{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T10:28:19Z","timestamp":1782124099603,"version":"3.54.5"},"reference-count":70,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2023,1,2]],"date-time":"2023-01-02T00:00:00Z","timestamp":1672617600000},"content-version":"unspecified","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013342","name":"NIHR Imperial Biomedical Research Centre","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100013342","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute of Health Research","doi-asserted-by":"crossref","award":["ICA-CDRF-2017-03-070"],"award-info":[{"award-number":["ICA-CDRF-2017-03-070"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/P006493\/1"],"award-info":[{"award-number":["MR\/P006493\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,12,15]]},"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Vestibular dysfunction is common in patients with acute traumatic brain injury (aTBI). Persisting vestibular symptoms (ie, dizziness and imbalance) are linked to poor physical, psychological and socioeconomic outcomes. However, routine management of vestibular dysfunction in aTBI is not always standard practice. We aimed to identify and explore any healthcare professional barriers or facilitators to managing vestibular dysfunction in aTBI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A qualitative approach was used. Data were collected using face to face, semi-structured interviews and analysed using the Framework approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Two major trauma centres in London, UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>28 healthcare professionals participated: 11 occupational therapists, 8 physiotherapists and 9 surgical\/trauma doctors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Vestibular assessment and treatment were not routinely undertaken by trauma ward staff. Uncertainty regarding responsibility for vestibular management on the trauma ward was perceived to lead to gaps in patient care. Interestingly, the term dizziness was sometimes perceived as an \u2018invisible\u2019 and vague phenomenon, leading to difficulties identifying or \u2018proving\u2019 dizziness and a tendency for making non-specific diagnoses. Barriers to routine assessment and treatment included limited knowledge and skills, a lack of local or national guidelines, insufficient training and concerns regarding the practical aspects of managing vestibular dysfunction. Of current trauma ward staff, therapists were identified as appropriate healthcare professionals to adopt new behaviours regarding management of a common form of vestibular dysfunction (benign paroxysmal positional vertigo). Strategies to support this behaviour change include heightened clarity around role, implementation of local or national guidelines, improved access to training and multidisciplinary support from experts in vestibular dysfunction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study has highlighted that role and knowledge barriers exist to multidisciplinary management of vestibular dysfunction in aTBI. Trauma ward therapists were identified as the most appropriate healthcare professionals to adopt new behaviours. Several strategies are proposed to facilitate such behaviour change.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"isrctn\" xlink:href=\"ISRCTN91943864\">ISRCTN91943864<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-067967","type":"journal-article","created":{"date-parts":[[2023,1,2]],"date-time":"2023-01-02T10:55:23Z","timestamp":1672656923000},"page":"e067967","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Why are patients with acute traumatic brain injury not routinely assessed or treated for vestibular dysfunction in the UK? A qualitative study"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"isrctn91943864","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2628-9861","authenticated-orcid":false,"given":"Rebecca M","family":"Smith","sequence":"first","affiliation":[{"name":"Brain and Vestibular Group, Centre for Vestibular Neurology, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Burgess","sequence":"additional","affiliation":[{"name":"School of Population Health & Environmental Sciences, King's College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vassilios","family":"Tahtis","sequence":"additional","affiliation":[{"name":"Therapy Department, King's College Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Marsden","sequence":"additional","affiliation":[{"name":"School of Health Professions, Plymouth University, Plymouth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6578-0904","authenticated-orcid":false,"given":"Barry M","family":"Seemungal","sequence":"additional","affiliation":[{"name":"Brain and Vestibular Group, Centre for Vestibular Neurology, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,1,2]]},"reference":[{"key":"2025120519041195000_13.1.e067967.1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3233\/VES-2009-0343","article-title":"Classification