title: Evaluation of booklet-based self-management of symptoms in Ménière disease: a randomized controlled trial.
abstract: OBJECTIVE
  This study examined the effectiveness of booklet-based education in vestibular rehabilitation (VR) and symptom control (SC) techniques to manage vertigo and dizziness in Ménière disease.
  
  
  METHODS
  Participants (n = 360) were randomized to a waiting list control group or to receive either a VR or an SC self-management booklet. VR involved provoking dizziness in a controlled manner by making repeated head movements in order to promote neurological and psychological habituation. SC involved using applied relaxation, challenging negative beliefs, and lifestyle modification to reduce amplification of dizziness by anxiety. Subjective improvement in health, enablement (ability to understand and cope with symptoms), and adherence were measured at 3 and 6 months. Symptoms, handicap, anxiety and depression, and negative beliefs about symptoms were assessed pretreatment and at 3 and 6 months.
  
  
  RESULTS
  At 6-month follow-up, 45 (37.5%) of the VR group and 47 (39.2%) of the SC group reported improvement compared with 19 (15.8%) controls; the relative probability of improvement compared with controls was 2.37 (95% confidence interval [CI], 1.48-3.80) for VR and 2.47 (95% CI, 1.55-3.95) for SC. Both intervention groups reported greater enablement than controls (p < .001, d > 0.70). At 3 months, the VR group had reduced symptoms, anxiety, handicap, and negative beliefs about dizziness; the SC group had reduced handicap; but the control group showed no improvement. Reported adherence levels were low and strongly related to outcome.
  
  
  CONCLUSIONS
  Self-management booklets offer an inexpensive and easily disseminated means of helping people with Ménière disease to cope with dizziness symptoms.
authors.affiliation: School of Psychology, University of Southampton, Highfield, Southampton SO17 1BJ, UK. L.Yardley@soton.ac.uk
authors.forename: Lucy
authors.initials: L
authors.lastname: Yardley
authors.forename: Sarah
authors.initials: S
authors.lastname: Kirby
mesh_terms: D003469:Culture; D004244:Dizziness / Q000209:etiology / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation; D005500:Follow-Up Studies; D006185:Habituation, Psychophysiologic; D019416:Head Movements; D006801:Humans; D008019:Life Style; D008575:Meniere Disease / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D010174:Pamphlets; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D012064:Relaxation Therapy; D012648:Self Care; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014717:Vertigo / Q000209:etiology / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation; D014722:Vestibule, Labyrinth / Q000503:physiopathology