Overall Clinical Bottom Line: Dizziness and imbalance are common complaints amongst people of all ages, are frequently reported in visits to primary care providers, and have a significant negative effect on quality of life (Tinetti, 2000). In addition, dizziness and imbalance increase risk of falls. Falling is a major cause of morbidity and mortality in older adults (Shumway-Cook et al., 1997). Treatment addressing dizziness and fall risk is within the scope of physical therapy practice, but we would like to know if the evidence supports its use. The articles evaluated in this critically appraised topic (CAT) address our clinical question, “Does vestibular and balance rehabilitation therapy (VBRT) reduce fall risk and improve quality of life for the dizzy patient?”
We reviewed ten studies that helped answer our clinical question. These studies examined subjects with dizziness of central, peripheral, and mixed origins, as well as general imbalance. Evidence from multiple comparisons showed no difference in response to VBRT based on etiology or severity of dizziness or imbalance, nor any demographic characteristic, including age. Studies with moderate to high internal validity demonstrated that VBRT effectively improved balance and decreased report of dizziness symptoms. These studies reported that mean improvements meeting or exceeding the minimal clinically important difference (MCID) for appropriate outcome measures. Additionally, home exercise programs (HEPs) appeared to have an important role in producing and maintaining improvements. Based on our appraisal of the literature, we feel confident that providing VBRT and HEPs to patients of any age presenting with dizziness and imbalance will decrease fall risk and increase quality of life.
Clinical Scenario: Over the course of our clinical internships, we have seen varying frequencies of referrals for PT treatment for dizziness and fall risk. In some clinics, many patients are seen for an extensive course of vestibular and balance rehabilitation therapy (VBRT) with clinical outcome measures used to justify initiation and termination of treatment. In other clinics, patients with dizziness are infrequently referred, and treatment does not necessarily include VBRT. Given the high personal and financial costs of falling and the damaging effect of chronic dizziness on quality of life, we would like to know if VBRT is effective at decreasing fall risk and improving quality of life. If so, the information gathered in our critically appraised topic (CAT) could be used to encourage physician referrals to PT for VBRT. If not, we might choose to spend PT treatment time on other types of interventions aimed at reducing fall risk, such as increasing strength to improve functional mobility.
Clinical Question: Population—Patients of all ages with subjective complaints of dizziness and imbalance and history of loss of balance Intervention—Vestibular and balance rehabilitation therapy (VBRT) including habituation, substitution, gait, and balance exercises Comparison—Standard medical treatment, no treatment, or placebo Outcome—Subjective report of decreased symptoms, decreased future falls
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