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

Abstract

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.

Navigating unsteady ground: vestibular rehabilitation in postural perceptual positional dizziness: A narrative review

“…Within three months, significant improvements were observed in anxiety levels, quality of life, depression, and dizziness handicap inventory [15]. Preliminary results suggest that this type of therapy may be even more effective than hospital-based vestibular rehabilitation and could potentially be considered as a treatment option for PPPD [15].…”

“…However, the journey to integrate vestibular rehabilitation into the management of PPPD is not without complexities [8]. The diagnosis of PPPD often requires meticulous exclusion of other vestibular and medical conditions.…”

“…The diagnosis of PPPD often requires meticulous exclusion of other vestibular and medical conditions. Additionally, the personalized and multidimensional nature of PPPD symptoms calls for a nuanced approach to rehabilitation [6][7][8].…”

“…Recently, a pilot study was conducted in Malaysia to compare the effects of home-based vestibular rehabilitation therapy in patients with PPPD. The participants were monitored at 4 and 12 weeks after the start of therapy using dizziness handicap scores, DASS-21 scores, and quality of life assessments with EQ-5D VAS scores [15]. Within three months, significant improvements were observed in anxiety levels, quality of life, depression, and dizziness handicap inventory [15].…”

“…The participants were monitored at 4 and 12 weeks after the start of therapy using dizziness handicap scores, DASS-21 scores, and quality of life assessments with EQ-5D VAS scores [15]. Within three months, significant improvements were observed in anxiety levels, quality of life, depression, and dizziness handicap inventory [15]. Preliminary results suggest that this type of therapy may be even more effective than hospital-based vestibular rehabilitation and could potentially be considered as a treatment option for PPPD [15].…”