Maneuvers for the treatment of benign positional paroxysmal vertigo: a systematic review.
Benign Paroxysmal Positional Vertigo (BPPV) is one of the most frequent diseases of the vestibular system and it is characterized by episodes of recurrent vertigo triggered by head movements or position changes. There are several approaches for treatment, but efficacy is still being discussed.


OBJECTIVE
To asses the effectiveness of the specific maneuvers available to the treatment of BPPV.


METHODS
An electronic search at the main databases, including MEDLINE, LILACS, PEDro, Cochrane Collaborations Database was performed, and we selected only randomized clinical trials studying adults with diagnosis of BPPV confirmed by the Dix-Hallpike test. The trials should have included physical maneuvers such as Epley and Semont. The main outcome was Dix-Hallpike negative test and the changes to subjective complaints. The trials were assessed using Jadad's scale and only studies with quality scores equal or above 3 were pooled on a meta-analyses to assess their effectiveness.


RESULTS
We found five controlled clinical trials phase I comparing the Epley's maneuver with controls or placebo. The meta-analysis showed positive evidence of Epley's maneuver to the posterior semicircular canal (effect size = 0.11 [CI 95% 0.05, 0.26] of objective improvement [Dix-Halpike] within one week, 0.24 [CI 95% 0.13, 0.45] within one month and 0.16 [CI 95% 0.08, 0.33] of improvement reported by the patients within one week. There are no studies about the efficacy of Semont's maneuver.


CONCLUSIONS
There is scientific evidence showing good efficacy of Epley's maneuver in the treatment.
Teixeira
Lázaro Juliano
LJ
University of Vale do Itajaí, Univali, SC, Brazil. lazaro@univali.br
Machado
João Natel Pollonio
JN
D006801:Humans; D018953:Kinesiology, Applied; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014717:Vertigo / Q000188:drug therapy / Q000534:rehabilitation*