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Meta-Analysis
. 2015 Jan 13;1(1):CD005397.
doi: 10.1002/14651858.CD005397.pub4.

Vestibular rehabilitation for unilateral peripheral vestibular dysfunction

Michelle N McDonnell  1 , Susan L Hillier
Affiliations
Meta-Analysis

Vestibular rehabilitation for unilateral peripheral vestibular dysfunction

Michelle N McDonnell et al. Cochrane Database Syst Rev. .

Abstract

Background: This is an update of a Cochrane review first published in The Cochrane Library in Issue 4, 2007 and previously updated in 2011.Unilateral peripheral vestibular dysfunction (UPVD) can occur as a result of disease, trauma or postoperatively. The dysfunction is characterised 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.

Objectives: To assess the effectiveness of vestibular rehabilitation in the adult, community-dwelling population of people with symptomatic unilateral peripheral vestibular dysfunction.

Search methods: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The most recent search was 18 January 2014.

Selection criteria: Randomised controlled trials of adults living in the community, diagnosed with symptomatic unilateral peripheral vestibular dysfunction. We sought comparisons of vestibular rehabilitation versus control (e.g. placebo), other treatment (non-vestibular rehabilitation, e.g. pharmacological) or another form of vestibular rehabilitation. Our primary outcome measure was change in the specified symptomatology (for example, proportion with dizziness resolved, frequency or severity of dizziness). Secondary outcomes were measures of function, quality of life and/or measure(s) of physiological status, where reproducibility has been confirmed and shown to be relevant or related to health status (for example, posturography), and adverse effects

Data collection and analysis: We used the standard methodological procedures expected by The Cochrane Collaboration.

Main results: We included 39 studies involving 2441 participants with unilateral peripheral vestibular disorders in the review. Trials addressed the effectiveness of vestibular rehabilitation against control/sham interventions, medical interventions or other forms of vestibular rehabilitation. Non-blinding of outcome assessors and selective reporting were threats that may have biased the results in 25% of studies, but otherwise there was a low risk of selection or attrition bias.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 (odds ratio (OR) 2.67, 95% confidence interval (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 (standardised mean difference (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.

Authors' conclusions: There 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 resolves symptoms and improves functioning in the medium term. However, there is evidence that for the specific diagnostic group of BPPV, physical (repositioning) manoeuvres are more effective in the short term than exercise-based vestibular rehabilitation; although a combination of the two is effective for longer-term functional recovery. There is insufficient evidence to discriminate between differing forms of vestibular rehabilitation.

PubMed Disclaimer

Conflict of interest statement

Michelle McDonnell: none known. Susan Hillier: none known.

