Online Rehabilitation Program Reduces Chronic Dizziness

Bridget M. Kuehn

May 11, 2017

An online rehabilitation program may offer relief for older patients experiencing chronic dizziness, according to results from a randomized trial published in the May/June issue of the Annals of Family Medicine.

"With the increasing Internet use being seen in older adults, our Internet-based vestibular rehabilitation intervention could enable clinicians to provide broad and rapid access to low-cost, evidence-based treatment for their patients experiencing dizziness," Adam Geraghty, PhD, a senior research fellow at the University of Southampton, United Kingdom, and colleagues, write.

The researchers randomly assigned 296 patients from 54 primary care practices to either usual care or a free online rehabilitation program. The six-session online program guides patients through a series of head movement exercises and is based on vestibular rehabilitation booklets. The sessions also incorporate cognitive behavioral coping techniques, including relaxation exercises, breathing, and strategies for changing the way the individual thinks about their symptoms. Those in the usual care group received physician reassurance, medications to help relieve symptoms, and possibly educational leaflets. Symptoms were assessed in both groups at 3 and 6 months, using the Vertigo Symptom Scale–Short Form (VSS-SF).

Compared with those in the usual care group, patients in the online group reported less dizziness at both 3 and 6 months. Median VSS-SF scores were 2.75 points (95% confidence interval [CI], 1.39 - 4.12 points; P < .001) and 2.26 points (95% CI, 0.39 - 4.12; P = .02) lower at 3 and 6 months, respectively.

Participants in the online program also had lower dizziness-related disability on the Dizziness Handicap Inventory at 3 months (6.15 points; 95% CI, 2.81 - 9.49 points; P < .001) and 6 months (5.58 points; 95% CI, 1.19 - 10.0 points; P = .01). The improvements were comparable to those seen in trials of booklet-based vestibular rehabilitation, the authors noted.

The drop-out rate was higher in the online rehabilitation group, with 23.1% dropping out by 3 months compared with just 6.6% in the usual care group.

"Some patients may have found the dizziness-inducing head movements off-putting and dropped out," the authors explain. They suggest that physicians might need to advise patients about what to expect and offer additional reassurance.

Dizziness is a common symptom experienced by older adults in the United States. Most cases are caused by benign paroxysmal positional vertigo, the researchers explain. Although the cause is usually not serious, its consequences can be. Dizziness may lead to falls, anxiety or depression, or fall avoidance behaviors that contribute to disability, increasing frailty, or a loss of independence.

The evidence to date suggests that simple head movement exercises that help individuals learn to compensate for vestibular dysfunction are the most effective treatment, the authors wrote. Now, they show that older primary care patients may find relief through online vestibular rehabilitation programs.

Overall, the study adds to evidence that online programs may be useful in this age group.

"Internet-based interventions may provide a promising means of greatly increasing the provision of evidence-based self-management strategies for older adults in primary care," the authors write.

The authors have disclosed no relevant financial relationships.

Ann Fam Med. 2017;15:209-216. Full text

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