Project Overview +

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder and causes disabling symptoms. BPPV produces a sensation of spinning called vertigo that is both paroxysmal and positional, meaning it occurs suddenly and with a change in head position. The disorder stems from free-floating particles that enter a semi-circular canal ("canaliths") of the inner ear.

BPPV is diagnosed using a simple and reliable positional test, the Dix-Hallpike test (DHT). The treatment, the Canalith Repositioning Maneuver (CRM), is performed in minutes at the bedside. With these processes, patients can be readily identified and treated at the bedside, quickly and without expensive tests. Yet, these guideline-supported evidence-based practices are substantially underutilized.

This project aims to implement these processes in a real world care setting, through a multi-faceted implementation strategy. The project has the potential to simultaneously improve patient outcomes and healthcare efficiencies.

Aims +

The goal of this project is to implement BPPV processes in the Emergency Department (ED). The central hypothesis is that a multi-faceted behavioral and educational implementation strategy will increase the use of BPPV processes.

  • Aim 1: Investigators will develop a theory-based, multi-faceted BPPV behavioral and educational strategy (including a web-based multimedia point of care clinical tool).
  • Aim 2: A randomized controlled trial will be used to test the effect of a decision aid on guideline concordant practice patterns and BPPV knowledge using a previously validated method of vignette-based research.
  • Aim 3: The investigators will implement and evaluate, in a community ED setting, the effect of the implementation strategy on the use of BPPV processes using a staggered enrollment randomized trial design.

Participants +

Practicing emergency medicine physicians from six emergency departments in Corpus Christi, Texas.

Intervention +

Intervention work is divided into three phases.

Phase 1 is designing and developing an implementation strategy. This strategy is designed to achieve targeted behaviors consistent with the BPPV Guidelines, guided by a model of predicted behavior change and their associated measures. The strategy will be multi-faceted (educational sessions, web-based decision aid, referral network, local champions) and rooted in behavioral science. Our implementation strategy is tailored based on a systematic assessment of contextual barriers and facilitators to desired behavior change.

In Phase 2, we test an essential component of the strategy the point of care decision aid on its effect on practice patterns and safety under standardized conditions using a validated method of vignette research.

Phase 3 is a real world implementation study in emergency departments in Corpus Christi, TX.

Dizztinct - Dizziness Treatment for Patients

08/01/2013 - 07/31/2017


National Institute on Deafness and Other Communication Disorders

Principal Investigator:

Kevin A. Kerber, MD


Angela Fagerlin, PhD
William Meurer, MD