PT Critically Appraised Topics

Document Type

Critically Appraised Topic

Publication Date


Clinical Scenario

While on our clinical rotations, we saw patients who had or were suspected of having BPPV. All of these patients were in a hospital setting and were admitted for various reasons - not always for the vestibular dysfunction. Those who tested positive for BPPV were treated with the Epley maneuver. We wanted to know the evidence for the effectiveness of this treatment.

Clinical Question

Population: Adults with benign paroxysmal positional vertigo

Intervention: Epley maneuver

Comparison: Placebo group

Outcome: Resolution of vertigo as confirmed by a negative Dix-Hallpike maneuver and a subjective report of decreased symptoms of vertigo

Clinical Bottom Line

We evaluated three articles written between the years of 2000 and 2005 that assessed the efficacy of the canalith repositioning procedure (CRP, or Epley maneuver) to treat adults suffering from BPPV. These studies support the use of the CRP in treating BPPV in adults. The articles by Froehling et al. and Yimtae et al. both very closely matched our clinical question and were of excellent quality (ranking 9/10 and 7/10 on the PEDro scale, respectively). The Froehling et al. article was a randomized controlled trial with 50 adults with BPPV comparing the CRP to a sham maneuver. Yimtae et al. used a randomized controlled trial design with 58 adults with BPPV and compared the Epley maneuver and cinnarizine (anti-vertiginous drug) to cinnarizine alone. For elimination of vertigo symptoms, the NNT according to the Froehling et al. and Yimtae et al. studies was 4 (1.8 – 17.6) and 3 (1.8 – 5.4), respectively. The NNT to result in a negative Dix-Hallpike maneuver was 4 (1.8 – 60.8) for the Froehling et al. study and 4 (1.9 – 3.6) for the Yimtae et al. study. The data from the Yimtae et al. article also demonstrated a decreased use of anti-vertiginous medicine when subjects were treated with CRP as compared to the control group. Thus, treating BPPV with the CRP can help decrease adverse drug reactions. Although the article by Prokopakis et al. did not closely match our clinical PICO, it was an excellent descriptive study with a sample size of 592 adults with BPPV. This study supported the low incidence rate and severity of symptoms (74% of subjects experienced light-headedness for only 48-72 hours and 8% experienced severe nausea and vertigo) due to treatment with the Epley maneuver in a very large sample size. All of these articles had strong internal validity. Based on the evidence, we would confidently recommend the Epley maneuver as a safe and effective treatment for BPPV in adults. The data from these studies also demonstrate that the Epley maneuver is a high-benefit, low-cost treatment considering the short treatment time and minor nature and low rate of adverse effects.