Efficacy of vestibular rehabilitation using unidirectional rotation paradigm in VOR asymmetry: systematic review and meta-analysis

Abstract

Purpose: Unilateral vestibular dysfunction leads to significant asymmetry in the horizontal vestibulo-ocular reflex (VOR) during swift head movements. This reflex can be enhanced through rehabilitation exercises and visual-vestibular adaptation techniques. This systematic review aims to evaluate the current evidence on the effectiveness of unidirectional rotation treatments for improving symptoms and function in patients with vestibular disorders.

Methods: A systematic review was conducted following the PRISMA 2020 guidelines, using databases such as PubMed, Cochrane Library, EMBASE, and Scopus. Included were experimental studies, randomized controlled trials (RCTs), or pilot RCTs. Meta-analysis was performed based on the findings of these studies.

Results: Among 24 articles identified, three addressed the systematic review's question, two observational studies (one retrospective and one prospective) and a RCT. Studies included data from a total of 200 participants with vestibular disorders (n = 96; 48% males) for the meta-analysis. A meta-analysis, including a subgroup analysis, was conducted to assess the improvement in VOR asymmetry following vestibular rehabilitation. The analysis compared pre- and post-rehabilitation directional preponderance (DP) across three studies. Results showed a significant improvement in VOR asymmetry, with a mean difference of 18.72% in favour of rehabilitation.

Conclusion: Our findings substantiate the efficacy of unilateral vestibular stimulation in reducing asymmetry in the VOR among patients with vestibular dysfunction. This modality represents a promising rehabilitation strategy, significantly enhancing vestibular function and patient outcomes.

Keywords: Directional preponderance; Treatment outcomes; Unidirectional rotation; VOR; Vestibular dysfunction; Vestibular rehabilitation.