Benefits of vestibular rehabilitation on patient-reported outcomes in older adults with vestibular disorders: a randomized clinical trial

Abstract

Background: Chronic dizziness has a negative impact on emotional aspects, functional capacity, and quality of life of older people.

Objective: To compare the effects of the conventional Cawthorne & Cooksey and the multimodal Cawthorne & Cooksey protocols on patient-reported outcomes in older adults with vestibular disorders.

Methods: This is a single-blind, randomized controlled trial with three-months' follow-up. Older adults with chronic dizziness were randomly assigned to conventional or multimodal protocols. The protocols were performed in individual 50-minute sessions, twice weekly, for two months. The primary outcome was the Dizziness Handicap Inventory (DHI) and the secondary outcomes were the Visual Analogue Scale, the Vestibular Disorders Activities of Daily Living Scale, the Geriatric Depression Scale, and the Activities-specific Balance Confidence Scale. Outcomes were collected at baseline, post-treatment and three-month follow-up; and analyzed on an intention-to-treat approach.

Results: Eighty-two patients were randomized into the conventional (n = 40) or multimodal (n = 42) protocols. There was no between-group difference on DHI at post-treatment (Mean Difference (MD): -0.7; 95% CI: -9.2, 7.8) and at three-month follow-up (MD: -1.6; 95% CI: -9.5, 6.2). No between-group difference was found for the secondary outcomes. All patient-reported outcomes in the within-group analysis showed significant improvement between baseline and post-treatment, and changes were maintained between post-treatment and follow-up. Following treatment, 55% of patients in the conventional and 57% in the multimodal protocol reached DHI clinical improvement (decrease ≥18).

Conclusions: The addition of multimodal exercises to the conventional Cawthorne & Cooksey protocol did not promote extra benefits on patient-reported outcomes in older adults with chronic dizziness.

Trial registration: Australian New Zealand Clinical Trials Registry-ANZCTR (ACTRN12610000018011), the trial was registered January 7, 2010 and the first participant was enrolled April 15, 2010. URL of the registry: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=334985.

Keywords: Aged; Dizziness; Patient-reported measures; Rehabilitation; Self-perceived measures; Vestibular diseases.