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Guided and unguided internet based vestibular rehabilitation versus usual care for dizzy adults of 50 years and older: a protocol for a three armed randomised trial

Guided and unguided internet based vestibular rehabilitation versus usual care for dizzy adults of 50 years and older: a protocol for a three armed randomised trial
Guided and unguided internet based vestibular rehabilitation versus usual care for dizzy adults of 50 years and older: a protocol for a three armed randomised trial
Introduction:dizziness is a common symptom in general practice with a high prevalence among older adults. The most common cause of dizziness in general practice is peripheral vestibular disease. Vestibular rehabilitation (VR) is a safe and effective treatment for peripheral vestibular disease that entails specific exercises to maximise the central nervous system compensation for the effects of vestibular pathology. An internet-based VR intervention has recently been shown to be safe and effective. Online interventions are low cost and easily accessible, but prone to attrition and non-adherence. A combination of online and face-to-face therapy, known as blended care, may balance these advantages and disadvantages.

Methods and analysis: a single-blind, three-arm, randomised controlled trial among patients aged 50 years and over presenting with dizziness of vestibular origin in general practice will be performed. In this study, we will compare the clinical and cost-effectiveness of stand-alone internet-based VR and internet-based VR with physiotherapeutic support (‘blended care’) with usual care during 6 months of follow-up. We will use a translated Dutch version of a British online VR intervention. Randomisation will be stratified by dizziness severity. The primary outcome measure is the Vertigo Symptoms Scale—Short Form. Intention-to-treat analysis will be performed, adjusting for confounders. The economic evaluation will be conducted from a societal perspective. We will perform an additional analysis on the data to identify predictors of successful treatment in the same population to develop a clinical decision rule for general practitioners.

Ethics and dissemination: the ethical committee of the VU University Medical Center approved ethics and dissemination of the study protocol. The insights and results of this study will be widely disseminated through international peer-reviewed journals and conference presentations.
van Vugt, V
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van der Wouden, C
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Bosmans, J
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Smallbrugge, M
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van Diest, W
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Essery, Rosie
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Yardley, Lucy
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van der Horst, H
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Maarsingh, O
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van Vugt, V
838ed526-e660-452a-a8ba-9d7a7502f23a
van der Wouden, C
e789795d-8900-4ea8-8f48-0360f7e73987
Bosmans, J
e0794e9d-2459-4b2d-b5da-30b4bdee332a
Smallbrugge, M
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van Diest, W
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Essery, Rosie
6bf53e81-577f-4a95-ba45-11aa64d1ee53
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
van der Horst, H
f0e52e2c-a950-45ff-a8f1-75f6624c254b
Maarsingh, O
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van Vugt, V, van der Wouden, C, Bosmans, J, Smallbrugge, M, van Diest, W, Essery, Rosie, Yardley, Lucy, van der Horst, H and Maarsingh, O (2017) Guided and unguided internet based vestibular rehabilitation versus usual care for dizzy adults of 50 years and older: a protocol for a three armed randomised trial. BMJ Open, 7 (1). (doi:10.1136/bmjopen-2016-015479).

Record type: Article

Abstract

Introduction:dizziness is a common symptom in general practice with a high prevalence among older adults. The most common cause of dizziness in general practice is peripheral vestibular disease. Vestibular rehabilitation (VR) is a safe and effective treatment for peripheral vestibular disease that entails specific exercises to maximise the central nervous system compensation for the effects of vestibular pathology. An internet-based VR intervention has recently been shown to be safe and effective. Online interventions are low cost and easily accessible, but prone to attrition and non-adherence. A combination of online and face-to-face therapy, known as blended care, may balance these advantages and disadvantages.

Methods and analysis: a single-blind, three-arm, randomised controlled trial among patients aged 50 years and over presenting with dizziness of vestibular origin in general practice will be performed. In this study, we will compare the clinical and cost-effectiveness of stand-alone internet-based VR and internet-based VR with physiotherapeutic support (‘blended care’) with usual care during 6 months of follow-up. We will use a translated Dutch version of a British online VR intervention. Randomisation will be stratified by dizziness severity. The primary outcome measure is the Vertigo Symptoms Scale—Short Form. Intention-to-treat analysis will be performed, adjusting for confounders. The economic evaluation will be conducted from a societal perspective. We will perform an additional analysis on the data to identify predictors of successful treatment in the same population to develop a clinical decision rule for general practitioners.

Ethics and dissemination: the ethical committee of the VU University Medical Center approved ethics and dissemination of the study protocol. The insights and results of this study will be widely disseminated through international peer-reviewed journals and conference presentations.

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Accepted/In Press date: 21 December 2016
e-pub ahead of print date: 20 January 2017
Published date: January 2017
Organisations: Human Wellbeing, Psychology

Identifiers

Local EPrints ID: 411204
URI: https://eprints.soton.ac.uk/id/eprint/411204
PURE UUID: 3cab4119-e416-4e72-8d1b-4dc36e9afeff
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X

Catalogue record

Date deposited: 15 Jun 2017 16:31
Last modified: 10 Sep 2019 00:50

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Contributors

Author: V van Vugt
Author: C van der Wouden
Author: J Bosmans
Author: M Smallbrugge
Author: W van Diest
Author: Rosie Essery
Author: Lucy Yardley ORCID iD
Author: H van der Horst
Author: O Maarsingh

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