Evidence-based physical therapy for BPPV using the International Classification of Functioning, Disability and Health model: a case report (original) (raw)
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Variables Affecting Treatment in Benign Paroxysmal Positional Vertigo
The Laryngoscope, 2000
Objective To identify variables affecting outcome in patients with benign paro‐ysmal positional vertigo (BPPV) treated with canalith repositioning maneuvers.Study Design Retrospective review of patients at a tertiary vestibular rehabilitation center.Methods Variables identified for statistical analysis included method of diagnosis, age, se‐, onset association with trauma, semicircular canal involvement, presence of bilateral disease, treatment visits, and cycles of canalith repositioning maneuvers per treatment visit. Multivariate statistical analysis using Pearson χ2, likelihood ratio, linear‐by‐linear association, and cross‐tabulation tests were performed.Results Two hundred fifty‐nine patients with BPPV who received treatment were identified from 1996 to 1998. Average follow‐up time was 16.9 months. 74.8% required one treatment visit, 19.0% required a second treatment visit, and 98.4% were successfully treated after three treatment visits. The remainder required up to seven treat...
Otology & Neurotology, 2019
Objectives: To compare the efficacy of the home treatment program combined with office-based canalith repositioning procedure (CRP) versus office-based CRP alone for benign paroxysmal positional vertigo (BPPV). Study Design: Randomized controlled trial. Method: One hundred six patients with BPPV were randomly assigned to the home treatment program combined with office-based CRP group and the office-based CRP only group. The canalith repositioning procedure was performed in all patients at an outpatient clinic. The patients in the home treatment group were additionally instructed to do the exercise tailored for their affected canal at home every day. The presence of nystagmus was recorded. The symptom of vertigo and its impact on daily life were evaluated by the Dizziness Handicap Inventory (DHI) and a visual analog scale (VAS). All outcomes were evaluated at 1, 2, and 4 weeks after the initial treatment. A cure was defined as a patient having no nystagmus on the appointment date. Results: The success rate of the home treatment program combined with office-based CRP group and the office-based CRP only group were 100 and 91.67%, respectively (p ¼ 0.043). The nystagmus duration, latency, DHI, and VAS scores decreased significantly from baseline at 1, 2, and 4 weeks for both groups (p < 0.001). No significant side effects were noted in either of the groups. Conclusion: The office-based CRP plus home treatment program was more effective than the CRP only group for BPPV. Both groups were effective in reducing the symptom of vertigo and its impact on daily life. Trial Registration: Clinicaltrials.in.th/TCTR20160810001
No More Postural Restrictions in Posterior Canal Benign Paroxysmal Positional Vertigo
Otology & Neurotology, 2008
Objective: To establish if postural restrictions are useful after repositioning maneuvers in posterior canal benign paroxysmal positional vertigo (BPPV). Study Design: Prospective double-blind consecutive case study. Setting: This study was conducted at a tertiary referral hospital. Patients: Three hundred ninety-one consecutive patients diagnosed of posterior canal BPPV with a positive Dix-Hallpike test. Intervention: Two hundred seven patients diagnosed during the first year of our study were instructed to follow postural restrictions after repositioning maneuvers, and 184 patients who were diagnosed in the second year of our study did not receive any postural restriction after treatment. All of them were reevaluated 10 days later, and they were followed up until their symptoms resolved. Main Outcome Measures: We compared the success rates of each treatment analyzing the number of maneuvers needed until symptoms resolved, recurrence rate, and subjective recovery at the end of treatment between both groups. Results: There were no statistical differences in number of maneuvers needed to resolve symptoms between patients who restricted their movements (80.2% of success with 1 maneuver) and those who did not (72.3%). Recurrence rate was not statistically different among groups (2.3 and 3.1%), and almost all patients declared to feel better after treatment in both groups (97.1 and 98.9%). Conclusion: Efficacy of Epley maneuver is not improved by postural restrictions. Therefore, we do not recommend any postural restrictions to patients with posterior canal BPPV.
