Epley Maneuver for Benign Paroxysmal Positional Vertigo: Evidence Synthesis for Guidelines for Reasonable and Appropriate Care in the Emergency Department
Academic Emergency Medicine
Khoujah, D., Naples, J. G., et al. (2023).
Academic Emergency Medicine, 30(5), 501-516.
This umbrella systematic review and meta-analysis investigates the use of the Epley Maneuver for individuals with posterior canal benign paroxysmal positional vertigo (pc-BPPV) in any setting. An umbrella review was used to identify systematic reviews of which the highest quality one was used to identify individual studies of low risk of bias to be included in the meta-analysis. Individual studies from one additional high-quality systematic review were included in the sensitivity analysis. Specific details about the selected, high-quality systematic reviews are available elsewhere in the Evidence Maps. See the Associated Article(s) section below for the citations.
Society for Academic Emergency Medicine
From database inception to December 23, 2021
Systematic reviews were identified for the umbrella review. The meta-analysis consisted of randomized-controlled trials (RCTs). The sensitivity analysis included RCTs and observational studies.
7 systematic reviews in the qualitative synthesis. 8 low risk of bias studies selected from 1 high-quality systematic review for meta-analysis. 7 additional low risk of bias studies from 1 additional high-quality systematic review used in sensitivity analysis.
Meta-analysis of four RCTs evaluating symptom resolution at 1 week was in favor of the Epley maneuver (OR = 7.19, 95% CI = [1.52, 33.98]). Similarly, meta-analysis of five RCTs evaluating resolution of vertigo symptoms at 1 month also favored the Epley maneuver (OR = 14.87, 95% CI = [6.13, 36.03]). <br /><br />Meta-analysis of three RCTs showed higher conversion to negative Dix-Hallpike at 1 week with the Epley maneuver (OR = 6.67, 95% CI = [1.52, 29.23]). Likewise, meta-analysis of two RCTs evaluating the conversion of Dix-Hallpike from positive to negative at 1 month was in favor of Epley (OR = 4.21, 95% CI = [1.59, 11.11]).<br /><br />Sensitivity analysis revealed that outcomes from combining RCTs with observational studies were consistent with outcomes reported from RCTs alone.