Figures

1
1
Study flow diagram for 2014 update.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 1 Subjective improvement in dizziness.
1.2
1.2. Analysis
Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 2 Vertigo Symptom Scale.
1.3
1.3. Analysis
Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 3 Gait ataxia.
1.4
1.4. Analysis
Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 4 VD‐ADL (physical).
1.5
1.5. Analysis
Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 5 Sway path.
1.6
1.6. Analysis
Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 6 Dynamic visual acuity.
1.7
1.7. Analysis
Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 7 Vestibular Handicap Questionnaire.
1.8
1.8. Analysis
Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 8 Sharpened Romberg test (scores).
1.9
1.9. Analysis
Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 9 Dizziness Handicap Inventory.
1.10
1.10. Analysis
Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 10 Dynamic Gait Index.
1.11
1.11. Analysis
Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 11 Romberg test.
1.12
1.12. Analysis
Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 12 Vertigo intensity.
1.13
1.13. Analysis
Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 13 Posturography.
1.14
1.14. Analysis
Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 14 Vertigo intensity (BD versus sham).
2.1
2.1. Analysis
Comparison 2 Vestibular rehabilitation versus other treatment, Outcome 1 Dizziness cure rate.
2.2
2.2. Analysis
Comparison 2 Vestibular rehabilitation versus other treatment, Outcome 2 Dynamic Gait Index.
2.3
2.3. Analysis
Comparison 2 Vestibular rehabilitation versus other treatment, Outcome 3 Subjective improvement in dizziness.
2.4
2.4. Analysis
Comparison 2 Vestibular rehabilitation versus other treatment, Outcome 4 Vertigo intensity (BD versus CRM).
2.5
2.5. Analysis
Comparison 2 Vestibular rehabilitation versus other treatment, Outcome 5 Vertigo intensity (XS versus CRM).
2.6
2.6. Analysis
Comparison 2 Vestibular rehabilitation versus other treatment, Outcome 6 Dizziness Handicap Inventory.
3.1
3.1. Analysis
Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 1 Vertigo Symptom Scale.
3.2
3.2. Analysis
Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 2 Dizziness Handicap Inventory.
3.3
3.3. Analysis
Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 3 Repetitive head movement task.
3.4
3.4. Analysis
Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 4 Vertigo VAS.
3.5
3.5. Analysis
Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 5 Romberg test (eyes closed).
3.6
3.6. Analysis
Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 6 Tandem walk.
3.7
3.7. Analysis
Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 7 Posturography.
3.8
3.8. Analysis
Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 8 Subjective improvement in dizziness.
3.9
3.9. Analysis
Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 9 Vertigo intensity.
3.10
3.10. Analysis
Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 10 Vertigo frequency.
3.11
3.11. Analysis
Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 11 Vertigo Handicap Questionnaire.
3.12
3.12. Analysis
Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 12 Ataxia.
3.13
3.13. Analysis
Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 13 Vestibular disorders ‐ activities of daily living scale.
3.14
3.14. Analysis
Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 14 Dynamic Gait Index.
3.15
3.15. Analysis
Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 15 Beck Depression Inventory.
3.16
3.16. Analysis
Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 16 Subjective health.
3.17
3.17. Analysis
Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 17 Beck Anxiety Inventory.
3.18
3.18. Analysis
Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 18 Situational vertigo questionnaire.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Mruzek 1995 {published data only}
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Pavlou 2004 {published data only}
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Pavlou 2012 {published data only}
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Rossi‐Izquierdo 2011 {published data only}
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References to studies excluded from this review

Amor‐Dorado 2012 {published data only}
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Andersson 2006 {published data only}
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Jauregui‐Renaud 2007 {published data only}
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References to ongoing studies

ACTRN12609000284268 {unpublished data only}
    1. Winoto A. Does adding otolith specific exercises to a standard vestibular rehabilitation programme improve outcomes for adults with inner ear dizziness?. http://apps.who.int/trialsearch/trial.aspx?trialid=ACTRN12609000284268 (accessed 25 August 2010). [ACTRN12609000284268]
Aquaroni Ricci 2012 {published data only}
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ISRCTN86912968 {unpublished data only}
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Meldrum 2012 {published data only}
    1. Meldrum D, Herdman S, Moloney R, Murray D, Duffy D, Malone K, et al. Effectiveness of conventional versus virtual reality based vestibular rehabilitation in the treatment of dizziness, gait, balance impairment in adults with unilateral peripheral vestibular loss: a randomised controlled trial. BMC Ear, Nose & Throat Disorders 2012;12:3‐8. - PMC - PubMed
NCT00702832 {unpublished data only}
    1. Mørkved S. Effects of vestibular rehabilitation in the treatment of patients with acute vestibular loss ‐ a randomized controlled trial. http://clinicaltrials.gov/ct2/show/NCT00702832 (accessed 25 August 2010). [NCT00702832]

Additional references

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Hilton 2014
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References to other published versions of this review

Hillier 2005
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Hillier 2007
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Hillier 2011
    1. Hillier SL, McDonnell M. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database of Systematic Reviews 2011, Issue 2. [DOI: 10.1002/14651858.CD005397.pub3] - DOI - PubMed

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