of vestibular symptoms: towards an international classification of vestibular disorders","volume":"19","author":"Bisdorff","year":"2009","journal-title":"J Vestib Res"},{"key":"2025120519041195000_13.1.e067967.2","doi-asserted-by":"crossref","first-page":"S286","DOI":"10.1016\/j.apmr.2013.07.029","article-title":"Mild traumatic brain injury after motor vehicle collisions: what are the symptoms and who treats them? a population-based 1-year inception cohort study","volume":"95","author":"Hartvigsen","year":"2014","journal-title":"Arch Phys Med Rehabil"},{"key":"2025120519041195000_13.1.e067967.3","doi-asserted-by":"publisher","DOI":"10.1080\/02699050500488041"},{"key":"2025120519041195000_13.1.e067967.4","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-019-09403-z"},{"key":"2025120519041195000_13.1.e067967.5","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.clineuro.2017.01.021","article-title":"Patients with chronic dizziness following traumatic head injury typically have multiple diagnoses involving combined peripheral and central vestibular dysfunction","volume":"155","author":"Arshad","year":"2017","journal-title":"Clin Neurol Neurosurg"},{"key":"2025120519041195000_13.1.e067967.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3999(00)00202-6"},{"key":"2025120519041195000_13.1.e067967.7","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1080\/02699052.2017.1377348","article-title":"Dizziness-related disability following mild-moderate traumatic brain injury","volume":"31","author":"Kleffelgaard","year":"2017","journal-title":"Brain Inj"},{"key":"2025120519041195000_13.1.e067967.8","doi-asserted-by":"crossref","first-page":"490","DOI":"10.3109\/02699052.2014.995226","article-title":"Quality-Of-Life for individuals with a vestibular impairment following an acquired brain injury (ABI); the clients' perspective","volume":"29","author":"Killington","year":"2015","journal-title":"Brain Inj"},{"key":"2025120519041195000_13.1.e067967.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2004.02.012"},{"key":"2025120519041195000_13.1.e067967.10","doi-asserted-by":"crossref","first-page":"2291","DOI":"10.3109\/09638288.2014.1002578","article-title":"Falls and fallers in traumatic brain injury (TBI) rehabilitation settings: an integrative review","volume":"37","author":"McKechnie","year":"2015","journal-title":"Disabil Rehabil"},{"key":"2025120519041195000_13.1.e067967.11","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1080\/09638288.2016.1212112","article-title":"An examination of patient characteristics that contribute to falls in the inpatient traumatic brain injury rehabilitation setting","volume":"39","author":"McKechnie","year":"2017","journal-title":"Disabil Rehabil"},{"key":"2025120519041195000_13.1.e067967.12","doi-asserted-by":"crossref","DOI":"10.1001\/archinternmed.2009.66","article-title":"Disorders of balance and vestibular function in US adults","volume":"169","author":"Agrawal","year":"2009","journal-title":"Arch Intern Med"},{"key":"2025120519041195000_13.1.e067967.13","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1002\/rnj.89","article-title":"Modifiable and nonmodifiable risk factors for falls after traumatic brain injury: an exploratory investigation with implications for medication use","volume":"39","author":"Murphy","year":"2014","journal-title":"Rehabil Nurs"},{"key":"2025120519041195000_13.1.e067967.14","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3181f6f5e5"},{"key":"2025120519041195000_13.1.e067967.15","doi-asserted-by":"publisher","DOI":"10.1186\/1752-2897-3-9"},{"key":"2025120519041195000_13.1.e067967.16","doi-asserted-by":"publisher","DOI":"10.1097\/HTR.0b013e318236bd86"},{"key":"2025120519041195000_13.1.e067967.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2014.09.005"},{"key":"2025120519041195000_13.1.e067967.18","doi-asserted-by":"crossref","DOI":"10.3389\/fnbeh.2015.00334","article-title":"Role of the insula and vestibular system in patients with chronic subjective dizziness: an fMRI study using Sound-Evoked vestibular stimulation","volume":"9","author":"Indovina","year":"2015","journal-title":"Front Behav Neurosci"},{"key":"2025120519041195000_13.1.e067967.19","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1002\/hbm.23411","article-title":"Neuroticism modulates brain visuo-vestibular and anxiety systems during a virtual rollercoaster task","volume":"38","author":"Riccelli","year":"2017","journal-title":"Hum Brain Mapp"},{"key":"2025120519041195000_13.1.e067967.20","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1080\/02699052.2022.2034955","article-title":"Does training therapists to manage benign paroxysmal positional vertigo in patients with acute traumatic brain injury reduce vestibular neurology referrals?","volume":"36","author":"Marroney","year":"2022","journal-title":"Brain Inj"},{"key":"2025120519041195000_13.1.e067967.21","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g104"},{"key":"2025120519041195000_13.1.e067967.22","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awaa386"},{"key":"2025120519041195000_13.1.e067967.23","unstructured":"NHS England . Nhs standard contract for major trauma services, 2013."