Vestibular rehabilitation for unilateral peripheral vestibular dysfunction

Area of Science:

• Neurology
• Rehabilitation Medicine
• Audiology

Background:

• Unilateral peripheral vestibular dysfunction (UPVD) presents with dizziness, visual disturbances, and balance issues, often requiring management through medication, physical maneuvers, or vestibular rehabilitation.
• This review is an update of a Cochrane review first published in 2007, with previous updates in 2011, focusing on the effectiveness of vestibular rehabilitation.

Purpose of the Study:

• To evaluate the efficacy of vestibular rehabilitation for adults experiencing symptomatic unilateral peripheral vestibular dysfunction in a community setting.

Main Methods:

• Conducted a systematic review of randomized controlled trials involving adults with symptomatic UPVD.
• Searched multiple databases for published and unpublished trials up to January 18, 2014.
• Included trials comparing vestibular rehabilitation to control, other treatments, or different forms of vestibular rehabilitation, with primary outcomes focused on symptom resolution and secondary outcomes on function and quality of life.

Main Results:

• Vestibular rehabilitation demonstrated a statistically significant effect in reducing dizziness frequency compared to control or no intervention (OR 2.67, 95% CI 1.85 to 3.86).
• Significant improvements were observed in secondary outcome measures related to activity and participation, such as the Dizziness Handicap Inventory (SMD -0.83, 95% CI -1.02 to -0.64).
• For benign paroxysmal positional vertigo (BPPV), physical repositioning maneuvers were superior in short-term cure rates (OR 0.19, 95% CI 0.07 to 0.49) compared to movement-based vestibular rehabilitation, with no reported adverse effects.

Conclusions:

• Vestibular rehabilitation is a safe and effective management strategy for UPVD, supported by moderate to strong evidence from high-quality randomized controlled trials.
• Moderate evidence suggests vestibular rehabilitation resolves symptoms and enhances function in the medium term.
• While physical maneuvers are more effective for short-term BPPV treatment, combined approaches with vestibular rehabilitation promote longer-term functional recovery; evidence for differentiating between vestibular rehabilitation types is insufficient.