Vestibular rehabilitation for unilateral peripheral vestibular dysfunction

Vestibular rehabilitation is effective for patients with unilateral peripheral vestibular dysfunction.

A Cochrane review included 39 studies with 2441 patients with unilateral peripheral vestibular disorders. Trials addressed the effectiveness of vestibular rehabilitation against control/sham interventions, medical interventions or other forms of vestibular rehabilitation.

Individual and pooled analyses of the primary outcome, frequency of dizziness, showed a statistically significant effect in favour of vestibular rehabilitation over control or no intervention (OR 2.67, 95% CI 1.85 to 3.86; four studies, 565 participants). Secondary outcomes measures related to levels of activity or participation measured, for example, with the Dizziness Handicap Inventory, which also showed a strong trend towards significant differences between the groups (SMD -0.83, 95% CI -1.02 to -0.64). The exception to this was when movement-based vestibular rehabilitation was compared to physical manoeuvres for benign paroxysmal positional vertigo (BPPV), where the latter was shown to be superior in cure rate in the short term (OR 0.19, 95% CI 0.07 to 0.49). There were no reported adverse effects.

• Vestibular rehabilitation vs. control (placebo, sham, usual care or no intervention):
  • Subjective improvement in dizziness (OR 2.67, 95% CI 1.85 to 3.86; 4 trials, n=698).
  • Vertigo symptom scale (VSS) (SMD -0.68, 95% CI -0.87 to -0.49; 3 trials, n=673)
  • Statistically significant outcomes were also found in favor of active treatment for gait ataxia, vestibular disorders activities of daily living, sway path, dynamic visual acuity, vertigo handicap questionnaire, sharpened Romberg scores, dizziness handicap inventory and dynamic gait index.
• Vestibular rehabilitation vs. other treatment (non-vestibular rehabilitation):
  • Dizziness cure rate (OR 0.13, 95% CI 0.03 to 0.51; 1 trial, n=106)
  • Dynamic gait index (SMD fixed -0.87, 95% CI -1.69 to -0.06; 1 trial, n=26)
  • Differences between the groups were non-significant for all other parameters studied.
• Vestibular rehabilitation vs other form of vestibular rehabilitation:
  • Vertigo symptom scale (VSS-V) (SMD 1.12, 95% CI 0.45 to 1.80; 1 trial, n=40)
  • Differences were non-significant for all other parameters studied.

There were no reported adverse effects.

Ədəbiyyat

1. McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev 2015;1():CD005397.