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Vestibular rehabilitation for unilateral peripheral vestibular dysfunctionHillier SL, Hollohan V
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SummaryVestibular rehabilitation for unilateral peripheral vestibular dysfunction to improve dizziness, balance and mobility.People with vestibular problems often experience dizziness and trouble with vision, balance or mobility. The vestibular disorders that are unilateral and peripheral (UPVD) are those that affect one side of the vestibular system (unilateral) and only the portion of the system that is outside of the brain (peripheral - part of the inner ear). Examples of these disorders include: benign paroxysmal positional vertigo (BPPV), vestibular neuritis, labyrinthitis, unilateral Ménière's, or vestibulopathies following surgical procedures such as labyrinthectomy, or acoustic neuroma resection. Vestibular rehabilitation (VR) for these disorders is becoming increasingly used and involves various movement-based regimes. Components of VR may involve learning to bring on the symptoms to 'desensitise' the vestibular system, learning to coordinate eye and head movements, improving balance and walking skills, learning about the condition and how to cope or become more active. Twenty one randomised clinical trials were found that investigated the use of VR in this group of disorders. All studies used a form of VR and involved adults who lived in the community with symptomatic, confirmed UPVD. The studies were varied in that they compared VR with other forms of management (for example medication, usual care, passive manoeuvres), with control or placebo interventions or with other forms of VR. Another source of variation between studies was the use of different outcome measures (for example reports of dizziness, improvements in balance, vision, walking or ability to participate in daily life). Because of the variation between studies, only limited pooling of data was possible. The three studies able to be combined demonstrated that VR was more effective than control or sham interventions in improving subjective reports of dizziness. Other single studies all found in favour of VR for improvements in areas such as balance, vision, gait and participation. The exception to these findings was for the specific diagnostic group of people with BPPV, where comparisons of VR versus manoeuvres showed that the physical repositioning manoeuvres were more effective in dizziness symptom reduction, particularly in the short term. There were no reports of adverse effects following any VR, and in the studies with a follow-up assessment (3-12 months), positive effects were maintained. There was inadequate evidence that one form of VR is superior to another. There is a growing body of evidence to support the use of vestibular rehabilitation with people with dizziness and functional loss as a result of UVPD, and whilst the studies were generally of moderate to high quality they were varied in their methods.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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October 17. 2007 AbstractBackgroundUnilateral peripheral vestibular dysfunction (UPVD) can occur as a result of disease, trauma or post-operatively. The dysfunction is characterized by complaints of dizziness, visual or gaze disturbances and balance impairment. Current management includes medication, physical manoeuvres and exercise regimes, the latter known collectively as vestibular rehabilitation (VR). ObjectivesTo assess the effectiveness of vestibular rehabilitation in the adult, community dwelling population of people with symptomatic unilateral peripheral vestibular dysfunction. Search strategyThe search included the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library Issue 1 2007, MEDLINE (1950 to 2007) and EMBASE (1974 to 2007). The date of the last search was March 2007. Selection criteriaRandomised trials of adults living in the community, diagnosed with symptomatic unilateral peripheral vestibular dysfunction. Comparisons sought were:
Outcome measures that were considered included: frequency and severity of dizziness or visual disturbance; changes in balance impairment, function or quality of life; measure/s of physiological status with known functional correlation. Data collection and analysisBoth authors independently extracted data and assessed trials for quality. Main resultsThirty-two trials were identified and eleven were excluded because of mixed/unclear vestibular pathology, leaving twenty-one trials in the review. Included studies addressed the effectiveness of vestibular rehabilitation against control/sham interventions, non-vestibular rehabilitation interventions or other forms of vestibular rehabilitation, by comparing the subjects in each group who had significant resolution of symptoms and/or improved function. Individual and pooled data showed a statistically significant effect in favour of the vestibular rehabilitation over control or no intervention. The exception to this was when movement based vestibular rehabilitation was compared to physical manoeuvres for benign paroxysmal positional vertigo, where the latter was shown to be superior in cure rate in the short term. There were no reported adverse effects. Authors' conclusionsThere is moderate to strong evidence that vestibular rehabilitation is a safe, effective management for unilateral peripheral vestibular dysfunction, based on a number of high quality randomised controlled trials. There is moderate evidence that vestibular rehabilitation provides a resolution of symptoms in the medium term. However there is evidence that for the specific diagnostic group of benign paroxysmal positional vertigo, physical (repositioning) manoeuvres are more effective in the short term than exercise based vestibular rehabilitation. There is insufficient evidence to discriminate between differing forms of vestibular rehabilitation. |
