Potential effects of multimodal psychosomatic inpatient treatment for patients with functional vertigo and dizziness symptoms – A pilot trial

Limburg, Karina; Schmid-Mühlbauer, Gabriele; Sattel, Heribert; Dinkel, Andreas; Radziej, Katharina; Gonzales, Melanie; Ronel, Joram; Lahmann, Claas

doi:10.1111/papt.12177

Cited by 12 publications

(6 citation statements)

References 50 publications

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“…However, there are better results when CBT is adapted to target illness-specific factors such as anxiety-related postural behaviour [ 5 ]. There are also promising multidisciplinary programs [ 2 , 25 ], but these can be costly and difficult to replicate. 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.…”

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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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: 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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“…Generally, the studies show a small but clinically relevant effect of CBT concerning dizziness (Edelman et al., 2012; Limburg et al., 2019; Schmid et al., 2011). However, in a one‐year follow‐up of 20 patients with phobic postural vertigo no treatment effect remained after CBT (Holmberg et al., 2007).…”

Section: Introductionmentioning

confidence: 99%

Multimodal treatment of persistent postural–perceptual dizziness

et al. 2020

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“…In therapy-naive patients with chronic vestibular diseases, the baseline handicap explained that most of the variance correlated with the handicap at a 3-month follow-up [ 23 ]. In patients with functional vertigo and dizziness subjected to a multimodal psychosomatic inpatient treatment, the vertigo-related handicap at admission was the only significant predictor of vertigo-related handicap at follow-up [ 14 ]. Additionally, in patients with acute unilateral vestibular neuritis, the initial handicap was found to be associated with a higher handicap after vestibular rehabilitation [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Therapeutic approaches for chronic dizziness/vertigo comprise pharmacotherapy [ 8 , 9 ], vestibular rehabilitation as an exercise-based therapy [ 10 , 11 ], and cognitive–behavioral therapy (CBT) [ 12 ]. In recent years, interdisciplinary multimodal therapy concepts have been developed [ 13 , 14 ] to address multifactorial influences for chronic dizziness/vertigo. One example of a specialized vertigo center is the Center for Vertigo and Dizziness of Jena University Hospital.…”

Section: Introductionmentioning

confidence: 99%

What Predicts Improvement of Dizziness after Multimodal and Interdisciplinary Day Care Treatment?

Prell

Finn

Zipprich

et al. 2022

JCM

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Background: Vertigo and dizziness are common in community-dwelling people and can be treated in specialized multidisciplinary settings. To develop tailored interventions, however, we have to explore risk factors for favorable and unfavorable outcomes. Methods: We prospectively investigated patients with chronic vertigo and dizziness subjected to our 5-day multimodal and interdisciplinary day care treatment in the Center for Vertigo and Dizziness of Jena University Hospital, Germany. The Vertigo Severity Scale (VSS), the Body Sensations Questionnaire (BSQ), the Hospital Anxiety and Depression Scale (HADS), the Agoraphobic Cognitions Questionnaire (ACQ), the Mobility Inventory (MI), and the burden and intensity of dizziness (using a visual analogue scale) were assessed at baseline (n = 754) and after 6 months (n = 444). In addition, 14 Likert-scaled questions were used to quantify the change in personal attitude and behavior towards the complaints after 6 months. Results: Dizziness-related burden and intensity improved with a large effect size. The largest improvement was seen in the attitudes towards dizziness, the understanding of somatic causes, and the perceived ability to influence dizziness. However, the ability to work and to carry out professional activity was improved to a lesser extent. The overall improvement of dizziness was associated with the absence of a depressive mood, a short duration of vertigo, a lower VSS, a lower perceived intensity of vertigo, and distinct vertigo diagnoses, namely Meniere’s disease, vestibular migraine, vestibular neuritis, vestibular paroxysmia, and vestibular schwannoma. Worsening of dizziness/vertigo was associated with depressive symptoms, permanent vertigo, distinct vertigo diagnoses (central vertigo, multisensory deficit), and a higher perceived burden due to vertigo. Conclusion: The six-month outcome of patients with dizziness presented to a specialized outpatient clinic appears to be favorable. Nevertheless, people with the abovementioned risk factors at baseline have less benefit and probably need adapted and tailored vertigo interventions to improve long-term outcome.

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Potential effects of multimodal psychosomatic inpatient treatment for patients with functional vertigo and dizziness symptoms – A pilot trial

Cited by 12 publications

References 50 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

Multimodal treatment of persistent postural–perceptual dizziness

What Predicts Improvement of Dizziness after Multimodal and Interdisciplinary Day Care Treatment?

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