title: Effectiveness of primary care-based vestibular rehabilitation for chronic dizziness.
abstract: 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.
  
  
  METHODS
  Single-blind randomized, controlled trial.
  
  
  METHODS
  20 general practices in southern England.
  
  
  METHODS
  170 adult patients with chronic dizziness who were randomly assigned to vestibular rehabilitation (n = 83) or usual medical care (n = 87).
  
  
  METHODS
  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.
  
  
  METHODS
  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]).
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Southampton, Highfield, Southampton, United Kingdom. L.Yardley@soton.ac.uk
authors.forename: Lucy
authors.initials: L
authors.lastname: Yardley
authors.forename: Margaret
authors.initials: M
authors.lastname: Donovan-Hall
authors.forename: Helen E
authors.initials: HE
authors.lastname: Smith
authors.forename: Bronagh M
authors.initials: BM
authors.lastname: Walsh
authors.forename: Mark
authors.initials: M
authors.lastname: Mullee
authors.forename: Adolfo M
authors.initials: AM
authors.lastname: Bronstein
mesh_terms: D002908:Chronic Disease; D004244:Dizziness / Q000451:nursing / Q000503:physiopathology* / Q000628:therapy*; D005081:Exercise Therapy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011187:Posture / Q000502:physiology; D011320:Primary Health Care; D016037:Single-Blind Method; D016896:Treatment Outcome; D014722:Vestibule, Labyrinth / Q000503:physiopathology*