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Vestibular rehabilitation is a widely used treatment for vestibular dysfunction. It can improve dizziness, fall risk, balance, and emotional status. However, some patients do not get benefit from vestibular rehabilitation. In this study, the authors assessed the impact of dizziness on patients’ quality of life. They also aimed to determine the factors associated with the outcome of physical-therapist-supervised vestibular rehabilitation in patients with peripheral vestibular disorders. The authors conducted a retrospective study including 47 patients with a diagnosis of peripheral vestibular dysfunction. These patients underwent vestibular rehabilitation by a physical therapist, lasting 40 minutes once a week for four weeks. The patients also performed a home programme three times a day for 10 minutes each, everyday. Dizziness handicap inventory (DHI), timed up-and-go test (TUG), dynamic gait index (DGI), functional gait assessment (FGA), activity-specific balance confidence scale (ABC scale), and hospital anxiety and depression scale (HADS) were measured before and after the intervention. Although there was significant improvement in the overall outcomes of the various scales, not all patients showed improvement. Some patients’ conditions worsened or remained unchanged. Age, sex and time from onset of dizziness were not associated with improvement in DHI. Only balance confidence (ABC score) was associated with an improvement in DHI. The authors acknowledged several limitations of their study. Generalisability of their results might be limited as it was a small single institution study. Since the rehabilitation was short at four weeks, some of the worse performing patients might have needed more time to show an improvement. Clinicians should therefore assess psychological aspects, particularly confidence in balance, as this seems to impact on outcome of vestibular rehabilitation. In these patients, cognitive behavioural therapy (CBT) or other psychological interventions may be a consideration.

Factors affecting the outcome of vestibular rehabilitation in patients with peripheral vestibular disorders.
Ogihara H, Kamo T, Tanaka R, et al.
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Praneta Kulloo

Lewisham and Greenwich NHS Trust, UK.

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