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29 late cancellation rate was 15.4% (A late cancellation is made within 1 week of the appointment).
The Circle Which statement applies to you most at present? Only choose one
Tick as appropriate
I am not ready for treatment of my dizziness/balance problem at the moment I have been thinking that I might need help with my dizziness/balance problems I have started seeking information about treatment for dizziness/balance problems I am ready to do balance exercises if they are recommended I am comfortable with the idea of doing balance exercises and accepting my altered abilities I am no longer doing my exercises I am living well with my balance problem and the changes I have made to my lifestyle to accommocate my new balance abilities Figure 3. The ‘Circle’ modified for vestibular rehabilitation patients.
treatment. For example, “I see that you have marked importance as ‘8’. So why would it be ‘8’ rather than ‘7’ or ‘9’?”. The ‘Box’ is a decisional matrix that is a balance sheet with lists for and against behaviour change.The important feature of the ‘Box’ is that it starts with the patient identifying reasons to remain at ‘the status quo’ and ends with the patient identifying the reasons for behaviour change. The patient needs to be their own motivator for behaviour change for the technique to be most effective. The ‘Circle’ is related to identifying the patient’s ‘readiness’ for change. It is based on the work of Prochaska and DiClemente and their spiral model of change. It includes five stages: Precontemplation, Contemplation, Preparation, Action and Maintenance.The circle is used in clinic to identify those patients who are ready for treatment and those who are not ready for treatment.
This study’s aim was to compare how the use of a motivational approach to behaviour change would improve patient clinic attendance and thus therapy adherence. Vestibular rehabilitation is the recommended primary treatment for stable vestibular lesions (Shepard et al, 1995). The prognosis for uncompensated peripheral vestibular lesions is generally very good with the percentage of patients who dramatically or completely improve set at 90% (Shepard et al, 1995). Adherence to vestibular rehabilitation programs can however prove to be difficult as is the case in many chronic health conditions. A review of our clinic attendance was compiled to determine the efficacy of the customised vestibular rehabilitation program.The review entailed an audit of the patient database and the data was reviewed in terms of: attendance, did not attends (DNA’s); and cancellation history for the six month period from September 2012 to February 2013. The percentage of DNA’s was 12.6% and the
A review of current literature revealed that patient motivation may be a key element to the high DNA rate for this particular speciality, thus a motivational approach to the patient pathway was introduced.This motivational approach was employed on two levels. The first was a change to the patient pathway. All new patients would need to attend an introductory educational group session which would explain the vestibular rehabilitation in terms of: current research, time commitment and the possible prognosis for therapy. The patient would then ‘opt in’ or ‘opt out’ of the therapy program. The second level would be the employment of motivational interviewing techniques in the individual therapy sessions. This was the employment of the ‘Line’, the ‘Box’ and the ‘Circle’. The patient is sent a questionnaire with the ‘Line’, the ‘Box’ and the ‘Circle’ and requested to complete the form for the first individual therapy session. The patient is only sent this information if they have opted for therapy and have attended the introductory session. The clinician would then work with the patient through the answers that they provided on the questionnaire. The changes were implemented and the data was reviewed again for the period 9 September 2013- February 2014. The same time of year was utilised to minimise the effect of extraneous variables. The percentage of DNA’s was then 4.7% (previously 12.6%) and the patient late appointment cancellation rate was 4.7% (previously 15.4%). The conclusion is that a motivational approach to vestibular rehabilitation delivery appears to be related with improved clinic attendance and thus indirectly improved program adherence. Further re-
An important part of learning a new behaviour is for the patient to identify and acknowledge the value of the new behaviour (Konle-Parker, 2001). featured articles