},{"key":"2025120519041195000_13.1.e067967.24","article-title":"Force dependency of benign paroxysmal positional vertigo in acute traumatic brain injury: a prospective study","author":"Rust","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"2025120519041195000_13.1.e067967.25","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1017\/S0047279400015348","article-title":"Robert Walker (ED.), applied qualitative research, Gower, Aldershot, 1985. 203 PP. \u00a317.50, paper \u00a37.95","volume":"15","author":"Finch","year":"1986","journal-title":"J Soc Policy"},{"key":"2025120519041195000_13.1.e067967.26","unstructured":"Creswell J . Qualitative inquiry and research design: choosing among five approaches. London: SAGE Publications, 2012: 40\u201366."},{"key":"2025120519041195000_13.1.e067967.27","unstructured":"Ritchie J , Lewis J . Qualitative research practice: a guide for social science students and researchers. London: SAGE Publications, 2003."},{"key":"2025120519041195000_13.1.e067967.28","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-13-117"},{"key":"2025120519041195000_13.1.e067967.29","doi-asserted-by":"publisher","DOI":"10.1177\/0269216312461678"},{"key":"2025120519041195000_13.1.e067967.30","doi-asserted-by":"publisher","DOI":"10.1002\/pon.3464"},{"key":"2025120519041195000_13.1.e067967.31","doi-asserted-by":"publisher","DOI":"10.1136\/jfprhc-2014-101082"},{"key":"2025120519041195000_13.1.e067967.32","doi-asserted-by":"crossref","DOI":"10.1186\/1471-227X-14-18","article-title":"Identifying barriers and facilitators to ambulance service assessment and treatment of acute asthma: a focus group study","volume":"14","author":"Shaw","year":"2014","journal-title":"BMC Emerg Med"},{"key":"2025120519041195000_13.1.e067967.33","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016459"},{"key":"2025120519041195000_13.1.e067967.34","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-009389"},{"key":"2025120519041195000_13.1.e067967.35","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2013.01.006"},{"key":"2025120519041195000_13.1.e067967.36","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2007.07.011"},{"key":"2025120519041195000_13.1.e067967.37","doi-asserted-by":"crossref","first-page":"e0133837","DOI":"10.1371\/journal.pone.0133837","article-title":"A qualitative investigation of health care professionals', patients' and partners' views on psychosocial issues and related interventions for couples coping with cancer","volume":"10","author":"Regan","year":"2015","journal-title":"PLoS One"},{"key":"2025120519041195000_13.1.e067967.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2012.05.003"},{"key":"2025120519041195000_13.1.e067967.39","doi-asserted-by":"publisher","DOI":"10.1177\/1460458210377480"},{"key":"2025120519041195000_13.1.e067967.40","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-7-38"},{"key":"2025120519041195000_13.1.e067967.41","doi-asserted-by":"publisher","DOI":"10.1136\/qshc.2004.011155"},{"key":"2025120519041195000_13.1.e067967.42","doi-asserted-by":"crossref","unstructured":"Miles J , Gilbert P . A Handbook of Research Methods for Clinical & Health Psychology. Oxford University Press: Oxford, 2005.","DOI":"10.1093\/med:psych\/9780198527565.001.0001"},{"key":"2025120519041195000_13.1.e067967.43","doi-asserted-by":"crossref","DOI":"10.1186\/1748-5908-9-31","article-title":"Understanding diagnosis and management of dementia and guideline implementation in general practice: a qualitative study using the theoretical domains framework","volume":"9","author":"Murphy","year":"2014","journal-title":"Implementation Sci"},{"key":"2025120519041195000_13.1.e067967.44","first-page":"2","volume-title":"BIBLIOGRAPHIE: qualitative research practice a guide for social science students and researchers","volume":"19","author":"Decrop","year":"2004"},{"key":"2025120519041195000_13.1.e067967.45","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"2025120519041195000_13.1.e067967.46","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2017.00267"},{"key":"2025120519041195000_13.1.e067967.47","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2004.021717"},{"key":"2025120519041195000_13.1.e067967.48","doi-asserted-by":"crossref","DOI":"10.1016\/j.physio.2018.08.007","article-title":"A survey of current management of benign paroxysmal positional vertigo (BPPV) by physiotherapists' interested in vestibular rehabilitation in the UK","volume":"105","author":"Male","year":"2019","journal-title":"Physiotherapy"},{"key":"2025120519041195000_13.1.e067967.49","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1007\/s00415-020-10228-4","article-title":"Vestibular rehabilitation in Europe: a survey of clinical and research practice","volume":"267","author":"Meldrum","year":"2020","journal-title":"J Neurol"},{"key":"2025120519041195000_13.1.e067967.50","unstructured":"Burrows L , Bryce K , Cole H . The ACPIVR framework for physiotherapists working within vestibular and balance system health care, 2021."