Effectiveness of primary care-based vestibular rehabilitation for chronic dizziness
University of Southampton, Highfield, Southampton, United Kingdom. Annals of internal medicine
(Impact Factor: 17.81).
Dizziness is a very common symptom and is usually managed in primary care. Vestibular rehabilitation for dizziness is a simple treatment that may be suitable for primary care delivery, but its effectiveness has not yet been determined.
To evaluate the effectiveness of nurse-delivered vestibular rehabilitation in primary care for patients with chronic dizziness.
Single-blind randomized, controlled trial.
20 general practices in southern England.
170 adult patients with chronic dizziness who were randomly assigned to vestibular rehabilitation (n = 83) or usual medical care (n = 87).
Each patient received one 30- to 40-minute appointment with a primary care nurse. The nurse taught the patient exercises to be carried out daily at home, with the support of a treatment booklet.
Primary outcome measures were baseline, 3-month, and 6-month assessment of self-reported spontaneous and provoked symptoms of dizziness, dizziness-related quality of life, and objective measurement of postural stability with eyes open and eyes closed.
At 3 months, improvement on all primary outcome measures in the vestibular rehabilitation group was significantly greater than in the usual medical care group; this improvement was maintained at 6 months. Of 83 treated patients, 56 (67%) reported clinically significant improvement compared with 33 of 87 (38%) usual care patients (relative risk, 1.78 [95% CI, 1.31 to 2.42]).
Psychological elements of the therapy may have contributed to outcomes, and the treatment may be effective only for well-motivated patients.
Vestibular rehabilitation delivered by nurses in general practice improves symptoms, postural stability, and dizziness-related handicap in patients with chronic dizziness.
Available from: PubMed Central
- "Treatment typically consists of reassurance and antivertiginous and antiemetic drugs to relieve symptoms [6-9]. However, several reviews of the management of dizziness have concluded that no medication in current use has well-established curative or prophylactic value or is suitable for long-term palliative use . Unconventional remedies, such as acupuncture, should be considered and scientifically evaluated . "
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ABSTRACT: Dizziness is one of the most challenging symptoms in medicine. No medication for dizziness in current use has well-established curative or prophylactic value or is suitable for long-term palliative use. Unconventional remedies,such as acupuncture, should be considered and scientifically evaluated. However, there has been relatively little evidence in randomized controlled clinical trials on acupuncture to treat chronic dizziness. The aim of our study is to evaluate the efficacy and safety of acupuncture in patients with dizziness.Methods/design: This trial is a randomized, single-blind, controlled study. A total of 80 participants will be randomly assigned to two treatment groups receiving acupuncture and sham acupuncture treatment, respectively, for 4 weeks. The primary outcome measures are theDizziness Handicap Inventory (DHI) andtheVertigo Symptom Scale (VSS). Treatment will be conducted over a period of 4 weeks, at a frequency of two sessions per week. The assessment is at baseline (before treatment initiation), 4 weeks after the first acupuncture session, and 8 weeks after the first acupuncture session.
The results from this study will provide clinical evidence on the efficacy and safety of acupuncture in patients with chronic dizziness.Trial registration: International Standard Randomized Controlled Trial Number Register: ISRCTN52695239.
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- "Yardley i wsp. zwracają uwagę na coraz większą rolę, jaką odgrywa rehabilitacja w leczeniu zawrotów głowy i zaburzeń równowagi . Wyrównanie aktywności biologicznej między systemami przedsionkowymi obwodowymi i ośrodkowym jest istotą procesu kompensacji i założeniem rehabilitacji. "
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ABSTRACT: The aim of the study was to evaluate the impact of physiotherapy on balance stability and quality of life improvement in patients with central vestibular system dysfunction.Material and methodsThe study was conducted on 31 patients (23 females, 8 males) with vertigo/dizziness and unsteadiness diagnosed for central vestibular system impairment based on videonystagraphy examinations, in ENT Department Medical University of Lodz between 2010-2011 years. Patients’ history of diseases were collected. The physiotherapeutic programme was individually introduced during four weeks (five time a week). The intervention included balance training and habituation exercises. At baseline and after patients were evaluated therapy with WHO Quality of Life-BREF (WHOQOL-BREF) and Dizzeness Handicap Inventory (DHI) self-assessment scales. Clinical examination with Romberg and stand one leg tests (eyes opened and closed) was performed.ResultsAfter therapy statistically significant differences in total DHI score (p < 0.005) and 3 subscales: physical, emotional, functional (p < 0.05) and WHOQOL-BREF only physical subscale (p < 0.05) compared baseline were found. There were no statistical differences between psychological, social relationships and environment subscales. In clinical evaluation significant reduction of unsteadiness in Romberg test (p < 0.05) and in stand one leg tests eyes opened and closed tests (p < 0.05) were found.Conclusion
In patients with central vestibular system impairment after physical therapy betterment in clinical examination and some subjective self-assessment scales were observed. Lack of significant improvement in psychological, social relationships and environment domain in WHOQOL-BREF subscale indicated that these patients may need more psychological support or extensions in physiotherapy.
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- "In this chronic group rehabilitation is the most important aspect of the treatment and can be applied even in primary care settings (Yardley et al., 2004). The complexity of the rehabilitation offered to the patient will depend on two factors, 1) How much, if any, rehabilitation and advice your patient has already had, and 2) How much access you have to vestibular rehabilitation services and how good your rehabilitation team is. "
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ABSTRACT: In this review we present a pragmatic approach to the patient with chronic vestibular symptoms. Even in the chronic patient a retrospective diagnosis should be attempted, in order to establish how the patient reached the current situation. Simple questions are likely to establish if the chronic dizzy symptoms started as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, vestibular migraine, Meniere's disease or as a brainstem stroke. Then it is important to establish if the original symptoms are still present, in which case they need to be treated (e.g. repositioning maenouvres for BPPV, migraine prophylaxis) or if you are only dealing with chronic dizzy symptoms. In addition the doctor or physiotherapist needs to establish if the process of central vestibular compensation has been impeded due to additional clinical problems, e.g. visual problems (squints, cataract operation), proprioceptive deficit (neuropathy due to diabetes or alcohol), additional neurological or orthopaedic problems, lack of mobility or confidence, such as fear of falling or psychological disorders. A general neurological examination should also be conducted, amongst other reasons to make sure your patient's ;chronic dizziness' is not due to a neurological gait disorder. Treatment of the syndrome of chronic dizziness is multidisciplinary but rehabilitation and simple counselling should be available to all patients. In contrast, vestibular suppressants or tranquilisers should be reduced or, if possible, stopped.
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