Physical Therapy, 2014
highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness and appropriateness of interventions-medications, surgery, education, nutrition, exercise-and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature. 1 Each article in this PTJ series summarizes a Cochrane review or other scientific evidence on a single topic and presents clinical scenarios based on real patients or programs to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on an adult patient with benign paroxysmal positional vertigo. Can a canalith repositioning procedure help this patient?
Family Medicine & Primary Care Review, 2016
Background. Vertigo as a symptom accompanies many pathological processes leading to damage of the vestibular system at a peripheral or central level. it is a manifestation of systemic diseases. Vertigo is one of the most common causes of presentation of the patient to a general practitioner. one of the most common causes of sudden vertigo is benign paroxysmal positional vertigo (BPPV). Objectives. assessment of the effectiveness of the canalith repositioning procedure in idiopathic and posttraumatic BPPV. Material and methods. 50 people with BPPV aged 22-78 (mean 53 ± 13), divided into 2 groups of 25 subjects each, suffering from posttraumatic (group a, aged 53 ± 15) and idiopathic (group B, aged 53 ± 11) vertigo. The treatment was conducted using the epley manoeuver, controlling its effectiveness by means of the Dix-hallpike manoeuvre. Results. all the treated patients benefited from the therapy. the percentage of patients cured after the first two medical manoeuvres was 52% (13) and 92% (23) in groups a and B, respectively, which is a statistically significant difference (p = 0.0016). Patients in group B had an 18 times higher chance of regression of symptoms as early as after the first medical manoeuvre. The number of performed manoeuvres which guaranteed full effectiveness was on average 1.16 per patient with only one semicircular canal affected, and 3.5 when semicircular canals on both sides were affected. Conclusions. 1. the application of motor rehabilitation in the course of BPPV is a non-invasive method for treating vertigo with high effectiveness. 2. trauma in medical history prolongs the treatment of BPPV using manoeuvre. 3. if BPPV affects both sides, the manoeuvre should be repeated more times. 4. the characteristic medical history and risk factors (trauma) facilitate forming a suspicion of the diagnosis with a high probability as early as in the office of a general practitioner.
Physiotherapy, 2018
Extensive research has identified the best assessment and treatment manoeuvres for each subtype of BPPV. Education in vestibular rehabilitation (VR) is inconsistent. It is unclear if the evidence has been adopted by UK physiotherapists in clinical practice and no research has investigated this specifically. Design: An online survey with closed-and open-text answers. Participants: A purposive sample of physiotherapists interested in VR. A response rate of 67% (100/150) was obtained, from which 20 responses were excluded. Results: Participants had good evidence-based awareness in assessment (99%) and treatment (90%) of posterior BPPV. Horizontal BPPV assessment awareness was lower than treatment (46% versus 75%). Differential diagnosis was poor in subjective (25%) and objective stages of assessment (43%). 36% were able to list ≥3 test precautions with all three nystagmus characteristics described by 29%. 81% encourage activity restrictions post-treatment. Only 28% were aware of practice guidelines or Cochrane reviews in BPPV. External courses were rated the top method for learning how to manage BPPV (53%). Lack of peer support (34%) was the main challenge faced whilst learning. Recommendations for improving BPPV education included more external courses (26%) and competency guidelines (15%). Conclusions: Good awareness of research evidence was observed in some aspects of BPPV management but many areas require development. Translation and implementation of evidence remains poor and suggests changes in education and knowledge dissemination are warranted.
Balance improvement in patients with benign paroxysmal positional vertigo
Clinical Rehabilitation, 2008
Objective: To investigate the effect of an additional vestibular stimulated exercise programme on balance for patients with benign paroxysmal positional vertigo. Design: Randomized controlled trial. Setting: Medical centre. Subjects: Twenty-six subjects with benign paroxysmal positional vertigo involving the unilateral posterior semicircular canal. Interventions: Subjects were randomized into experimental or control groups. Thirteen subjects in the experimental group received the canalith repositioning manoeuvre and vestibular stimulated exercise training three times a week for four weeks. Thirteen subjects in the control group received only the canalith repositioning manoeuvre. Main measures: Static balance tests, tandem walk test, Dynamic Gait Index and subjective rating of the intensity of vertigo were measured at baseline, two-week and four-week assessments. Results: Compared with the control group, subjects in the experimental group demonstrated a statistically significant improvement in single leg stance with eyes closed at the two-week assessment (P50.05). Furthermore, stance on foam surface with eyes closed, single-leg stance with eyes closed, and Dynamic Gait Index at the four-week assessment were also significantly improved (P50.05).
