Document Detail


Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review.
MedLine Citation:
PMID:  20338918     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo.
PURPOSE: The purpose of this systematic review was to determine whether patients diagnosed with posterior canal (PC) BPPV, based on positional testing, and treated with a particle repositioning maneuver will show the resolution of benign paroxysmal positional nystagmus (BPPN) on the Dix-Hallpike Test performed 24 hours or more after treatment.
DATA SOURCES: Data were obtained from an electronic search of the MEDLINE, EMBASE, and CINAHL databases from 1966 through September 2009.
STUDY SELECTION: The study topics were randomized controlled trials (RCTs), quasi-RCTs, the diagnosis of PC BPPV, treatment with the particle repositioning maneuver, and outcome measured with a positional test 24 hours or more after treatment.
DATA EXTRACTION: Data extracted were study descriptors and the information used to code for effect size.
DATA SYNTHESIS: In 2 double-blind RCTs, the odds in favor of the resolution of BPPN were 22 times (95% confidence interval=3.41-141.73) and 37 times (95% confidence interval=8.75-159.22) higher in people receiving the canalith repositioning procedure (CRP) than in people receiving a sham treatment. This finding was supported by the results reported in 8 nonmasked quasi-RCTs. Studies with limited methodological quality suggested that a liberatory maneuver (LM) was more effective than a control intervention; there was no significant difference in the effectiveness of the LM and the effectiveness of the CRP; the self-administered CRP was more effective than the self-administered LM; and the CRP administered together with the self-administered CRP was more effective than the CRP administered alone. The Brandt-Daroff exercises were the least effective self-administered treatments.
LIMITATIONS: The limitations included the methodological quality of the studies, the lack of quality-of-life measures, and confounding factors in reporting vertigo.
CONCLUSIONS: Randomized controlled trials provided strong evidence that the CRP resolves PC BPPN, and quasi-RCTs suggested that the CRP or the LM performed by a clinician or with proper instruction at home by the patient resolves PC BPPN. There were no data on the effects of the maneuvers on outcomes relevant to patients.
Authors:
Janet Odry Helminski; David Samuel Zee; Imke Janssen; Timothy Carl Hain
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Publication Detail:
Type:  Journal Article; Review     Date:  2010-03-25
Journal Detail:
Title:  Physical therapy     Volume:  90     ISSN:  1538-6724     ISO Abbreviation:  Phys Ther     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-03     Completed Date:  2010-06-10     Revised Date:  2011-10-06    
Medline Journal Info:
Nlm Unique ID:  0022623     Medline TA:  Phys Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  663-78     Citation Subset:  AIM; IM    
Affiliation:
Department of Physical Therapy, Midwestern University, 555 31st St, Downers Grove, IL 60515, USA. jhelmi@midwestern.edu
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MeSH Terms
Descriptor/Qualifier:
Head Movements
Humans
Nystagmus, Physiologic
Physical Therapy Modalities*
Posture / physiology
Randomized Controlled Trials as Topic
Semicircular Canals / physiopathology
Vertigo / rehabilitation*
Comments/Corrections
Comment In:
Ann Emerg Med. 2011 Sep;58(3):286-7   [PMID:  21435739 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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