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Internet based vestibular rehabilitation with and without physiotherapy support for adults aged 50 and older with a chronic vestibular syndrome in general practice: three armed randomised controlled trial

Internet based vestibular rehabilitation with and without physiotherapy support for adults aged 50 and older with a chronic vestibular syndrome in general practice: three armed randomised controlled trial
Internet based vestibular rehabilitation with and without physiotherapy support for adults aged 50 and older with a chronic vestibular syndrome in general practice: three armed randomised controlled trial
Objective: To investigate the clinical effectiveness and safety of stand alone and blended internet based vestibular rehabilitation (VR) in the management of chronic vestibular syndromes in general practice.

Design: Pragmatic, three armed, parallel group, individually randomised controlled trial.

Setting: 59 general practices in the Netherlands.

Participants: 322 adults aged 50 and older with a chronic vestibular syndrome.

Interventions: Stand alone VR comprising a six week, internet based intervention with weekly online sessions and daily exercises (10-20 minutes a day). In the blended VR group, the same internet based intervention was supplemented by face-to-face physiotherapy support (home visits in weeks 1 and 3). Participants in the usual care group received standard care from a general practitioner, without any restrictions.

Main outcome measures: The primary outcome was vestibular symptoms after six months as measured by the vertigo symptom scale-short form (VSS-SF range 0-60, clinically relevant difference ≥3 points). Secondary outcomes were dizziness related impairment, anxiety, depressive symptoms, subjective improvement of vestibular symptoms after three and six months, and adverse events.

Results: In the intention-to-treat analysis, participants in the stand alone and blended VR groups had lower VSS-SF scores at six months than participants in the usual care group (adjusted mean difference −4.1 points, 95% confidence interval −5.8 to −2.5; and −3.5 points, −5.1 to −1.9, respectively). Similar differences in VSS-SF scores were seen at three months follow-up. Participants in the stand alone and blended VR groups also experienced less dizziness related impairment, less anxiety, and more subjective improvement of vestibular symptoms at three and six months. No serious adverse events related to online VR occurred during the trial.

Conclusion: Stand alone and blended internet based VR are clinically effective and safe interventions to treat adults aged 50 and older with a chronic vestibular syndrome. Online VR is an easily accessible form of treatment, with the potential to improve care for an undertreated group of patients in general practice.

Trial registration: Netherlands Trial Register NTR5712.
0959-8138
van Vugt, Vincent
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van der Wouden, Johannes
f031bfa1-1f52-4cc0-805f-e9ab9908ded7
Essery, Rosie
6bf53e81-577f-4a95-ba45-11aa64d1ee53
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Twisk, Jos
9dc532fa-8bf2-44a0-b0f9-a73ecaf2bcf5
van der Horst, Henrietta
4947323c-2c73-4c45-9bea-85866c6f1867
Maarsingh, Otto
7ba29f1d-490e-4b95-8e02-55e2ee2aea82
van Vugt, Vincent
b9f7ffd6-4e63-4751-be79-385af2f5fcaf
van der Wouden, Johannes
f031bfa1-1f52-4cc0-805f-e9ab9908ded7
Essery, Rosie
6bf53e81-577f-4a95-ba45-11aa64d1ee53
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Twisk, Jos
9dc532fa-8bf2-44a0-b0f9-a73ecaf2bcf5
van der Horst, Henrietta
4947323c-2c73-4c45-9bea-85866c6f1867
Maarsingh, Otto
7ba29f1d-490e-4b95-8e02-55e2ee2aea82

van Vugt, Vincent, van der Wouden, Johannes, Essery, Rosie, Yardley, Lucy, Twisk, Jos, van der Horst, Henrietta and Maarsingh, Otto (2019) Internet based vestibular rehabilitation with and without physiotherapy support for adults aged 50 and older with a chronic vestibular syndrome in general practice: three armed randomised controlled trial. British Medical Journal, 367, [I5922]. (doi:10.1136/bmj.l5922).

Record type: Article

Abstract

Objective: To investigate the clinical effectiveness and safety of stand alone and blended internet based vestibular rehabilitation (VR) in the management of chronic vestibular syndromes in general practice.

Design: Pragmatic, three armed, parallel group, individually randomised controlled trial.

Setting: 59 general practices in the Netherlands.

Participants: 322 adults aged 50 and older with a chronic vestibular syndrome.

Interventions: Stand alone VR comprising a six week, internet based intervention with weekly online sessions and daily exercises (10-20 minutes a day). In the blended VR group, the same internet based intervention was supplemented by face-to-face physiotherapy support (home visits in weeks 1 and 3). Participants in the usual care group received standard care from a general practitioner, without any restrictions.

Main outcome measures: The primary outcome was vestibular symptoms after six months as measured by the vertigo symptom scale-short form (VSS-SF range 0-60, clinically relevant difference ≥3 points). Secondary outcomes were dizziness related impairment, anxiety, depressive symptoms, subjective improvement of vestibular symptoms after three and six months, and adverse events.

Results: In the intention-to-treat analysis, participants in the stand alone and blended VR groups had lower VSS-SF scores at six months than participants in the usual care group (adjusted mean difference −4.1 points, 95% confidence interval −5.8 to −2.5; and −3.5 points, −5.1 to −1.9, respectively). Similar differences in VSS-SF scores were seen at three months follow-up. Participants in the stand alone and blended VR groups also experienced less dizziness related impairment, less anxiety, and more subjective improvement of vestibular symptoms at three and six months. No serious adverse events related to online VR occurred during the trial.

Conclusion: Stand alone and blended internet based VR are clinically effective and safe interventions to treat adults aged 50 and older with a chronic vestibular syndrome. Online VR is an easily accessible form of treatment, with the potential to improve care for an undertreated group of patients in general practice.

Trial registration: Netherlands Trial Register NTR5712.

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More information

Accepted/In Press date: 24 September 2019
e-pub ahead of print date: 5 November 2019

Identifiers

Local EPrints ID: 436611
URI: http://eprints.soton.ac.uk/id/eprint/436611
ISSN: 0959-8138
PURE UUID: f01d5da5-e0ef-46af-b7ff-526533080c69
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X

Catalogue record

Date deposited: 18 Dec 2019 17:30
Last modified: 07 Oct 2020 01:42

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Contributors

Author: Vincent van Vugt
Author: Johannes van der Wouden
Author: Rosie Essery
Author: Lucy Yardley ORCID iD
Author: Jos Twisk
Author: Henrietta van der Horst
Author: Otto Maarsingh

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