Effectiveness of Primary Care–Based Vestibular Rehabilitation for Chronic Dizziness

19 October 2004 | Volume 141 Issue 8 | Pages 598-605

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.

Design: Single-blind randomized, controlled trial.

Setting: 20 general practices in southern England.

Patients: 170 adult patients with chronic dizziness who were randomly assigned to vestibular rehabilitation (n = 83) or usual medical care (n = 87).

Intervention: 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.

Measurements: 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]).

Limitations: 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.

Editors' Notes Context Chronic dizziness is a common and difficult to manage symptom among primary care patients. Vestibular rehabilitation exercises improve symptoms in some patients, but primary care settings infrequently use this treatment. Contribution The authors randomly assigned patients to a 30- to 40-minute session during which a nurse in a primary care setting taught them vestibular exercises or to a control group. Patients assigned to the nurse intervention had significantly greater improvement in dizziness symptoms than patients in the control group. Implications Nurse-delivered vestibular rehabilitation is a feasible and effective treatment option for primary care patients with chronic dizziness. –The Editors

 

Author and Article Information

From University of Southampton, Southampton; Brighton and Sussex Medical School, Brighton; and Imperial College London, London, United Kingdom.

Note: This trial is registered as ISRCTN63019017 on the metaRegister of Controlled Trials, National Health Service Research and Development Regional Programmes.

Acknowledgments: The authors thank Dr. John Beasley, who ensured that the generalizability of these findings was not lost because of international differences in health care delivery and terminology.

Grant Support: By grant SEO 083 from the Directorate of Health and Social Care South, London, United Kingdom.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Lucy Yardley, PhD, School of Psychology, University of Southampton, Highfield, Southampton SO17 1BK, United Kingdom; e-mail, L.Yardley{at}soton.ac.uk.

Current Author Addresses: Dr. Yardley and Ms. Donovan-Hall: School of Psychology, University of Southampton, Highfield, Southampton SO17 1BJ, United Kingdom.

Dr. Smith: Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Falmer, Brighton BN1 9PH, United Kingdom.

Dr. Walsh: School of Nursing and Midwifery, University of Southampton, Highfield, Southampton, SO17 1BJ, United Kingdom.

Mr. Mullee: Medical Statistics, Health Care Research Unit and Southampton Statistical Sciences Research Institute, University of Southampton, Highfield, Southampton SO17 1BJ, United Kingdom.

Dr. Bronstein: Division of Neuroscience and Psychological Medicine, Imperial College, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, United Kingdom.

Author Contributions: Conception and design L. Yardley, M. Donovan-Hall, H.E. Smith, B.M. Walsh.

Analysis and interpretation of data: L. Yardley, M. Donovan-Hall, H.E. Smith, M. Mullee, A.M. Bronstein.

Drafting of the article: L. Yardley, B.M. Walsh, M. Mullee, A.M. Bronstein.

Critical revision of the article for important intellectual content: L. Yardley, M. Donovan-Hall, H.E. Smith, B.M. Walsh, A.M. Bronstein.

Final approval of the article: L. Yardley, M. Donovan-Hall, H.E. Smith, B.M. Walsh, M. Mullee.

Provision of study materials or patients: L. Yardley, H.E. Smith.

Statistical expertise: L. Yardley, M. Mullee.

Obtaining of funding: L. Yardley, H.E. Smith, B.M. Walsh.

Administrative, technical or logistic support: L. Yardley, M. Donovan-Hall.

Collection and assembly of data: L. Yardley, M. Donovan-Hall.

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