Effectiveness of primary care-based vestibular rehabilitation for chronic dizziness.
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.
Yardley
Lucy
L
University of Southampton, Highfield, Southampton, United Kingdom. L.Yardley@soton.ac.uk
Donovan-Hall
Margaret
M
Smith
Helen E
HE
Walsh
Bronagh M
BM
Mullee
Mark
M
Bronstein
Adolfo M
AM
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*