A randomised controlled trial of internet-based vestibular rehabilitation for older adults with chronic dizziness in primary care

Conference: 
SAPC ASM 2016 - Dublin
Talk Code: 
3C.5
Presenter: 
Lucy Yardley
Co-authors: 
Rosie Essery, Sarah Kirby, Beth Stuart, David Turner, Paul Little, Adolfo Bronstein, Gerhard Andersson, Per Carlbring, Lucy Yardley
Author institutions: 
University of Southampton, Imperial College London, University of East Anglia, Linkoping University, Stockholm University

Problem

Vestibular dysfunction occurs in 50% of those over age 60, and with an ageing population the health burden will increase. Vestibular Rehabilitation (VR) has been shown to be effective for dizziness caused by vestibular dysfunction, but it is seldom provided in primary care. The rapid growth in internet access provides a very promising vehicle for VR to achieve widespread health impact. We aimed to determine the effectiveness of internet-based VR on chronic dizziness in older adults in primary care.

Approach

We conducted a single centre randomised controlled trial comparing an internet-based VR intervention with usual primary care. 296 primary care patients aged 50 years and over with current dizziness exacerbated by head movements were recruited from 54 primary care practices from southern England. Patients in the intervention arm accessed an automated internet-based intervention that taught VR exercises and suggested cognitive behavioural management strategies. Dizziness was measured by the Vertigo Symptom Short-Form (VSS-SF) at baseline, 3 and 6 months. The primary outcome was VSS-SF score at 6 months (ISRCTN: 86912968).

Findings

The VSS-SF was completed by 250 (84%) at 3 months and 230 (78%) at 6 months. Dizziness symptoms were significantly lower in the internet-based VR group compared to usual care at 3 (2.75, 95% CI:1.39, 4.12; p<0.001 and 6 months (2.26, 95% CI: 0.39, 4.12; p=0.018). Dizziness-related disability was also significantly lower in the internet-based VR condition, at 3 (5.33, 95% CI: 1.41, 9.26; p=0.008) and 6 month (5.58 95% CI: 1.19, 10.0; p=0.013).

Consequences

Internet-based VR improves dizziness and reduces dizziness-based disability in older primary care patients without requiring structured guidance. The effectiveness without the need for health professional support indicates that this intervention could be made rapidly available to GPs for provision to their patients. The intervention may also be useful for other health professionals including hospital doctors, audiologists, audiological physiotherapists and for direct use by individuals experiencing dizziness

Submitted by: 
Adam Geraghty
Funding acknowledgement: 
This research was funded by the Dunhill Medical Trust grant number R222/1111. The funder had no role in the design, conduct, analysis or decision to submit this manuscript