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There are conflicting results in the literature about home-based vestibular rehabilitation training (VRT) as opposed to physiotherapist-led training. A randomised controlled trial was designed to interrogate this further. The primary aim was to assess “the effects of a booklet-based exercise program that is individually adapted by a physiotherapist”, compared to issuing the booklet to patients to get on with the exercises themselves. Seventy-four adult patients, the majority aged between 60 years and 79 years, with “chronic dizziness, vertigo, and balance problems (>3 month) due to peripheral (uni- or bilateral hypofunction – 90% of patients) or central vestibular (brainstem, cerebellum) disorders” were included. The vestibular disorders excluded were episodic disorders such as vestibular migraine, Meniere’s and BPPV. After an initial assessment, T0, participants were randomised into two equal groups of 37 subjects: intervention group (directed by physiotherapist – PT) who received specific instructions based on the booklet for 60 minutes, and the self-directed group who received no specific instructions, served as controls. All participants were required to perform the exercises for 20 minutes twice a day. Patients were assessed at four weeks (T1) and after another four weeks (T2) of exercises. The primary outcome measure used was the German version of the Dizziness Handicap Inventory (DHI). Secondary outcome measures used the Visual Analogue Scale for dizziness and balance (VAS), Activity-Specific Balance Confidence scale (ABC), Vestibular Activity and Participation Questionnaire (VAP), instrumented static posturography, the Timed-up-and-Go test (TUG), the Falls Efficacy Scale (FES-I), the therapy diary, the Problematic Experiences of Therapy Scale (PETS), and the accuracy scales. In both groups, there was significant improvement in all subsections (physical, emotional and functional) of DHI scores at T1 and further improvement at T2. But the improvement was greater in the intervention group at T2 (DHI-e: p = 0.016; DHI-f: p = 0.042). In the majority of the secondary outcome measures, although both groups got better, the improvement was greater in the intervention group. The authors concluded that “a single intervention by an experienced physiotherapist might be sufficient to optimise the efficiency of the home-care program” of VRT. Many clinicians will agree with this conclusion. However, it is worth noting that the control group also improved significantly at follow-up and so, in my view, a self-directed booklet based VRT should not be discounted altogether and may be better than nothing where there is scarcity of trained vestibular physiotherapists.

Specific and individualized instructions improve the efficacy of booklet-based vestibular rehabilitation at home – a randomized controlled trial (RCT).
Kellerer S, Amberger T, Schlick C, et al.
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Victor Osei-Lah

Bournemouth, UK.

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