The Epley Maneuver Versus Cawthorne-Cooksey Exercises in the Treatment of Benign Paroxysmal Positional Vertigo (BPPV)

Study Overview
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Brief Summary
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Observation of the effects of Cawthorne-Cooksey exercises applied after the Epley maneuver on balance, vertigo symptoms, and quality of life in BPPV patients.

Detailed Description
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Study Objective: To observe the efficacy of Cawthorne-Cooksey exercises applied after the Epley maneuver on balance, vertigo symptoms, and quality of life in patients with posterior canal BPPV. Study Design: Single-blind randomized controlled study Sample Size: Thirty-six patients were recruited in the study and were randomized equally into Epley maneuver (EpleyM) and Epley maneuver and exercise (EpleyM&Exe) groups. Study Method: All patients were treated with the Epley maneuver, while CawthorneCooksey exercises were given to the EpleyM&Exe group as home exercises for 6 weeks. Static and dynamic balance, vertigo and associated symptoms, and quality of life were assessed with the Nintendo Wii Balance Board, Berg Balance Test, Vertigo Symptom Scale, and Dizziness Handicap Inventory, respectively. The assessments were repeated at the 1st, 3rd, and 6th weeks.

Official Title
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Effectiveness of the Epley Maneuver Versus Vestibular Exercises in the Treatment of Benign Paroxysmal Positional Vertigo (BPPV)

Conditions
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Benign Paroxysmal Positional Vertigo

Intervention / Treatment
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* Procedure: Epley maneuver


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: having posterior semicircular canal BPPV with upbeating-torsional nystagmus and positional vertigo as evaluated by the Dix-Hallpike Test agreeing to undergo the Epley maneuver after that test agreeing to participate in the study Exclusion Criteria: having history or symptoms of vestibular system disorders other than BPPV or central nervous system disorders causing dizziness having cervical and/or lumbar pathology due to which the Epley maneuver could not be performed having lower extremity pain or an operation that prevented standing and/or weight bearing having anterior or horizontal canal BPPV having previously undergone a vestibular rehabilitation program
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Epley maneuver<br>The Epley maneuver was performed for all patients (both EpleyM and EpleyM&Exe groups) included in this study until nystagmus had disappeared in each position. If nystagmus/vertigo was not seen, the Epley maneuver was not performed for patients at the 1st, 3rd, and 6th week assessments. | Procedure: Epley maneuver<br>* Epley maneuver<br>|
| Other: Cawthorne-Cooksey exercises combined with the Epley maneuver<br>Additional Cawthorne-Cooksey exercises were prescribed to the EpleyM&Exe group. The physiotherapist explained and demonstrated the exercises to each patient and the patients practiced the exercises until they performed them correctly. Then the exercises were prescribed twice a day and repeated 10 times for 6 weeks as a home exercise program. | Procedure: Epley maneuver<br>* Epley maneuver<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Nintendo Wii Balance Board (WBB) | COP displacement on double leg with eyes open/closed (%): Lower scores (approaching 50%) indicate better static balance. Frontal plane stability on dominant leg with eyes open/closed (%): The total score ranges between 0 and 100%. Higher scores indicate better static balance. | one hour | 
| Berg Balance Test (BBT) | The minimum score of the BBT is 0 and the total maximum score of the BBT is 56. Higher scores indicate better dynamic balance. | one hour | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Vertigo Symptom Scale (VSS) | The total score ranges between 0 and 60 points, with higher scores indicating lower vertigo associated symptoms. | one hour | 
| Dizziness Handicap Inventory (DHI) | The total score ranges between 0 and 100 points, with higher scores indicating lower quality of life. | one hour |