Study protocol for a nationwide implementation of internet-based vestibular rehabilitation for patients with chronic vestibular symptoms (I-RECOVER)

Implementation Science Communications, vol. 4, pp. 147

Abstract

BACKGROUND: Vestibular rehabilitation is a safe and effective exercise-based treatment for patients with chronic vestibular symptoms. However, it is underused in general practice. Internet-based vestibular rehabilitation (Vertigo Training), which has proven to be effective as well, was developed to increase uptake. We now aim to improve the quality of care for patients with vestibular symptoms by carrying out a nationwide implementation of Vertigo Training. We will evaluate the effect of this implementation on primary care. METHODS: Our implementation study consists of three successive phases: 1) We will perform a retrospective observational cohort study and a qualitative interview study to evaluate the current management of patients with vestibular symptoms in primary care, in particular anti-vertigo drug prescriptions, and identify areas for improvement. We will use the results of this phase to tailor our implementation strategy to the needs of general practitioners (GPs) and patients. 2) This phase entails the implementation of Vertigo Training using a multicomponent implementation strategy, containing: guideline adaptations; marketing strategy; pharmacotherapeutic audit and feedback meetings; education; clinical decision support; and local champions. 3) In this phase, we will evaluate the effect of the implementation in three ways. a. Interrupted time series. We will use routine primary care data from adult patients with vestibular symptoms to compare the number of GP consultations for vestibular symptoms, referrals for vestibular rehabilitation, prescriptions for anti-vertigo drugs, and referrals to physiotherapy and secondary care before and after implementation. b. Prospective observational cohort study. We will extract data from Vertigo Training to investigate the usage and the characteristics of participants. We will also determine whether these characteristics are associated with successful treatment. c. Qualitative interview study. We will conduct interviews with GPs to explore their experiences with the implementation. DISCUSSION: This is one of the first studies to evaluate the effect of a nationwide implementation of an innovative treatment on Dutch primary care. Implementation strategies have been researched before, but it remains unclear which ones are the most effective and under what conditions. We therefore expect to gain relevant insights for future projects that aim to implement innovations in primary care.

Authors 13

1. Hà Ngo corresponding

   Amsterdam Public Health · Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. t.n.h.ngo@amsterdamumc.nl

   Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands. t.n.h.ngo@amsterdamumc.nl

   Amsterdam Public Health Research Institute, Amsterdam, The Netherlands

   Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

2. Otto R Maarsingh

   Amsterdam Public Health · Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Amsterdam Public Health Research Institute, Amsterdam, The Netherlands

   Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands

   Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

3. Raymond van de Berg

   Maastricht University Medical Centre · Maastricht University

   Affiliation as printed

   Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands

4. Marco H. Blanker

   University Medical Center Groningen

   Affiliation as printed

   Department of Primary and Long-Term Care, University Medical Centre Groningen, Hanzeplein 1, Groningen, The Netherlands

   Department of Primary and Long-Term Care, University Medical Centre Groningen, Groningen, The Netherlands

5. Tjasse Doewe Bruintjes Aachen Department of Otorhinolaryngology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center · Gelre Hospitals

   Affiliation as printed

   Department of Otorhinolaryngology, Gelre Hospital Apeldoorn, Apeldoorn, The Netherlands

   Department of Otorhinolaryngology, Leiden University Medical Centre, Leiden, The Netherlands

6. Rene Franciscus Castien

   Amsterdam Public Health · Amsterdam Movement Sciences · Vrije Universiteit Amsterdam

   Affiliation as printed

   Amsterdam Public Health Research Institute, Amsterdam, The Netherlands

   Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, Amsterdam, The Netherlands

7. Rob F. Dijkstra

   Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands

   Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

8. Sandra Rutgers
   Affiliation as printed

   Patient Association Hoormij•NVVS, Houten, The Netherlands

9. Pauline Slottje

   Amsterdam Public Health · Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Amsterdam Public Health Research Institute, Amsterdam, The Netherlands

   Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands

   Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

10. Jos W. R. Twisk

    Amsterdam Public Health · Amsterdam University Medical Centers · Vrije Universiteit Amsterdam

    Affiliation as printed

    Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands

11. Lucy Yardley

    University of Bristol · University of Southampton

    Affiliation as printed

    School of Psychological Science, University of Bristol, Bristol, UK

    School of Psychology, University of Southampton, Southampton, UK

12. Jettie Bont

    Amsterdam Public Health · Amsterdam UMC Location Vrije Universiteit Amsterdam

    Affiliation as printed

    Amsterdam Public Health Research Institute, Amsterdam, The Netherlands

    Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands

    Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

13. Vincent Alexander van Vugt

    Amsterdam Public Health · Amsterdam UMC Location Vrije Universiteit Amsterdam

    Affiliation as printed

    Amsterdam Public Health Research Institute, Amsterdam, The Netherlands

    Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands

    Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands