Free online vestibular rehabilitation tool 'highly effective' for vertigo symptoms

GPs should consider online vestibular rehabilitation rather than 'excessively prescribed' anti-vertigo medications for patients with chronic vestibular symptoms, say researchers.

Vestibular rehabilitation is not commonly used to treat vertigo, despite being recommended in guidelines. | GETTY IMAGES
Vestibular rehabilitation is not commonly used to treat vertigo, despite being recommended in guidelines. | GETTY IMAGES

An 'easily accessible' 6-week internet-based vestibular rehabilitation course reduces symptoms of vertigo in patients with chronic vestibular syndromes, a study published in the BMJ has shown.

Researchers recruited 322 adults aged ≥50 years with a chronic vestibular syndrome from 59 general practices in The Netherlands. Participants were randomised to receive internet-based vestibular rehabilitation comprising weekly online sessions and daily exercises (10–20 minutes a day), with or without face-to-face physiotherapy support (home visits in weeks 1 and 3), or standard GP care with no restrictions.

The primary outcome was vestibular symptoms after 6 months as assessed by the vertigo symptom scale-short form (VSS-SF). The scale has a range of 0–60, with a score of ≥12 indicating severe symptoms; a difference of ≥3 points is considered clinically significant.

In the intention-to-treat analysis, patients in the internet-only and physiotherapy-supported vestibular rehabilitation groups had lower VSS-SF scores at 6 months than patients in the standard care group (adjusted mean differences −4.1 points [95% CI −5.8 to −2.5] and −3.5 points [95% CI −5.1 to −1.9], respectively).

Similar differences in VSS-SF scores were seen at 3 months (4.3 [95% CI 5.9 to 2.6] and 3.9 [95% CI 5.5 to 2.3] for internet-only and physiotherapy-supported vestibular rehabilitation, respectively, vs standard care).

Simple exercises

Participants in both vestibular rehabilitation groups experienced less dizziness-related impairment, less anxiety, and greater subjective improvement of vestibular symptoms at 3 and 6 months. 'Several participants told us how surprised they were that, after experiencing vestibular symptoms for so many years, such simple exercises could help them,' said the researchers.

No serious adverse events related to online vestibular rehabilitation occurred during the trial. 

The researchers acknowledge that only a small percentage (<10%) of patients who were invited to participate enrolled in the trial, which could represent a selection bias. Those who agreed to participate might have been particularly motivated to use vestibular rehabilitation, which should be taken into account for implementation in daily general practice.

The researchers conclude, however, that 'by providing general practitioners with an easily accessible, low cost form of treatment, online VR [vestibular rehabilitation] has the potential to substantially improve care for a largely undertreated group of patients with a chronic vestibular syndrome in general practice'. 

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