Protocol for a Randomised Controlled Feasibility Study of Psychologically Informed Vestibular Rehabilitation for People With Persistent Dizziness (INVEST Trial)

Abstract

Background: Dizziness is a common complaint that often persists and leads to disability and distress. Several cognitive and behavioural responses may contribute to the neurobiological adaptations that maintain persistent vestibular symptoms. This paper will present the protocol of a two-arm parallel group feasibility randomised controlled trial designed to determine whether a fully powered efficacy trial is achievable by examining the feasibility of recruitment, acceptability and potential benefits of an integrated cognitive behavioural therapy and vestibular rehabilitation (CBT-VR) treatment for people with persistent dizziness. Methods: Forty adult patients will be recruited from a tertiary vestibular clinic with persistent movement triggered dizziness for three months or longer who have moderate-high levels of dizziness handicap. Participants will be 1:1 randomised, using a minimisation procedure, to six sessions (12-14 weeks’) of either CBT-VR (intervention arm) or VR only (control arm). Measures will be collected at baseline and 4 months post randomisation. The primary feasibility outcomes include descriptive data on numbers meeting eligibility criteria, rates of recruitment, numbers retained post randomisation, treatment adherence and an acceptability questionnaire. Treatment effects on self-report outcomes will be estimated to determine that 95% confidence intervals for the effects are consistent with anticipated effects and minimum clinically important differences, and to provide information needed for the power calculation of an efficacy trial. A nested qualitative study will be conducted post-intervention (intervention group only) to explore the acceptability of the intervention and identify any areas in need of improvement. Discussion: If a trial of CBT-VR is feasible, acceptability data will be used to enhance the intervention if needed and refine the multicentre RCT protocol. Future studies will need to consider the training required for other physiotherapists to deliver the intervention.Trial registration: ISRCTN 10420559

Impairment of attention network function in posterior circulation ischemia-evidence from the Attention Network Test

“…The most common causes of PCI are atherosclerotic lesions, embolism, and small penetrating artery disease, which lead to functional defects in the inner ear, brainstem, and cerebellum (Vuilleumier et al, 1995;Caplan, 2000;Caplan et al, 2004;Savitz and Caplan, 2005). Clinical evidence shows that posterior circulation ischemic vertigo (PCIV) is at high risk of recurrence, with anxiety, depression, and other psychiatric disorders (Gulli et al, 2009;Herdman et al, 2020), which should cause alarm among clinicians. Most PCIV patients are middle-aged and elderly.…”

Rendimiento cognitivo en personas con patologías vestibulares: Una revisión integradora de la literatura

“…El impacto de las alteraciones vestibulares sobre la calidad de vida y los aspectos físico, emocional y social ha sido ampliamente estudiado y documentado (Agrawal et al, 2009;Herdman et al, 2020;MacDowell et al, 2017;Petri et al, 2017;Vélez León et al, 2010). No obstante, el estudio del impacto de patologías vestibulares sobre el rendimiento cognitivo es limitado pese a que se han establecido relaciones anátomo-funcionales entre el sistema vestibular y cierta áreas corticales, principalmente a partir de estudios de neuroimagen (Jang et al, 2018;Kirsch et al, 2016).…”