Effectiveness of Primary Care–Based Vestibular Rehabilitation for Chronic Dizziness

  1. Lucy Yardley, PhD;
  2. Margaret Donovan-Hall, MSc;
  3. Helen E. Smith, BSMS, DM;
  4. Bronagh M. Walsh, RN, PhD;
  5. Mark Mullee, MSc, CStat; and
  6. Adolfo M. Bronstein, FRCP, PhD
  1. From University of Southampton, Southampton; Brighton and Sussex Medical School, Brighton; and Imperial College London, London, United Kingdom.

    Abstract

    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.

    Article and Author Information

    • 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.

    Responses to this article

    • IN RESPONSE
      • Lucy Yardley and
      • on behalf of all co-authors
      Ann Intern Med published online October 26, 2009
    • "Treating" Controls in Unblinded Trials
      • Paul S. Heckerling
      Ann Intern Med published online October 26, 2009

    Summary for Patients

    • Summaries for Patients:Effectiveness of Nurse-Delivered Instruction in Special Exercises for Patients with Chronic Dizziness Ann Intern Med October 19, 2004 141:I-48
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    This Article

    1. Ann Intern Med October 19, 2004 vol. 141 no. 8 598-605
    1. » Abstract
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