Abstract: We included 39 studies involving 2441 participants with unilateral peripheral vestibular disorders in the review. Trials addressed the effectiveness of vestibular rehabilitation against control/sham interventions, medical interventions or other forms of vestibular rehabilitation. Non-blinding of outcome assessors and selective reporting were threats that may have biased the results in 25% of studies, but otherwise there was a low risk of selection or attrition bias. Individual and pooled analyses of the primary outcome, frequency of dizziness, showed a statistically significant effect in favour of vestibular rehabilitation over control or no intervention (odds ratio (OR) 2.67, 95% confidence interval (CI) 1.85 to 3.86; four studies, 565 participants). Secondary outcomes measures related to levels of activity or participation measured, for example, with the Dizziness Handicap Inventory, which also showed a strong trend towards significant differences between the groups (standardised mean difference (SMD) -0.83, 95% CI -1.02 to -0.64). The exception to this was when movement-based vestibular rehabilitation was compared to physical manoeuvres for benign paroxysmal positional vertigo (BPPV), where the latter was shown to be superior in cure rate in the short term (OR 0.19, 95% CI 0.07 to 0.49). There were no reported adverse effects. There is moderate to strong evidence that vestibular rehabilitation is a safe, effective management for unilateral peripheral vestibular dysfunction, based on a number of high-quality randomised controlled trials. There is moderate evidence that vestibular rehabilitation resolves symptoms and improves functioning in the medium term. However, there is evidence that for the specific diagnostic group of BPPV, physical (repositioning) manoeuvres are more effective in the short term than exercise-based vestibular rehabilitation; although a combination of the two is effective for longer-term functional recovery. There is insufficient evidence to discriminate between differing forms of vestibular rehabilitation.

Plain-language summary: We found 39 randomised controlled trials (involving 2441 participants) that investigated the use of vestibular rehabilitation in this group of disorders. All studies used a form of vestibular rehabilitation and involved adults who lived in the community with symptomatic, confirmed UPVD. The studies were varied in that they compared vestibular rehabilitation with other forms of management (for example, medication, usual care or passive manoeuvres), with control or placebo interventions or with other forms of vestibular rehabilitation. Another source of variation between studies was the use of different outcome measures (for example, reports of dizziness, improvements in balance, vision or walking, or ability to participate in daily life). Due to the variation between studies, only limited pooling (combining) of data was possible. The results of four studies could be combined, which demonstrated that vestibular rehabilitation was more effective than control or sham interventions in improving subjective reports of dizziness, and in improving participation in life roles. Two studies gave a combined result in favour of vestibular rehabilitation for improving walking. Other single studies all found in favour of vestibular rehabilitation for improvements in areas such as balance, vision and activities of daily living. The exception to these findings was for the specific group of people with BPPV, where comparisons of vestibular rehabilitation with specific physical repositioning manoeuvres showed that these manoeuvres were more effective in dizziness symptom reduction, particularly in the short term. However, other studies demonstrated that combining the manoeuvres with vestibular rehabilitation was effective in improving functional recovery in the longer term. There were no reports of adverse effects following any vestibular rehabilitation. In the studies with a follow-up assessment (3 to 12 months) positive effects were maintained. There was no evidence that one form of vestibular rehabilitation is superior to another. There is a growing and consistent body of evidence to support the use of vestibular rehabilitation for people with dizziness and functional loss as a result of UPVD. The studies were generally of moderate to high quality but were varied in their methods. This evidence is up to date to 18 January 2014.