title: Rapid systematic review of repeated application of the epley maneuver for treating posterior BPPV.
abstract: OBJECTIVE
  To evaluate the effect of repeated application of the Epley maneuver on patient-reported symptom relief and resolution of nystagmus in patients with posterior benign paroxysmal positional vertigo (p-BPPV).
  
  
  METHODS
  PubMed, Embase, and the Cochrane Library.
  
  
  METHODS
  A systematic search was conducted. Studies reporting original study data were included. Relevance and risk of bias (RoB) of the selected articles were assessed. Studies with low relevance, high RoB, or both were excluded. Success percentages and mean values were extracted.
  
  
  RESULTS
  A total of 955 unique studies were retrieved. Fourteen of these satisfied the eligibility criteria. All of the included studies carried a high relevance and a moderate RoB. The majority of studies were 1-armed trials, in which the Epley was repeated only in case previous attempt(s) had failed. The maneuver was not repeated if it was successful. In 32% to 90% of patients, the first treatment session was successful. Reported cumulative success percentages ranged from 40% to 100% after the second session, 67% to 98% after the third session, 87% to 100% after the fourth session, and 100% in the studies in which patients received 5 sessions. One study evaluating the effect of multiple maneuvers in a single session showed a rise in success percentages from 84% for 1 maneuver to 90% after 2 maneuvers and 92% after 3 maneuvers.
  
  
  CONCLUSIONS
  Multiple studies with moderate RoB show a beneficial effect of multiple sessions of the Epley maneuver in p-BPPV patients who are not fully cleared of symptoms after the first session.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, the Netherlands.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Reinink
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, the Netherlands Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands ENT-research@umcutrecht.nl.
authors.forename: Inge
authors.initials: I
authors.lastname: Wegner
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, the Netherlands Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands.
authors.forename: Inge
authors.initials: I
authors.lastname: Stegeman
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, the Netherlands Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands.
authors.forename: Wilko
authors.initials: W
authors.lastname: Grolman
mesh_terms: D000328:Adult; D065635:Benign Paroxysmal Positional Vertigo; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000379:methods; D026741:Physical Therapy Modalities; D011187:Posture / Q000502:physiology; D012665:Semicircular Canals / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D014717:Vertigo / Q000175:diagnosis / Q000534:rehabilitation*; D055815:Young Adult
keywords: BPPV; CRP; Epley; canalith repositioning maneuver; systematic review; vertigo