Effectiveness of Nurse-Delivered Instruction in Special Exercises for Patients with Chronic Dizziness

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The summary below is from the full report titled "Effectiveness of Primary Care–Based Vestibular Rehabilitation for Chronic Dizziness." It is in the 19 October 2004 issue of Annals of Internal Medicine (volume 141, pages 598-605). The authors are L. Yardley, M. Donovan-Hall, H.E. Smith, B.M. Walsh, M. Mullee, and A.M. Bronstein.

What is the problem and what is known about it so far?

Chronic dizziness is a common and very troubling symptom. More than 1 of every 5 people older than 60 years of age has sought medical care, taken medication, or limited their activity because of dizziness. Most often, chronic dizziness is due to vestibular disorders, which are problems in the inner ear that affect balance. While these disorders are bothersome, they are not serious. Serious heart or nerve problems are rarely the cause of chronic dizziness. Doctors typically treat patients who have chronic dizziness with medications and reassurance. The medications do not help all patients. Another form of treatment for chronic dizziness is called vestibular rehabilitation and involves special exercises. The exercises include a series of eye, head, and body movements that stimulate the balance system and help it to compensate for the problem causing the dizziness. Unfortunately, research on the effectiveness of vestibular rehabilitation has been limited. Primary care doctors rarely use it to treat patients with chronic dizziness.

Why did the researchers do this particular study?

To determine whether patients who saw primary care doctors because of chronic dizziness would have greater symptom improvement with vestibular rehabilitation than with usual care (medications and reassurance).

Who was studied?

170 adults with more than 2 months of dizziness who saw a doctor in 1 of 20 primary care practices in the United Kingdom.

How was the study done?

The researchers assigned patients to receive either usual care (medications and reassurance) from their doctors or vestibular rehabilitation. Vestibular rehabilitation involved a 30- to 40-minute appointment with a nurse. The nurse taught the patient how to do daily exercises at home and gave them a booklet that provided additional information about dizziness and the exercises. At the start of the study and 3 and 6 months later, the researchers asked patients to complete a standard questionnaire about dizziness symptoms and examined them to look for evidence of balance problems. Information about the exercises can be found in the appendices.

What did the researchers find?

At both 3 and 6 months, patients who received vestibular rehabilitation were more likely to have improvements in dizziness than were patients who received usual care.

What were the limitations of the study?

The effectiveness of the treatment may depend on the skill of the nurse and the motivation of the patient.

What are the implications of the study?

Vestibular rehabilitation helps patients with chronic dizziness. This treatment can be provided by properly trained nurses in primary care practices.