Vestibular rehabilitation for unilateral peripheral vestibular dysfunction

Susan L Hillier; Michelle McDonnell

doi:10.1002/14651858.CD005397.pub2

Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados
Guías
Temas

Revisiones y protocolos relacionados

Topics

Temas

Figure 1

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.1

Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 1 Romberg test.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 2 Gait ataxia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 3 Subjective improvement in dizziness.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.4

Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 4 VD‐ADL (physical).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.5

Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 5 Sway path.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.6

Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 6 Dynamic visual acuity.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.7

Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 7 Vestibular symptom scale.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.8

Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 8 Vestibular handicap questionnaire.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.9

Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 9 Sharpened Romberg test (scores).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.10

Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 10 Vertigo intensity.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.11

Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 11 Posturography.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.12

Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 12 Vertigo intensity (BD vs sham).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.13

Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 13 Dizziness Handicap Inventory.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.14

Comparison 1 Vestibular rehabilitation versus control/placebo, Outcome 14 Dynamic Gait Index.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.1

Comparison 2 Vestibular rehabilitation versus other, Outcome 1 Subjective improvement in dizziness.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.2

Comparison 2 Vestibular rehabilitation versus other, Outcome 2 Dizziness cure rate.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.3

Comparison 2 Vestibular rehabilitation versus other, Outcome 3 Vertigo intensity (BD vs CRM).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.4

Comparison 2 Vestibular rehabilitation versus other, Outcome 4 Vertigo intensity (XS vs CRM).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.5

Comparison 2 Vestibular rehabilitation versus other, Outcome 5 Dizziness Handicap Inventory.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.6

Comparison 2 Vestibular rehabilitation versus other, Outcome 6 Dynamic Gait Index.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.1

Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 1 Repetitive head movement task.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.2

Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 2 Vertigo VAS.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.3

Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 3 Romberg test (eyes closed).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.4

Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 4 Tandem walk.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.5

Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 5 Posturography.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.6

Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 6 Vertigo symptom scale (vertigo component).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.7

Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 7 Dizziness Handicap Inventory.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.8

Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 8 Subjective improvement in dizziness.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.9

Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 9 Vertigo intensity.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.10

Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 10 Vertigo frequency.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.11

Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 11 Vertigo handicap questionnaire.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.12

Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 12 Ataxia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.13

Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 13 Vestibular disorders ‐ activities of daily living scale.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.14

Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 14 Posturography (Equitest composite).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.15

Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 15 Vertigo Symptom Scale (vertigo short form).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.16

Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 16 Subjective health.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.17

Comparison 3 Vestibular rehabilitation versus other form of vestibular rehabilitation, Outcome 17 Dizziness Handicap Inventory.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Table 1. Unilateral peripheral vestibulopathies