Importance of accurate diagnosis in benign paroxysmal positional vertigo (BPPV) therapy
Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2014
AIM To determine the importance of accurate topological diagnostics of the otolith and the differentiation of certain clinical forms of benign paroxysmal positional vertigo (BPPV). METHODS A prospective study was conducted at the County General Hospital Vukovar in the period from January 2011 till January 2012. A total of 81 patients with BPPV, 59 females (72.84%) and 22 (27.16%) males (p less than 0.001), mean age 60.1 (± 12.1) were examined. The diagnosis was confirmed and documented by videonystagmography (VNG). The disability due to disease and risk of falling were monitored by filling in the Dizziness Handicap Inventory (DHI) and Activities-specific Balance Confidence Scale (ABC) questionnaires at the beginning and at the end of the repositioning treatment. RESULTS In 79 (97.3%) patients posterior semicircular canal was affected, and in a small number of patients, two (2.47%) the lateral one. After the repositioning procedures were performed, there was a significant reduction o...
The Impact of Benign Paroxysmal Positional Vertigo on Quality of Life
2011
Objectives: Authors want to illustrate that BPPV infl uence the quality of patients’ life, therefore to demonstrate the utility of the treatment. Method and materials: The study was conducted in our clinic on a group of 55 patients diagnosed with BPPV over a fi ve month time frame. Each patient was asked to fi ll a DHI questionnaire in order to appreciate the impact of the condition over the patients’ quality of life. Results were statistically analyzed with the program Microsoft Excel 2003. Results: The most affected patients were those in their fi fth decade of life; 64% of patients were women, 36% of patients were men; PSC was the most frequently affected canal; at follow-up examination, one week after applying repositioning maneuver 52 patients were stable; most patients needed only one repositioning maneuver to cure the condition; 54 patients (98%) didn’t suffer any recurrences till the end of the study. Conclusions: DHI questionnaire proved to be a good assessment tool for the...
Trials, 2014
Background: Vertigo is a common medical condition with a broad spectrum of diagnoses which requires an integrated approach to patients through a structured clinical interview and physical examination. The main cause of vertigo in primary care is benign paroxysmal positional vertigo (BPPV), which should be confirmed by a positive D-H positional test and treated with repositioning maneuvers. The objective of this study is to evaluate the effectiveness of Epley's maneuver performed by general practitioners (GPs) in the treatment of BPPV. Methods/Design: This study is a randomized clinical trial conducted in the primary care setting. The study's scope will include two urban primary care centers which provide care for approximately 49,400 patients. All patients attending these two primary care centers, who are newly diagnosed with benign paroxysmal positional vertigo, will be invited to participate in the study and will be randomly assigned either to the treatment group (Epley's maneuver) or to the control group (a sham maneuver). Both groups will receive betahistine. Outcome variables will be: response to the D-H test, patients' report on presence or absence of vertigo during the previous week (dichotomous variable: yes/no), intensity of vertigo symptoms on a Likert-type scale in the previous week, total score on the Dizziness Handicap Inventory (DHI) and quantity of betahistine taken. We will use descriptive statistics of all variables collected. Groups will be compared using the intent-to-treat approach and either parametric or nonparametric tests, depending on the nature and distribution of the variables. Chi-square test or Fisher's exact test will be conducted to compare categorical measures and Student's t-test or Mann-Whitney U-test will be used for intergroup comparison variables. Discussion: Positive results from our study will highlight that treatment of benign paroxysmal positional vertigo can be performed by trained general practitioners (GPs) and, therefore, its widespread practice may contribute to improve the quality of life of BPPV patients.