Reducing the burden of dizziness in middle-aged and older people: A multifactorial, tailored, single-blind randomized controlled trial

Abstract

BackgroundDizziness is common among older people and is associated with a cascade of debilitating symptoms, such as reduced quality of life, depression, and falls. The multifactorial aetiology of dizziness is a major barrier to establishing a clear diagnosis and offering effective therapeutic interventions. Only a few multidisciplinary interventions of dizziness have been conducted to date, all of a pilot nature and none tailoring the intervention to the specific causes of dizziness. Here, we aimed to test the hypothesis that a multidisciplinary dizziness assessment followed by a tailored multifaceted intervention would reduce dizziness handicap and self-reported dizziness as well as enhance balance and gait in people aged 50 years and over with dizziness symptoms.Methods and findingsWe conducted a 6-month, single-blind, parallel-group randomized controlled trial in community-living people aged 50 years and over who reported dizziness in the past year. We excluded individuals currently receiving treatment for their dizziness, those with degenerative neurological conditions including cognitive impairment, those unable to walk 20 meters, and those identified at baseline assessment with conditions that required urgent treatment. Our team of geriatrician, vestibular neuroscientist, psychologist, exercise physiologist, study coordinator, and baseline assessor held case conferences fortnightly to discuss and recommend appropriate therapy (or therapies) for each participant, based on their multidisciplinary baseline assessments. A total of 305 men and women aged 50 to 92 years (mean [SD] age: 67.8 [8.3] years; 62% women) were randomly assigned to either usual care (control; n = 151) or to a tailored, multifaceted intervention (n = 154) comprising one or more of the following: a physiotherapist-led vestibular rehabilitation programme (35% [n = 54]), an 8-week internet-based cognitive-behavioural therapy (CBT) (19% [n = 29]), a 6-month Otago home-based exercise programme (24% [n = 37]), and/or medical management (40% [n = 62]). We were unable to identify a cause of dizziness in 71 participants (23% of total sample). Primary outcome measures comprised dizziness burden measured with the Dizziness Handicap Inventory (DHI) score, frequency of dizziness episodes recorded with monthly calendars over the 6-month follow-up, choice-stepping reaction time (CSRT), and gait variability. Data from 274 participants (90%; 137 per group) were included in the intention-to-treat analysis. At trial completion, the DHI scores in the intervention group (pre and post mean [SD]: 25.9 [19.2] and 20.4 [17.7], respectively) were significantly reduced compared with the control group (pre and post mean [SD]: 23.0 [15.8] and 21.8 [16.4]), when controlling for baseline scores (mean [95% CI] difference between groups [baseline adjusted]: −3.7 [−6.2 to −1.2]; p = 0.003). There were no significant between-group differences in dizziness episodes (relative risk [RR] [95% CI]: 0.87 [0.65 to 1.17]; p = 0.360), CSRT performance (mean [95% CI] difference betwe...

The contributions of physical activity and fitness for the optimal health and wellness of the elderly people

“…The importance of Physical activity are many as it diminishes the risk of various non-communicable and chronic health conditions, which includes heart disease, hypertension, type 2 diabetes, colon, post-menopausal breast and endometrial cancers, stroke, osteoporosis, osteoarthritis, depression, falls and disability in the elderly people 12,14,16,17,19,[21][22][23][24]26,[30][31][32][33][34][35][36][37][38] . From the extant review, it is therefore concluded that physical activities have numerous advantages for the prevention and management of many health-related conditions been faced by the elderly people.…”

“…A study on the Interventions to Prevent Falls in Older Adults revealed that exercise is associated with fewer people experiencing a fall and a reduced number of injurious falls in averageand high-risk older adults 31 . Furthermore, a multifactorial tailored approach (which included physical exercise) for treating dizziness (a risk factor for falls in elderly people) was effective in reducing dizziness handicap in community-living people aged 50 years and older 32 . Exercise decreases the risk of falls among elderly people with Alzheimer's disease using antihypertensive and psychotropic drugs 33 .…”

Lifestyle Management for Vestibular Disorders

“…Vestibular rehabilitation treatment (VRT) has been found to be an effective and safe treatment for certain vestibular disorders such as unilateral peripheral vestibular impairment and vestibular migraine, however not effective for other disorders such as Ménière's disease (McDonnell & Hillier, 2015;Vitkovic, Winoto, Rance, Dowell, & Pain, 2013). A systematic review of vestibular rehabilitation techniques for people with unilateral vestibular hypofunction found outcomes are typically reported in patient's functional ability to ambulate or their selfperceived handicap from dizziness (Arnold, Stewart, Moor, Karl, & Reneker, 2017 (Naber et al, 2011;Menant et al, 2018). Studies specifically addressing the management of lifestyle factors are limited.…”

Computerized clinical decision system and mobile application with expert support to optimize management of vertigo in primary care: study protocol for a pragmatic cluster-randomized controlled trial

“…A two-sided t-test for independent groups with an effect size of 0.3, an alpha of 0.05 and beta of 0.20 (power = 80%) results in a sample size of n = 352 individuals. The inclusion of 10 patients per cluster was assumed with a drop-out rate of 10%, which corresponds to the drop-out rate of similar studies [28,29]. Therefore, the inclusion of nine patients per cluster was assumed.…”