Vestibulopathy	Incidence	Aetiology	Symptoms	Diagnosis	Treatment
Benign paroxysmal positional vertigo (BPPV) (idiopathic) (Hilton 2004)	All age groups Peak 40 to 60 years 11 to 64 per 100,000 pa Females > males	Various: Canalithiasis (free‐floating debris in semicircular canals) Cupulolithiasis (debris attached to cupula)	Episodic vertigo after rapid head motion, lasting seconds to 1 min; +/‐ nausea; some balance deficits; nystagmus (latency, fatigue, rotatory and beating)	Dix‐Hallpike test (post) (Dix 1952) Lateral head‐trunk tilt (Brandt 1999) etc Use of ENG to record nystagmus	1. Repositioning manoeuvre/s relative to semicircular canal (Epley 1992, Semont 1988) 2. VR 3. Vestibular suppressant medication for symptom relief 4. Vestibular Neurectomy or post‐semicircular canal obliteration
Vestibular neuritis (Gans 2002)/neuronitis and labyrinthitis (Strupp 1998)	Unknown	Unclear Viral, auto‐immune or vascular mechanisms Viral or bacterial infection of labyrinthine fluids (labyrinthitis) or CN VIII (neuritis)	Acute onset Distressing tonal imbalance producing: rotatory vertigo; spontaneous nystagmus (horizontal); falls to the affected side; nausea	From history and presentation ENG and caloric irrigation show reduced or no response in horizontal semicircular canal; ocular tilt reaction	Symptomatic medication (vestibular suppressants) Bacterial/viral management VR
Ménière's disease (Scott 1994)	Unknown Equal males and females Greatest in 3rd and 4th decades	Unclear Endolymphatic hydrops	Acute: unpredictable and episodic Hearing loss, tinnitus and vertigo, +/‐ nausea, vomiting, visual disturbance, anxiety, motion sensitivity Chronic: UPVD or bilateral PVD	History and presentation Audiogram ENG with calorics	Acute: medication (antihistamines, suppressants) diet; low salt; diuretics Chronic: VR, psychological support, surgery (see next row)
Postoperative: Labyrinthectomy Neurectomy Intra‐tympanic injection of gentamycin	Unknown	For management of intractable UPVD, tumour removal, Ménière's	UPVD, i.e. spontaneous nystagmus, vertigo, disequilibrium, VOR gain, postural instability	—	VR Symptomatic medication (Dowdal‐Osborn 2002)
Perilymphatic fistula (Baloh 2003)	Unknown	History of head trauma, barotraumas or sudden strain; may be associated with chronic otitis or cholesteatoma; perforation of tympanic membrane	Unilateral hearing loss, vertigo, nystagmus	Induce symptoms by pressure in external ear canal Positive head thrust ENG Audiography	Symptomatic medication Surgical packing
ENG = electronystagmography pa = per year UPVD = unilateral peripheral vestibular disorder VOR = vestibular ocular reflex VR = vestibular rehabilitation

Table 1. Unilateral peripheral vestibulopathies

Ir a la tabla de la revisión

Comparison 1. Vestibular rehabilitation versus control/placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Romberg test Show forest plot	1	19	Odds Ratio (M‐H, Fixed, 95% CI)	2.7 [0.33, 21.98]

2 Gait ataxia Show forest plot	1	19	Odds Ratio (M‐H, Fixed, 95% CI)	0.04 [0.00, 0.77]

3 Subjective improvement in dizziness Show forest plot	4	565	Odds Ratio (M‐H, Fixed, 95% CI)	2.67 [1.85, 3.86]

4 VD‐ADL (physical) Show forest plot	1	16	Std. Mean Difference (IV, Fixed, 95% CI)	‐2.71 [‐4.17, ‐1.25]

5 Sway path Show forest plot	1	39	Std. Mean Difference (IV, Fixed, 95% CI)	‐2.94 [‐3.87, ‐2.01]

6 Dynamic visual acuity Show forest plot	1	21	Odds Ratio (M‐H, Fixed, 95% CI)	84.0 [4.51, 1564.26]

7 Vestibular symptom scale Show forest plot	3	553	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.68 [‐0.87, ‐0.49]

8 Vestibular handicap questionnaire Show forest plot	1	143	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.33 [‐0.66, 0.00]

9 Sharpened Romberg test (scores) Show forest plot	1	143	Std. Mean Difference (IV, Fixed, 95% CI)	0.35 [0.02, 0.68]

10 Vertigo intensity Show forest plot	1	31	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.06 [‐0.76, 0.64]

11 Posturography Show forest plot	1	31	Std. Mean Difference (IV, Fixed, 95% CI)	0.09 [‐0.61, 0.80]

12 Vertigo intensity (BD vs sham) Show forest plot	1	50	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.43 [‐0.99, 0.13]

13 Dizziness Handicap Inventory Show forest plot	4	491	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.80 [‐1.00, ‐0.60]

