Vestibular rehabilitation in elderly patients with postural instability: reducing the number of falls—a randomized clinical trial

Rossi-Izquierdo, Marcos; Gayoso-Diz, Pilar; Santos-Pérez, Sofía; Del-Río-Valeiras, María; Faraldo-García, Ana; Vaamonde-Sánchez-Andrade, Isabel; Lirola-Delgado, Antonio; Soto-Varela, Andrés

doi:10.1007/s40520-018-1003-0

Cited by 37 publications

(34 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…additional studies [46][47][48][49][50], and one study that was updated due to a new follow-up publication [51].…”

Section: Resultsmentioning

confidence: 99%

“…An improvement in standing on one leg with eyes closed (SOLEC) (+ 1 second, p = .038) and in walking heel to toe (-2 steps, p = .044). Training computer dynamic posturography exercises compared to no intervention (n = 139 participants, no primary outcome stated) revealed to no differences in SOT, LOS, DHI, TUG and FES-I in a four-arm study, for which other comparison groups are described as follows [51].…”

Section: Vr Versus No Interventionmentioning

confidence: 97%

“…Information about changes in SOT, DHI, TUG and FES-I is missing. No primary outcome was stated [51].…”

Section: New Variations Versus Established Forms Of Vrmentioning

confidence: 99%

See 2 more Smart Citations

Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review

Regauer

Seckler

Müller

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundVertigo, dizziness and balance disorders (VDB) are among the most relevant contributors to the burden of disability among older adults living in the community and associated with immobility, limitations of activities of daily living and decreased participation. The aim of this study was to identify the quality of evidence of physical therapy interventions that address mobility and participation in older patients with VDB and to characterize the used primary and secondary outcomes. MethodsA systematic search via MEDLINE (PubMed), Cochrane Library, CINAHL, PEDro, forward citation tracing and hand search was conducted initially in 11/2017 and updated in 7/2019. We included individual and cluster-randomized controlled trials and trials with quasi-experimental design, published between 2007 and 2017/2019 and including individuals ≥ 65 years with VDB. Physical therapy and related interventions were reviewed with no restrictions to outcome measurement. Screening of titles, abstracts and full texts, data extraction and critical appraisal was conducted by two independent researchers. The included studies were heterogeneous in terms of interventions and outcome measures. Therefore, a narrative synthesis was conducted. ResultsA total of 20 randomized and 2 non-randomized controlled trials with 1,876 patients met the inclusion criteria. The included studies were heterogeneous in terms of complexity of interventions, outcome measures and methodological quality. Vestibular rehabilitation (VR) was examined in twelve studies, computer-assisted VR (CAVR) in five, Tai Chi as VR (TCVR) in three, canal repositioning manoeuvres (CRM) in one and manual therapy (MT) in one study. Mixed effects were found regarding body structure/function and activities/participation. Quality of life and/or falls were assessed, with no differences between groups. VR is with moderate quality of evidence superior to usual care to improve balance, mobility and symptoms. Conclusion

show abstract

“…additional studies [46][47][48][49][50], and one study that was updated due to a new follow-up publication [51].…”

Section: Resultsmentioning

confidence: 99%

Section: Vr Versus No Interventionmentioning

confidence: 97%

See 1 more Smart Citation

Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review

Regauer

Seckler

Müller

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…The sample of the initial literature search comprised 16 studies [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45], the search update revealed 5 additional studies [46][47][48][49][50], and one study that was updated due to a new follow-up publication [51]. Thus, the nal sample comprised 22 studies with 1,876 participants.…”

Section: Resultsmentioning

confidence: 99%

“…An improvement in standing on one leg with eyes closed (SOLEC) (+1 second, p = .038) and in walking heel to toe (-2 steps, p = . Training computer dynamic posturography exercises compared to no intervention (n = 139 participants experiencing balance impairment without a vestibular disease, no primary outcome stated) revealed to no differences in SOT, LOS, DHI, TUG and FES-I in a four-arm study, for which other comparison groups are described as follows [51].…”