},{"key":"2025120519041195000_13.1.e067967.51","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.3109\/0142159X.2016.1170780","article-title":"The impact of positive doctor role modeling","volume":"38","author":"Passi","year":"2016","journal-title":"Med Teach"},{"key":"2025120519041195000_13.1.e067967.52","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0b013e3181c47b25"},{"key":"2025120519041195000_13.1.e067967.53","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-1241.2009.02104.x"},{"key":"2025120519041195000_13.1.e067967.54","doi-asserted-by":"publisher","DOI":"10.4065\/82.11.1329"},{"key":"2025120519041195000_13.1.e067967.55","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2318-14-97","article-title":"Fighting for control in an unpredictable life - a qualitative study of older persons' experiences of living with chronic dizziness","volume":"14","author":"Olsson M\u00f6ller","year":"2014","journal-title":"BMC Geriatr"},{"key":"2025120519041195000_13.1.e067967.56","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-024326"},{"key":"2025120519041195000_13.1.e067967.57","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2015-001087"},{"key":"2025120519041195000_13.1.e067967.58","doi-asserted-by":"crossref","first-page":"11","DOI":"10.3233\/VES-201518","article-title":"Is 'persistent postural perceptual dizziness' a helpful diagnostic label? A qualitative exploratory study","volume":"31","author":"Herdman","year":"2021","journal-title":"J Vestib Res"},{"key":"2025120519041195000_13.1.e067967.59","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.82.5.722"},{"key":"2025120519041195000_13.1.e067967.60","doi-asserted-by":"crossref","first-page":"1774","DOI":"10.1007\/s00415-020-09769-5","article-title":"Impact of anti-epileptic drug choice on discharge in acute traumatic brain injury patients","volume":"267","author":"Harris","year":"2020","journal-title":"J Neurol"},{"key":"2025120519041195000_13.1.e067967.61","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awh351"},{"key":"2025120519041195000_13.1.e067967.62","doi-asserted-by":"crossref","DOI":"10.1186\/s12909-021-02672-1","article-title":"Healthcare professionals in research (HPiR) Facebook community: a survey of U.K. doctoral and postdoctoral healthcare professionals outside of medicine","volume":"21","author":"Deane","year":"2021","journal-title":"BMC Med Educ"},{"key":"2025120519041195000_13.1.e067967.63","doi-asserted-by":"crossref","first-page":"15","DOI":"10.3233\/VES-2009-0339","article-title":"International survey of vestibular rehabilitation therapists by the Barany Society AD hoc Committee on vestibular rehabilitation therapy","volume":"19","author":"Cohen","year":"2009","journal-title":"J Vestib Res"},{"key":"2025120519041195000_13.1.e067967.64","unstructured":"Booth J , Hewison A . Role overlap between occupational therapy and physiotherapy during in-patient stroke rehabilitation\u202f: an exploratory study Role overlap between occupational therapy and physiotherapy during in-patient stroke rehabilitation\u202f: an exploratory study. 2009, 1820."},{"key":"2025120519041195000_13.1.e067967.65","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1017\/S0022215117000342","article-title":"Independent prescriber physiotherapist led balance clinic: the Southport and Ormskirk pathway","volume":"131","author":"Burrows","year":"2017","journal-title":"J Laryngol Otol"},{"key":"2025120519041195000_13.1.e067967.66","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1177\/0003489417718847","article-title":"Benign paroxysmal positional vertigo: management and its impact on falls","volume":"126","author":"Jumani","year":"2017","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"2025120519041195000_13.1.e067967.67","doi-asserted-by":"publisher","DOI":"10.1590\/S1808-86942010000100019"},{"key":"2025120519041195000_13.1.e067967.68","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-5-14"},{"key":"2025120519041195000_13.1.e067967.69","doi-asserted-by":"publisher","DOI":"10.1136\/qhc.12.3.215"},{"key":"2025120519041195000_13.1.e067967.70","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-6-42"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2022-067967","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T03:04:25Z","timestamp":1764990265000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2022-067967"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":70,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1,2]]},"published-print":{"date-parts":[[2023,1]]}},"alternative-id":["10.1136\/bmjopen-2022-067967"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2022-067967","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1]]}}}