have the same contents and presentation as the internet-based CBT [5961]; given that not all participants might have access to internet in their home, the booklet-based CBT will ensure that all participants from the intervention group who require a therapy addressing psychogenic dizziness will receive the same CBT intervention. The CBT program will involve 5 lessons including a weekly homework assignment over 8 weeks. 2. Referral to other mental health services if indicated.
Cardiovascular conditions 1. Medication management of postural hypotension [23]: the participant will be referred to a Consultant Geriatrician’s Falls Clinic for a medication review. 2. Onward referral to cardiologist if indicated.
Balance, strength, and gait impairments Otago Exercise Program [24, 62, 63]: this home-based exercise program consists of resistance training and balance training exercises; it will involve individualised prescription of exercise in 5 home visits by a physiotherapist and monthly follow-up phone calls. Participants will be encouraged to exercise 3 times a week (approximately 30 min each time) for 6 months.
Vision/sensation impairments 1. Review at Falls Clinic by a Consultant Geriatrician. 2. Onward referral to neurologist/ophthalmologist/optometrist if indicated.