Home-based virtual reality augmented vestibular rehabilitation for persistent postural-perceptual dizziness: A pilot...

Persistent postural-perceptual dizziness (PPPD) is a common functional vestibular disorder. Vestibular balance rehabilitation therapy (VBRT) is recommended, but access to adjunctive therapies that support self-management remains limited. This study aimed to assess the feasibility and preliminary clinical effects of home-based virtual reality (HB-VR) as an adjunct to individualized VBRT in adults with PPPD.

This prospective, single-centre controlled feasibility trial was conducted at a tertiary vestibular clinic between June 2022 and October 2024. Twenty adults with confirmed PPPD were sequentially allocated to receive VBRT alone (n = 10) or VBRT plus HB-VR (n = 10) for 12 weeks. Primary outcomes were feasibility, adherence and safety. Secondary outcomes included the Dizziness Handicap Inventory(DHI), Brief Illness Perception Questionnaire (BIPQ) along with other measures. Group-by-time effects were examined using Bayesian mixed-effects models with regions of practical equivalence (ROPE) defined by minimal clinically important differences.

Sixteen participants completed the intervention (VBRT n = 8; VBRT+HB-VR n = 8). No VR-related adverse events occurred, and user satisfaction was high. Both groups demonstrated improvement in DHI over 6 months, however group x time interactions were seen favouring VBRT+HB-VR across multiple outcomes. At follow-up, there was moderate evidence that the reduction in DHI exceeded the ROPE for clinical significance, and very strong evidence of a greater improvement in illness perception (BIPQ) in the HB-VR group compared with VBRT alone.

HB-VR integrated with VBRT was feasible and acceptable in people with PPPD. Preliminary evidence suggests that VR is associated with greater improvements in clinical outcomes to VBRT alone.