An evaluation of the cost-effectiveness of booklet-based self-management of dizziness in primary care, with and without expert telephone support

In a single blind two-centre pragmatic controlled trial, we will randomise 330 patients from 30 practices to a) self-help booklet with telephone support from a vestibular therapist, b) self-help booklet alone, c) routine medical care. Symptoms, disability, handicap and quality of life will be assessed by validated questionnaires administered by post at baseline, immediately post-treatment (3 months), and at one year follow-up. The study is powered to test our primary hypothesis, that the self-help booklet with telephone support will be more effective than routine care. We will also explore the effectiveness of the booklet without any support, and calculate the costs of treatment in each arm.If our trial indicates that patients can cost-effectively manage their dizziness in primary care, then it can be easily rolled out to relieve the symptoms of the many patients in primary care who currently have chronic, untreated, disabling dizziness. Treatment in primary care may reduce the development of psychological and physical sequelae that cause handicap and require treatment. There is also the potential to reduce the cost to the NHS of treating dizziness by reducing demand for referral to secondary care for specialist assessment and treatment.ClinicalTrials.gov trial registration ID number: NCT00732797Dizziness has a prevalence of up to 25% in the community [1-4], and 1 in 10 working age adults report some degree of handicap due to dizziness [3]. Dizziness is a more severe problem for older people; more than 1 in 5 people aged over 60 have current dizziness that has led to significant disability, medical consultation or medication use [5]. Dizziness is also associated with falls, fear of falling and loss of independence in older people [6,7].The most common cause of dizziness in primary care is peripheral vestibular disorder, and serious sinister pathology in patients with no other symptoms is very rare [2,8-12]. Most patients are therefore managed in primary care [1,9,13