Efficacy of Vestibular Rehabilitation in Vestibular Neuritis: A Systematic Review and Meta-Analysis
American Journal of Physical Medicine & Rehabilitation
Huang, H. H., Chen, C. C., et al. (2024).
American Journal of Physical Medicine & Rehabilitation, 103(1), 38-46.
This systematic review and meta-analysis investigates the effects of vestibular rehabilitation in individuals with vestibular neuritis.
Not stated
From database inception to May 15, 2023
Randomized-controlled trials
12 studies in the qualitative synthesis and 6 studies in the meta-analysis
Studies showed that one month after symptom onset, total sway path values were significantly lower in the vestibular rehabilitation group as compared to the usual daily activities group. DHI scores and anxiety were significantly improved in the rehabilitation group. Dynamic visual acuity also significantly improved in the treatment group. No significant differences were seen between groups for ocular torsion or the subjective visual vertical.
Two RCTs showed no significant differences between the vestibular rehabilitation and steroid groups in DHI scores measured at 1, 6, and 12 months. In terms of objective outcomes, caloric lateralization improved in both groups but significantly less improvement was seen in the rehabilitation group in the first month (pooled MD = 8.31, 95% CI = [0.29, 16.32]). However, at 3, 6, and 12 months, no significant differences were seen between groups for this measure. Number of abnormal VEMPs were not significantly between groups at 1 and 6 months, and after 12 months, there were no abnormal VEMPs in either group.
Five RCTs compared the effects of combination rehabilitation treatment and steriod treatment to steroid therapy alone. Significant differences were found for DHI scores at 1, 3, and 12 months in favor of combination therapy (MD = −14.86, 95% CI = [−16.57, −13.15] at 1 month; pooled MD = −4.63, 95% CI = [−7.45, −1.81] at 3 months; and MD = −9.50, 95% CI = [−18.58, −0.42] at 12 months). Three RCTs evaluated vestibular function by tests of caloric irrigation and two by VEMPs. Significantly lower caloric lateralization was seen for the combined therapy group at 1 and 3 months (pooled MD = −10.28, 95% CI = [−17.18, −3.37] at 1 month; pooled MD = −8.12, 95% CI = [−15.74, −0.51] at 3 months). Significantly less VEMPs were seen for the combination therapy group at 1 and 3 months (RR = 0.69, 95% CI = [0.50, 0.96] at 1 month; RR = 0.60, 95% CI = [0.39, 0.92] at 3 months). No abnormal VEMPs were seen at 6 or 12 months for either group.
One study reported the vestibular rehabilitation group showed reduced perceived dizziness compared to the steroid therapy group at 3 and 12 months. Scores on the HADS and VAS of feelings of imbalance were also lower in the combination therapy group at 12 months as compared to steroid therapy alone. Another study reported that patients in the combination therapy group had shorter length of stay in the hospital and had earlier alleviation of nystagmus with more favorable results on the vertigo symptom scale, sensory organization test, and Tinnneti questionnaire than in the steroid therapy group. An additional study showed spontaneous nystagmus didn't differ between combination therapy and steroid treatment alone.
