Title: Treatments for people with balance disorders; a suite of prioritised Cochrane systematic reviews following a multi-stakeholder scoping project
Funder: Department of Health and Social Care

Abstract: Balance disorders are common. They lead to significant suffering and a reduced quality of life. They can have a profound impact on peoples’ daily activities. Many are related to problems in the inner ear. Despite being so common, there have been few attempts to summarise the results of clinical studies in this area in systematic reviews, and no UK national guidelines to help people make informed decisions about treatment choices. As a result, there is a lot of difference in how balance disorders are managed around the country and uncertainty about what is ‘best practice’._x000D_ _x000D_ Cochrane ENT (ear, nose and throat) produces high-quality summaries (systematic reviews) of the clinical trials and studies in all ENT areas. We have run a number of projects with patients and health professionals to try and work out which conditions they should focus on. Our most recent one looked at the area of balance disorders. We consulted with stakeholders - individuals with balance disorders, support groups for individuals with disorders and healthcare professionals - in order to decide which balance disorders were most in need of new or updated reviews. This has produced a document that lists a priority order for reviews covering all ear-related balance disorders._x000D_ _x000D_ For this research proposal, we will address the top three priority topics identified in this process - Ménière’s disease, vestibular migraine and persistent postural-perceptual dizziness (PPPD). We will produce a set of Cochrane reviews that address the most important treatments for each of these three topics. These can then be used to help patients and those advising them to make good decisions about their treatment._x000D_ _x000D_ During the first part of this project (months 0 to 6) we will build on our work with stakeholders to develop our plans for the reviews by:_x000D_ _x000D_ - identifying the relevant important treatments (and what they are to be compared with) for each of the three conditions;_x000D_ - defining the sorts of patients that each of the reviews will focus on;_x000D_ - selecting and then prioritising the outcomes that will be used in the reviews for each of the three topics. ‘Outcomes’ meaning the thing measured in order to work out whether the treatment has made someone better or not, such as reduction in dizziness._x000D_ _x000D_ The second phase of the project (months 7 to 18) will be the preparation, publication and dissemination of a set of 8 to 12 reviews. We will do all of this in the best possible way, using the methods expected by Cochrane. The project team includes core members of the Cochrane ENT editorial staff (they have a lot of experience of what needs to be done to do this as well as possible) as well as the director of the Ménière’s Society, our Patient and Public Involvement lead. This is an organisation for people with any sort of balance disorder. The people with balance disorders included in the project team will be involved in all parts of review preparation, publication and dissemination._x000D_ _x000D_ The project will therefore produce a comprehensive set of reviews covering important treatments for three ear-related balance disorders that have been identified as priorities for research. It will also allow us to strengthen links with consumers, by working closely with the Ménière’s Society to encourage patient participation in the review process. Finally, by having a core team to drive the project forwards, we will be able to support new review authors who are keen to engage with the work of Cochrane.

Lay abstract: Balance disorders are common. They lead to significant suffering and a reduced quality of life. They can have a profound impact on peoples’ daily activities. Many are related to abnormalities of function in the inner ear. Despite their prevalence, there are few high-quality systematic reviews in this area, and no NICE guidelines to inform clinical practice. Consequently, there is considerable variation in how balance disorders are managed, and confusion over best practice._x000D_ _x000D_ Cochrane ENT have undertaken a number of prioritisation exercises, to identify which conditions require more comprehensive coverage and which reviews in our existing portfolio most need updating. Our most recent prioritisation exercise has been in the area of balance disorders. We consulted with patients, support groups for individuals with balance disorders and healthcare professionals in order to identify which balance disorders were most in need of new or updated reviews. This has produced a prioritisation document that lists the order of priority for reviews covering all ear-related balance disorders. _x000D_ _x000D_ For this research proposal, we will address the top three priority topics identified in the scoping process - Ménière’s disease, vestibular migraine and persistent postural-perceptual dizziness (PPPD). We will produce a suite of Cochrane reviews that address the most important interventions for each of these three topics. These can then be used to inform decision making. _x000D_ _x000D_ During the first part of this project (months 0 to 6) we will build on our work with stakeholders to develop the review protocols by: _x000D_ _x000D_ - identifying the relevant, important interventions (and comparators) for each of the three topic areas that will require a new or updated review;_x000D_ - defining the appropriate populations for each of the reviews;_x000D_ - selecting and then prioritising the outcomes that will be used in the reviews for each of the three topics. _x000D_ _x000D_ The second phase of the project (months 7 to 18) will be the preparation, publication and dissemination of a suite of 8 to 12 reviews. We will use the standard methodological processes, methods and procedures expected by Cochrane. The project team includes core members of the Cochrane ENT editorial base staff, intimately familiar with the procedures and standards required, as well as the director of the Ménière’s Society, our Patient and Public Involvement lead. The people with balance disorders included in the project team will be involved in all aspects of review preparation, publication and dissemination. _x000D_ _x000D_ The project will therefore produce a comprehensive suite of reviews covering important interventions for three of ear-related balance disorders that have been identified as priorities for research. It will also allow us to strengthen links with consumers, by working together with the Ménière’s Society to encourage patient participation in the review process. Finally, by having a core team to drive the project forwards, we will be able to support new review authors who are keen to engage with the work of Cochrane.

Research activity codes: 6.9 RESOURCES AND INFRASTRUCTURE (TREATMENT EVALUATION)
Health categories: EAR