What are the effects of different modes of exercise training for intermittent claudication? - A Cochrane Review summary with commentary

Abstract

Objective Secondary analysis, testing the effect on change in health-related quality of life of group-based vestibular rehabilitation in patients with mild-moderate traumatic brain injury, dizziness and balance problems. Design A single-blind randomized controlled trial. Subjects A total of 65 patients aged 16–60 years with a Rivermead Post-concussion Symptoms Questionnaire dizziness score ≥2, and DizzinessHandicap Inventory score >15 points. Data collection was performed at baseline 3.5 (standard deviation (SD) 2.1) months post-injury, end of intervention, and 4.4 (SD 1.0) months after baseline. Methods Quality of Life after Brain Injury was the main outcome. Independent variables were demographic and injury variables, Hospital Anxiety and Depression Scale, changes on the Rivermead Post-concussion Symptoms Questionnaire (RPQ3 physical and RPQ13 psychological/cognitive), and Vertigo Symptom Scale-Short Form. Results Mean age of participants was 39.4 years (SD 13.0); 70.3% women. Predictors of change inthe Quality of Life after Brain Injury were receiving the vestibular rehabilitation ( p =0.049), baseline psychological distress ( p =0.020), and changein RPQ3 physical ( p =0.047) and RPQ13 psychological/cognitive ( p =0.047). Adjusted R2 was 0.399,F=6.13, p < 0.001. Conclusion There was an effect in favour of the intervention group in improvement in health-related quality of life. Changes on the Rivermead Post-concussion Symptoms Questionnaire were also associated with change on the Quality of Life after Brain Injury. LAY ABSTRACT This paper is the first to present results of a vestibular rehabilitation intervention study on changes in health-related quality of life in patients with dizziness and balance problems after mild-to-moderate traumatic brain injury. The intervention group received exercises and guidance aimed at self-efficacy and how to cope with their dizziness and balance problems. In addition, both the intervention and control groups received treatment as usual, comprising multidisciplinary rehabilitation at a university hospital. The main result was measured as change on the Quality of Life after Brain Injury questionnaire. Post-concussion symptoms, vertigo and psychological distress were also measured. The study showed that the group receiving the vestibular rehabilitation intervention underwent more improvement in health-related quality of life than the group receiving usual treatment alone. Other factors that influenced the improvement in quality of life were psychological distress at the start of the study and fewer post-concussion symptoms.