Agreement between vestibular elective physical therapy students and experienced physical therapists in identifying nystagmus during positional testing and diagnosing benign paroxysmal positional vertigo (BPPV)

Abstract

Purpose: The aim of this study is to measure the effectiveness of a vestibular elective in preparing students to perform nystagmus identification and diagnosing benign paroxysmal positional vertigo (BPPV) through an investigation of agreement between student performances and experienced physical therapists. Methods: Seven students watched eye movement videos during positioning testing of 14 patients. Students recorded the nystagmus characteristics for each position and made diagnoses. The students completed additional surveys. Pairwise percent agreement and kappa statistics (κ) were used to compare agreement between each students’ conclusions to those of an experienced physical therapist obtained from a previous study. Krippendorff’s alpha (α) was used to analyze the overall reliability of student ability for these skills. Results: Interrater agreement between students and the expert was fair to almost perfect (κ = 0.22 to 1) in identifying nystagmus, and slight to almost perfect (κ = −0.02 to 1) in diagnosing BPPV. There was moderate agreement between students to identify nystagmus (α = 0.58–0.65, average agreement = 80–83%) during positional testing, and fair to moderate agreement to diagnose BPPV (α = 0.38 to 0.53, average agreement = 64–74%). Agreement was higher in cases of typical BPPV presentations. Students reported the task as difficult, had the necessary knowledge, and wanted more practice. Correlations (r = 0.76 to 0.82) were seen between clinical experience with BPPV and lower perceived difficulty. Conclusion: Students are capable of identifying nystagmus and diagnosing typical BPPV; however, students may require more practice, clinical experience, and mentorship to improve reliability. The results may help determine educational needs to prepare clinicians to manage individuals with BPPV.