Section: Vr Versus No Interventionmentioning

confidence: 99%

Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review

Regauer

Seckler

Müller

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Vertigo, dizziness and balance disorders (VDB) are among the most relevant contributors to the burden of disability among older adults living in the community and associated with immobility, limitations of activities of daily living and decreased participation. The aim of this study was to identify the quality of evidence of physical therapy interventions that address mobility and participation in older patients with VDB and to characterize the used primary and secondary outcomes.Methods: A systematic search via MEDLINE (PubMed), Cochrane Library, CINAHL, PEDro, forward citation tracing and hand search was conducted initially in 11/2017 and updated in 7/2019. We included individual and cluster-randomized controlled trials and trials with quasi-experimental design, published between 2007 and 2017/2019 and including individuals ≥ 65 years with VDB. Physical therapy and related interventions were reviewed with no restrictions to outcome measurement. Screening of titles, abstracts and full texts, data extraction and critical appraisal was conducted by two independent researchers. The included studies were heterogeneous in terms of interventions and outcome measures. Therefore, a narrative synthesis was conducted.Results: A total of 20 randomized and 2 non-randomized controlled trials with 1,876 patients met the inclusion criteria. The included studies were heterogeneous in terms of complexity of interventions, outcome measures and methodological quality. Vestibular rehabilitation (VR) was examined in twelve studies, computer-assisted VR (CAVR) in five, Tai Chi as VR (TCVR) in three, canal repositioning manoeuvres (CRM) in one and manual therapy (MT) in one study. Mixed effects were found regarding body structure/function and activities/participation. Quality of life and/or falls were assessed, with no differences between groups. VR is with moderate quality of evidence superior to usual care to improve balance, mobility and symptoms.Conclusion: To treat older individuals with VDB, VR in any variation and in addition to CRMs seems to be effective. High-quality randomized trials need to be conducted to inform clinical decision making.Trial Registration: PROSPERO 2017 CRD42017080291.

show abstract

Patient-Reported Disability After Computerized Posturographic Vestibular Retraining for Stable Unilateral Vestibular Deficit

David

Shahnaz

2022

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

IMPORTANCE Individuals with persistent unilateral vestibular deficits experience loss of quality of life and increased risk of falling, and they have few well-supported options for effective treatment.OBJECTIVES To evaluate whether vestibular retraining using computerized dynamic posturography is associated with reduced participant-reported disability for patients with an objectively assessed unilateral peripheral vestibular deficit and to assess the feasibility of conducting a randomized clinical trial of vestibular retraining using computerized dynamic posturography. DESIGN, SETTING, AND PARTICIPANTSThis single-group cohort study was conducted from April 29 to July 23, 2021, in a tertiary neurotology clinic among 13 individuals with a stable unilateral vestibular deficit present for more than 6 months, confirmed with videonystagmography and vestibular evoked myogenic potential testing. Statistical analysis was performed from July 7, 2021, to January 25, 2022.INTERVENTIONS Twelve twice-weekly sessions of posturography-assisted vestibular retraining with prescribed weight shifting tasks guided by an interactive display. MAIN OUTCOMES AND MEASURESChange in scores on the Dizziness Handicap Inventory (DHI), the Activities-Specific Balance Confidence (ABC) Scale, and the Falls Efficacy Scale-International (FES-I), which participants completed before and after retraining to measure their perception of their disability. They also completed posturography measurements. Secondary outcomes included tolerability of the intervention and rate of completion of the full protocol.RESULTS A total of 13 participants (8 men [62%]; median age, 51 years [range, 18-67 years]) were enrolled. All 13 participants completed the intervention and all follow-up. After treatment, the median changes in scores were −16 points (95% CI, −20 to 2) for the DHI, −9 (95% CI, −14 to 1) for the FES-I, and 11.9 (95% CI, 0-17.3) for the ABC Scale. Eight participants (62%) improved by greater than the minimum clinically important difference (MCID) for the DHI, whereas 4 (31%) exceeded the MCID for the ABC Scale, and 3 (23%) exceeded the MCID for the FES-I. Participants with moderate to severe disability at baseline (n = 7) had a larger magnitude of improvement in DHI scores than those with mild disability (n = 6) (−18 [95% CI, −78 to 2] vs −1 [95% CI, −8 to 16]). Six of the 7 patients (86%) with moderate to severe disability improved by greater than the MCID for DHI, wherease 4 of 7 patients (57%) improved by greater than the MCID for the ABC Scale, and 3 of 7 patients (43%) improved by greater than the MCID for the FES-I.CONCLUSIONS AND RELEVANCE This cohort study suggests that computerized, dynamic posturography-assisted retraining was associated with clinically meaningful improvements in participant-reported disability among those with stable unilateral vestibular deficit and moderate to severe disability. Further studies should compare posturography-assisted vestibular retraining with conventional physical therapy rehabilitation techniques.

show abstract

Vestibular rehabilitation in elderly patients with postural instability: reducing the number of falls—a randomized clinical trial

Abstract: We recommend performing VR in any older person with high risk of falls.

Cited by 37 publications

References 26 publications

Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review

Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review

Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review

Patient-Reported Disability After Computerized Posturographic Vestibular Retraining for Stable Unilateral Vestibular Deficit

Contact Info

Product

Resources

About