Vestibular Rehabilitation Affects Vestibular Asymmetry among Patients with Fall-Related Wrist Fractures - A Randomized Controlled Trial

Abstract

Background: Fall-related fractures are an increasing problem for society. Dizziness is identified as a risk factor for falls and vestibular asymmetry is often found among patients with fall-related fractures. An option to prevent fall-related fractures may be to identify patients with vestibular asymmetry and to improve their balance and asymmetry by exercise. Objective: To examine whether vestibular rehabilitation improves vestibular function, balance and self-rated health among patients with fall-related wrist fractures. Methods: Sixty-eight persons (65 women) with fall-related wrist fractures, mean age 72 years (54-89) participated in this randomized controlled trial. The following tests and measurements were performed: head shake test to evaluate vestibular asymmetry as primary outcome measure, five clinical balance measures, a force plate to measure postural sway, a tuning fork to measure vibration and the EQ5D questionnaire to measure self-rated health. The intervention comprised group-based vestibular rehabilitation sessions conducted twice a week for 9 weeks. Results: Nystagmus occurred in the head shake test in 65% (44 of 68) of the patients, indicating vestibular asymmetry. More patients in the intervention group (6 of 21) than in the control group (0 of 23) changed from having nystagmus in the head shake test at baseline (indicating vestibular asymmetry) to not having nystagmus at follow-up, and more patients in the control group (3 of 9) than in the intervention group (0 of 3) changed from not having nystagmus at baseline to have nystagmus at follow-up (p < 0.00). No other changes occurred between the two groups between baseline and follow-up. At baseline, patients with vestibular asymmetry had more balance deficits and increased postural sway compared to patients without (p = 0.00-0.05). Conclusion: Group sessions with vestibular rehabilitation twice a week for 9 weeks affected the occurrence of vestibular asymmetry positively among patients having vestibular asymmetry. Patients with vestibular asymmetry had more balance deficits and increased postural sway than patients without vestibular asymmetry. Vestibular assessment is important, and, in patients with diagnosed vestibular asymmetry, vestibular rehabilitation may prove beneficial on balance and possibly reduce the risk of future falls.

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

“…Thus, our findings underline that exercise therapy has to play a central role in treatment of VDB to support vestibular compensation [55]. VR is also as effective as no intervention in a study [37] when the investigated patients are a specific subgroup with a fall-related wrist fracture and generalisation of the results might be done with care. A further aspect relevant to clinical decisions is that more people in the VR group refrained from participation, so one might conclude that VR group training is less acceptable.…”

“…The sample of the initial literature search comprised 16 studies [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45], the search update revealed 5…”

“…A RCT (n = 85 participants) showed no differences in primary outcomes (tandem standing with eyes open and closed and walking in a modified figure of eight). In secondary outcomes, no differences were reported when measuring SOLEO, SOLEC, 5x-STS, postural sway, vibration sense, head-shake test, EQ5D-VAS and walking variations [37].…”

“…Primary outcome was clearly stated only in 7 studies [34,35,40,42,43,48,49] [34,35,40,42,43,44] [37,41,44,32]. In regard to the GRADE approach, overall risk of bias, indirectness, inconsistency, imprecision and publication bias were assessed, whereas imprecision was ranked down for every study due to a narrative synthesis in this review.…”

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

“…The sample of the initial literature search comprised 16 studies [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45], the search update revealed 5 additional studies [46][47][48][49][50], and one study that was updated due to a new follow-up publication [51]. Thus, the nal sample comprised 22 studies with 1,876 participants.…”