The referral-to-attendance gap in vestibular rehabilitation: a retrospective cohort study in diverse South Florida patients.

Introduction: Despite strong evidence for vestibular rehabilitation therapy (VRT), the proportion of referred patients who actually attend remains poorly characterized. This study quantified the VRT referral-to-attendance gap in a South Florida cohort and evaluated whether sociodemographic and insurance-related factors were associated with treatment uptake and clinical outcomes measured by the Dizziness Handicap Index (DHI) and Functional Gait Assessment (FGA). Methods: We conducted a retrospective chart review of 243 adults aged 18-80 (observed range 25-79) who were recommended VRT at the University of Miami Ear Institute between 2012 and 2022. Demographic information (age, sex, race, ethnicity, insurance status), vestibular diagnoses, and outcome measures were extracted. Functional outcomes were assessed with baseline and follow-up DHI and FGA scores. Neighborhood-level socioeconomic status was characterized using the Area Deprivation Index (ADI). Disparities in VRT attendance and outcomes were evaluated using Chi-square tests, Firth's penalized logistic regression, and analysis of covariance. Results: Of 243 patients referred for VRT, only 41% ( Conclusion: No measured sociodemographic or clinical variable explained non-attendance, suggesting that structural or logistical barriers may be the primary drivers of this gap. Neighborhood deprivation and insurance category were associated with clinically meaningful DHI improvement in exploratory analyses, but these findings are constrained by a small, racially homogeneous analytic sample and require confirmation in larger prospective studies with standardized outcome collection.