Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review

Regauer, Verena; Seckler, Eva; Müller, Martin; Bauer, Petra

doi:10.1186/s12877-020-01899-9

Cited by 21 publications

(19 citation statements)

References 62 publications

(64 reference statements)

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“…This condition is named presbyvestibulopathy, and recently, strict diagnostic criteria have been published [13] with the aim of ensuring a suitable categorization and homogenization of these patients. At this time, no pharmacological treatment for presbyvestibulopathy is indicated, and a strong body of evidence supports the usefulness of vestibular rehabilitation [14].…”

Section: Introductionmentioning

confidence: 99%

Current Insights into Treating Vertigo in Older Adults

Casani¹,

Gufoni²,

Capobianco³

2021

Drugs Aging

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The number of older people has been increasing over recent decades in Western populations. Dizziness, imbalance, and vertigo constitute some of the most common complaints in older patients, and risk of falling is the most frequent and worrying consequence. It has been reported that 15-20% of the adult population experiences these debilitating symptoms. Among the diseases that may be associated with vertigo, the three classes of otological, central, and functional (psychological) dizziness may be distinguished. Overall, vestibular disorders account for 48% of vertiginous complaints in the older population. The main focus of this article is to review the forms of pharmacotherapy for vertigo, especially with regard to older patients, who may be treated simultaneously with other drugs for different comorbidities. Interactions with other drugs should be considered in the choice of a particular course of treatment. Moreover, overuse of pharmacotherapy for the management of vertigo in the elderly may prevent the development of the central compensatory mechanism that sustains both static and dynamic imbalance after a vertiginous crisis. In the majority of patients, vestibular and physical rehabilitation are strongly advised and rarely contraindicated.

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Section: Introductionmentioning

confidence: 99%

Current Insights into Treating Vertigo in Older Adults

Casani¹,

Gufoni²,

Capobianco³

2021

Drugs Aging

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“…A fall is an obvious and severe outcome of dizziness or loss of balance ( 16 ). The close dependence between musculoskeletal abilities and balance functions are essential in order to allow an active lifestyle with a preserved quality of life ( 16 – 18 ). As a consequence, balance deficits, dizziness, and pain often lead to a decrease in activities of daily living.…”

Section: Introductionmentioning

confidence: 99%

Co-morbidities to Vestibular Impairments—Some Concomitant Disorders in Young and Older Adults

Malmström¹,

Hansson

Hafström

et al. 2021

Front. Neurol.

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Background: Dizziness and pain are common complaints that often appear concomitantly, with or without a causal relationship. However, these symptoms might maintain and exacerbate each other and other co-morbidities. Therefore, adequate rehabilitation may have to include an expanded focus on other deficits and preconditions, especially in older adults and in patients.Objective: To understand how frequently vestibular dysfunction coincided with medical conditions and aging, we studied two categories: Study 1: patients referred to a vestibular unit and Study 2: senior members in a fitness association.Method: Study 1: 49 patients [34 females/15 males; mean age 52 years (SEM 2.0)] seeking health care for balance disorders and vestibular deficits were asked in questionnaires about their perception of dizziness and pain, and emotional and functional strains. Study 2: 101 senior members in a fitness association [91 females/10 males; mean age 75 years (SEM 0.6)], were assessed for vestibular and balance deficits and for any co-morbidities. The participants were monitored for falls for 12 months after the initial assessments.Result: Study 1: Co-morbidity often existed between dizziness and pain (65%). The patients reported high emotional and functional strain related to their dizziness and pain. Patients older than 60 years reported longer durations of pain (p ≤ 0.028) but less emotional strain (p = 0.036), compared to younger patients. Study 2: 84% of the participants had a vestibular impairment, often without noticing any symptoms. Furthermore, 40% reported cardiovascular illnesses, 12% musculoskeletal disorders, and 63% reported other medical conditions. Forty-two percent experienced falls within 1 year after the initial assessments (thereof 42% in the group with vestibular deficits and 38% in the group without vestibular deficits).Conclusion: To enhance and preserve postural control, both in patients with vestibular deficits and in older adults, we suggest an expanded clinical perspective. Hence, we recommend detailed examinations of the vestibular system but simultaneously probing for possible co-morbidities. Since aging often entails deterioration of multimodal processes related to maintained mobility and postural stability, our results add focus on the importance of addressing balance disorders together with additional medical conditions.

