Epley and the slow boat from research to practice

[Extract]
THE CLINICAL PROBLEM
Why does it take months or years for a new clinical procedure to go from awareness to regular use? Even with simple treatments such as a fixed dose of a drug, progression from awareness to acceptance to application can be slow.1 Complex treatments requiring new skills or equipment can take much longer or never happen at all. Typical is the adoption of the Epley manoeuvre for benign paroxysmal positional vertigo (BPPV): common in general practice, with a 1-year prevalence in adults of around 1.6%. Although known for over a quarter of a century,2 a German survey suggested Epley is used in only 8% of patients.3 For many years as a general practitioner (GP) I referred BPPV patients to a colleague who could do the Epley. When the issue came up at the clinical meeting in my new practice, where no one knew the “how to,” we decided to check the evidence first, before learning the manoeuvre.