14 Dynamic Gait Index Show forest plot	2	93	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.92 [‐1.38, ‐0.46]

Comparison 1. Vestibular rehabilitation versus control/placebo

Ir a la tabla de la revisión

Comparison 2. Vestibular rehabilitation versus other

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Subjective improvement in dizziness Show forest plot	1	21	Odds Ratio (M‐H, Fixed, 95% CI)	4.0 [0.30, 53.47]

2 Dizziness cure rate Show forest plot	1	71	Odds Ratio (M‐H, Fixed, 95% CI)	0.13 [0.03, 0.51]

3 Vertigo intensity (BD vs CRM) Show forest plot	1	49	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.10 [‐0.66, 0.47]

4 Vertigo intensity (XS vs CRM) Show forest plot	2	75	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.16 [‐0.61, 0.30]

5 Dizziness Handicap Inventory Show forest plot	1	28	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [‐0.74, 0.74]

6 Dynamic Gait Index Show forest plot	1	26	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.87 [‐1.69, ‐0.06]

Comparison 2. Vestibular rehabilitation versus other

Ir a la tabla de la revisión

Comparison 3. Vestibular rehabilitation versus other form of vestibular rehabilitation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Repetitive head movement task Show forest plot	1	51	Std. Mean Difference (IV, Fixed, 95% CI)	0.45 [‐0.19, 1.09]

2 Vertigo VAS Show forest plot	1	54	Std. Mean Difference (IV, Fixed, 95% CI)	0.22 [‐0.32, 0.75]

3 Romberg test (eyes closed) Show forest plot	1	54	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.45 [‐0.99, 0.09]

4 Tandem walk Show forest plot	1	54	Std. Mean Difference (IV, Fixed, 95% CI)	0.25 [‐0.29, 0.79]

5 Posturography Show forest plot	1	40	Std. Mean Difference (IV, Fixed, 95% CI)	0.06 [‐0.56, 0.68]

6 Vertigo symptom scale (vertigo component) Show forest plot	1	40	Std. Mean Difference (IV, Fixed, 95% CI)	1.12 [0.45, 1.80]

7 Dizziness Handicap Inventory Show forest plot	1	14	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.62 [‐1.72, 0.47]

8 Subjective improvement in dizziness Show forest plot	1	14	Odds Ratio (M‐H, Fixed, 95% CI)	8.27 [0.35, 197.61]

9 Vertigo intensity Show forest plot	1	35	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.34 [‐1.03, 0.35]

10 Vertigo frequency Show forest plot	1	35	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.08 [‐0.77, 0.61]

11 Vertigo handicap questionnaire Show forest plot	1	35	Std. Mean Difference (IV, Fixed, 95% CI)	0.40 [‐0.29, 1.09]

12 Ataxia Show forest plot	1	35	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.38 [‐1.07, 0.31]

13 Vestibular disorders ‐ activities of daily living scale Show forest plot	1	35	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.22 [‐0.90, 0.47]

14 Posturography (Equitest composite) Show forest plot	1	35	Std. Mean Difference (IV, Fixed, 95% CI)	0.07 [‐0.61, 0.76]

15 Vertigo Symptom Scale (vertigo short form) Show forest plot	1	240	Std. Mean Difference (IV, Fixed, 95% CI)	0.04 [‐0.21, 0.30]

16 Subjective health Show forest plot	1	230	Odds Ratio (M‐H, Fixed, 95% CI)	1.0 [0.58, 1.71]

17 Dizziness Handicap Inventory Show forest plot	1	240	Std. Mean Difference (IV, Fixed, 95% CI)	0.08 [‐0.18, 0.33]

Comparison 3. Vestibular rehabilitation versus other form of vestibular rehabilitation

Ir a la tabla de la revisión

The Cochrane Library

Scolaris Language Selector Scolaris Language Selector

Idioma de la Revisión Cochrane

Idioma de la web

Scolaris Content Language Banner Portlet Scolaris Content Language Banner Portlet