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“…The systematic review revealed that for older people, active physical therapy using vestibular rehabilitation, regardless of any variations and in combination with repositioning manoeuvres was most effective [ 24 ]. The second review identified barriers to and facilitators of successful implementation of CPWs within the context, implementation and setting dimensions of Context and Implementation of Complex Interventions (CICI) framework dimensions [ 31 ], which need to be considered in the implementation of CPWs [ 26 ].…”

Section: Results Stepmentioning

confidence: 99%

“…The second review identified barriers to and facilitators of successful implementation of CPWs within the context, implementation and setting dimensions of Context and Implementation of Complex Interventions (CICI) framework dimensions [ 31 ], which need to be considered in the implementation of CPWs [ 26 ]. Detailed results of systematic reviews are published elsewhere [ 24 , 26 ].…”

Section: Results Stepmentioning

confidence: 99%

“…The first step included a synthesis of existing evidence by carrying out two systematic reviews to identify existing evidence. First, a systematic review to identify the quality of evidence of physical therapy interventions addressing mobility and participation in older patients with VDB was conducted [ 24 ]. Due to the heterogeneity of the included studies, a narrative synthesis across all types of interventions was conducted concerning the outcome measures covering aspects of the International Classification of Functioning, Disability and Health (ICF) [ 25 ], quality of life and general health.…”

Section: Step 1: Preparationmentioning

confidence: 99%

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Development of a complex intervention to improve mobility and participation of older people with vertigo, dizziness and balance disorders in primary care: a mixed methods study

et al. 2021

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Background Vertigo, dizziness and balance disorders (VDB) are common in older people and cause restrictions in mobility and social participation. Due to a multifactorial aetiology, health care is often overutilised, but many patients are also treated insufficiently in primary care. The purpose of this study was to develop a care pathway as a complex intervention to improve mobility and participation in older people with VDB in primary care. Methods The development process followed the UK Medical Research Council guidance using a mixed-methods design with individual and group interviews carried out with patients, physical therapists (PTs), general practitioners (GPs), nurses working in community care and a multi-professional expert panel to create a first draft of a care pathway (CPW) and implementation strategy using the Consolidated Framework of Implementation Research and the Expert recommendations for Implementing Change. Subsequently, small expert group modelling of specific components of the CPW was carried out, with GPs, medical specialists and PTs. The Behaviour Change Wheel was applied to design the intervention´s approach to behaviour change. To derive theoretical assumptions, we adopted Kellogg´s Logic Model to consolidate the hypothesized chain of causes leading to patient-relevant outcomes. Results Individual interviews with patients showed that VDB symptoms need to be taken more seriously by GPs. Patients demanded age-specific treatment offers, group sessions or a continuous mentoring by a PT. GPs required a specific guideline for diagnostics and treatment options including psychosocial interventions. Specific assignment to and a standardized approach during physical therapy were desired by PTs. Nurses favoured a multi-professional documentation system. The structured three-day expert workshop resulted in a first draft of CPW and potential implementation strategies. Subsequent modelling resulted in a CPW with components and appropriate training materials for involved health professionals. A specific implementation strategy is now available. Conclusion A mixed-methods design was suggested to be a suitable approach to develop a complex intervention and its implementation strategy. We will subsequently test the intervention for its acceptability and feasibility in a feasibility study accompanied by a comprehensive process evaluation to inform a subsequent effectiveness trial. Trial Registration The research project is registered in “Projektdatenbank Versorgungsforschung Deutschland” (Project-ID: VfD_MobilE-PHY_17_003910; date of registration: 30.11.2017).

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Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review

Cited by 21 publications

References 62 publications

Current Insights into Treating Vertigo in Older Adults

Current Insights into Treating Vertigo in Older Adults

Co-morbidities to Vestibular Impairments—Some Concomitant Disorders in Young and Older Adults

Development of a complex intervention to improve mobility and participation of older people with vertigo, dizziness and balance disorders in primary care: a mixed methods study

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