Acceptance and commitment therapy combined with vestibular rehabilitation for persistent postural-perceptual dizziness: A pilot study

Kuwabara, Junya; Kondo, Masaki; Kabaya, Kayoko; Watanabe, Wakako; Shiraishi, Nao; Sakai, Masaaki; Toshishige, Yuko; Ino, Keiko; Nakayama, Meiho; Iwasaki, Shinichi; Akechi, Tatsuo

doi:10.1016/j.amjoto.2020.102609

Cited by 29 publications

(12 citation statements)

References 25 publications

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“…Treatment effects for dizziness handicap were clinically meaningful and a larger proportion of the intervention group achieved a reliable improvement (60%) vs. the control group (35%). Although these treatment effects cannot be taken as evidence for efficacy, they compare favourably to similar published studies [ 1 , 22 – 24 , 31 ]. However, given the small sample size uncertainty in these estimates was considerable.…”

Section: Discussionsupporting

confidence: 67%

“…Due to their similarities, there has been a desire to combine CBT and VRT for a long time [ 4 , 36 , 44 ], but no theory-driven, evidence-based intervention with a standardised treatment manual currently exists. To date there are only a few case reports and pilot studies [ 1 , 22 – 24 , 31 ]. Moreover, previous trials do not test interventions against current best practice.…”

Section: Introductionmentioning

confidence: 99%

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The INVEST trial: a randomised feasibility trial of psychologically informed vestibular rehabilitation versus current gold standard physiotherapy for people with Persistent Postural Perceptual Dizziness

et al. 2022

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Background Persistent postural perceptual dizziness (PPPD) is a common and disabling functional neuro-vestibular disorder. We aimed to determine the feasibility and acceptability of conducting a randomised controlled trial of cognitive-behavioural therapy informed vestibular rehabilitation (INVEST intervention) designed for persistent dizziness. Methods A two-armed parallel groups randomised feasibility study of INVEST vs. a time-matched gold standard vestibular rehabilitation (VRT) control. Participants with PPPD were recruited from a specialist vestibular clinic in London, UK. Participants were individually randomised using a minimisation procedure with allocation concealment. Measures of feasibility and clinical outcome were collected and assessed at 4 months. Results Forty adults with PPPD were randomised to six sessions of INVEST (n = 20) or gold standard VRT (n = 20). Overall, 59% of patients screened met the inclusion criteria, of which 80% enrolled. Acceptability of INVEST, as assessed against the theoretical framework of acceptability (TFA), was excellent and 80% adhered to all 6 sessions. There were small to moderate treatment effects in favour of INVEST across all measures, including dizziness handicap, negative illness perceptions, symptom focussing, fear avoidance, and distress (standardised mean difference [SMD]g = 0.45; SMDg = 0.77; SMDg = 0.56; SMDg = 0.50, respectively). No intervention-related serious adverse events were reported. Conclusions The study results give strong support for the feasibility of a full-scale trial. Both arms had high rates of recruitment, retention, and acceptability. There was promising support of the benefits of integrated cognitive-behavioural therapy-based vestibular rehabilitation compared to gold standard vestibular rehabilitation. The study fulfilled all the a-priori criteria to advance to a full-scale efficacy trial. Trial registration number ISRCTN10420559.

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Section: Discussionsupporting

confidence: 67%

Section: Introductionmentioning

confidence: 99%

The INVEST trial: a randomised feasibility trial of psychologically informed vestibular rehabilitation versus current gold standard physiotherapy for people with Persistent Postural Perceptual Dizziness

et al. 2022

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“…54 In a feasibility pre-post study, the majority of participants with PPPD (74%) reported remission and/or good treatment response following 6 months of ACT with vestibular rehabilitation. 55…”

Section: Posttraumatic Headachementioning

confidence: 99%

Neuropsychiatric Treatment for Mild Traumatic Brain Injury: Nonpharmacological Approaches

et al. 2022

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Postconcussive symptoms following mild traumatic brain injury (mTBI)/concussion are common, disabling, and challenging to manage. Patients can experience a range of symptoms (e.g., mood disturbance, headaches, insomnia, vestibular symptoms, and cognitive dysfunction), and neuropsychiatric management relies heavily on nonpharmacological and multidisciplinary approaches. This article presents an overview of current nonpharmacological strategies for postconcussive symptoms including psychoeducation; psychotherapy; vestibular, visual, and physical therapies; cognitive rehabilitation; as well as more novel approaches, such as neuromodulation. Ultimately, treatment and management of mTBI should begin early with appropriate psychoeducation/counseling, and be tailored based on core symptoms and individual goals.

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“…1,8 Treatment recommendations for PPPD include vestibular rehabilitation therapy (VRT) with or without medications such as selective serotonin reuptake inhibitors (SSRI) and cognitive behavioral therapy (CBT). [1][2][3]5,[9][10][11] VRT is a program with graded exercises, consisting of eye, head, and body movements designed to stimulate the vestibular system. 8 The goals of these movements are to enhance gaze stability, improve postural stability, manage the vertigo symptoms and improve activities of daily living.…”

Section: Introductionmentioning

confidence: 99%

Home-based Vestibular Rehabilitation: A Feasible and Effective Therapy for Persistent Postural Perceptual Dizziness (A Pilot Study)

Teh

Abdullah

Kamaruddin

et al. 2022

Ann Otol Rhinol Laryngol

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Introduction: Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder where there is persistent dizziness or unsteadiness occurring on most days for more than 3 months duration. Treatment recommendations for PPPD include vestibular rehabilitation therapy (VRT) with or without medications and/or cognitive behavioral therapy. Objectives: This paper is a pilot study designed to compare the effects of Bal Ex as a home-based VRT on the quality of life (EQ-5D), dizziness handicap (DHI) and mental health (DASS-21) against hospital-based VRT. Design: This was an assessor-blinded, randomized controlled pilot study where PPPD patients were randomly selected to undergo Bal Ex, the home-based VRT (intervention group) or hospital-based (control group) VRT. The participants were reviewed at 4 weeks and 12 weeks after the start of therapy to assess the primary endpoints using the subjective improvement in symptoms as reported by patients, changes in DHI scores, DASS-21 scores and EQ5D VAS scores. Results: Thirty PPPD patients successfully completed the study with 15 in each study group. Within 4 weeks, there were significant improvements in the total DHI scores as well as anxiety levels. By the end of 12 weeks, there were significant improvements in the DHI, DASS-21 and EQ5D. The degree of improvement between Bal Ex and the control was comparable. Conclusion: VRT is an effective modality in significantly improving quality of life, dizziness handicap, depression, and anxiety levels within 3 months in PPPD. Preliminary results show Bal Ex is as effective as hospital-based VRT and should be considered as a treatment option for PPPD.

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Acceptance and commitment therapy combined with vestibular rehabilitation for persistent postural-perceptual dizziness: A pilot study

Cited by 29 publications

References 25 publications

The INVEST trial: a randomised feasibility trial of psychologically informed vestibular rehabilitation versus current gold standard physiotherapy for people with Persistent Postural Perceptual Dizziness

The INVEST trial: a randomised feasibility trial of psychologically informed vestibular rehabilitation versus current gold standard physiotherapy for people with Persistent Postural Perceptual Dizziness

Neuropsychiatric Treatment for Mild Traumatic Brain Injury: Nonpharmacological Approaches

Home-based Vestibular Rehabilitation: A Feasible and Effective Therapy for Persistent Postural Perceptual Dizziness (A Pilot Study)

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