Internet-Based Vestibular Rehabilitation for Older Adults With Chronic Dizziness: A Randomized Controlled Trial in Primary Care

Abstract

PURPOSE Vestibular rehabilitation is an effective intervention for dizziness due to vestibular dysfunction, but is seldom provided. We aimed to determine the effectiveness of an Internet-based vestibular rehabilitation program for older adults experiencing dizziness in primary care. METHODSWe undertook a single-center, single-blind randomized controlled trial comparing an Internet-based vestibular rehabilitation intervention (Balance Retraining, freely available from https://balance.lifeguidehealth.org) with usual primary care in patients from 54 primary care practices in southern England. Patients aged 50 years and older with current dizziness exacerbated by head movements were enrolled. Those in the intervention group accessed an automated Internet-based program that taught vestibular rehabilitation exercises and suggested cognitive behavioral management strategies. Dizziness was measured by the Vertigo Symptom Scale-Short Form (VSS-SF) at baseline, 3 months, and 6 months. The primary outcome was VSS-SF score at 6 months. RESULTS A total of 296 patients were randomized in the trial; 66% were female, and the median age was 67 years. The VSS-SF was completed by 250 patients (84%) at 3 months and 230 patients (78%) at 6 months. Compared with the usual care group, the Internet-based vestibular rehabilitation group had less dizziness on the VSS-SF at 3 months (difference, 2.75 points; 95% CI, 1.39-4.12; P <.001) and at 6 months (difference, 2.26 points; 95% CI, 0.39-4.12; P = .02, respectively). Dizziness-related disability was also lower in the Internet-based vestibular rehabilitation group at 3 months (difference, 6.15 points; 95% CI, 2.81-9.49; P <.001) and 6 months (difference, 5.58 points; 95% CI, 1.19-10.0; P = .01).CONCLUSIONS Internet-based vestibular rehabilitation reduces dizziness and dizziness-related disability in older primary care patients without requiring clinical support. This intervention has potential for wide application in community settings. Ann Fam Med 2017;15:209-216. https://doi.org/10.1370/afm.2070. INTRODUCTIOND izziness is a highly prevalent symptom 1,2 responsible for nearly 7 million consultations per year in the United States. 3 In primary care, the majority of dizziness is caused by vestibular dysfunction, including benign paroxysmal positional vertigo. 4 Dizziness in older adults is associated with falls, fear of falling, anxiety, and depression, contributing to substantial disability, increased frailty, and loss of independence. 5,6 With a growing aging population, the health burden will steadily increase. 7Although dizziness has higher prevalence in older adults, more than 1 in 10 people of working age experience dizziness that causes dysfunction or leads to medical consultations. 8 Often going untreated, dizziness can become chronic; in a recent primary care trial including adults of all ages, the mean duration of symptoms was 5.5 years.9 Medical and surgical interventions offer limited benefit 10 ; however, there is evidence that vestibular rehabilitation exercises are ...

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