Effectiveness of primary care-based vestibular rehabilitation for chronic dizziness
Yardley L., Donovan-Hall M., Smith HE., Walsh BM., Mullee M., Bronstein AM.
Background: Dizziness is a very common symptom and is usually managed in primary care. Vestibular rehabilitation for dizziness is a simple treatment that may be suitable for primary care delivery, but its effectiveness has not yet been determined. Objective: To evaluate the effectiveness of nurse-delivered vestibular rehabilitation in primary care for patients with chronic dizziness. Design: Single-blind randomized, controlled trial. Setting: 20 general practices in southern England. Patients: 170 adult patients with chronic dizziness who were randomly assigned to vestibular rehabilitation (n = 83) or usual medical care (n = 87). Intervention: Each patient received one 30- to 40-minute appointment with a primary care nurse. The nurse taught the patient exercises to be carried out daily at home, with the support of a treatment booklet. Measurements: Primary outcome measures were baseline, 3-month, and 6-month assessment of self-reported spontaneous and provoked symptoms of dizziness, dizziness-related quality of life, and objective measurement of postural stability with eyes open and eyes closed. Results: At 3 months, improvement on all primary outcome measures in the vestibular rehabilitation group was significantly greater than in the usual medical care group; this improvement was maintained at 6 months. Of 83 treated patients, 56 (67%) reported clinically significant improvement compared with 33 of 87 (38%) usual care patients (relative risk, 1.78 [95% CI, 1.31 to 2.42]). Limitations: Psychological elements of the therapy may have contributed to outcomes, and the treatment may be effective only for well-motivated patients. Conclusions: Vestibular rehabilitation delivered by nurses in general practice improves symptoms, postural stability, and dizziness-related handicap in patients with chronic dizziness.