Treatments for Benign Paroxysmal Positional Vertigo (BPPV)

Study Overview
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Brief Summary
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The purpose of this study was to determine the relative short- and long-term efficacy of several physical treatment paradigms commonly employed for the treatment of benign paroxysmal positional vertigo (BPPV), including the canalith repositioning (Epley) maneuver, the liberatory (Semont) maneuver, the Brandt-Daroff exercises and nonspecific vestibular habituation exercises. These procedures involve exercises and head manipulations. Vertigo intensity and frequency, the presence/absence of slow-phase eye movements, the degree of dizziness handicap and acts of daily living (ADL) were assessed. The study also ascertained the effects of co-morbid conditions on the response to treatment. While BPPV is a common and significant public health problem that has been recognized for several decades, this is the first systematic study of the relative treatment efficacy of different physical treatment modalities for this disorder.

Official Title
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Treatments for Benign Paroxysmal Positional Vertigo (BPPV)

Conditions
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Vertigo

Intervention / Treatment
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* Behavioral: Canalith repositioning maneuver (Epley maneuver)
* Behavioral: Semont maneuver
* Behavioral: Brandt-Daroff exercises
* Behavioral: Vestibular habituation exercises
* Behavioral: ShamManeuver


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients may be eligible for this study if they: Are at least 21 years old. Have a diagnosis of unilateral posterior semicircular canal BPPV according to established clinical test criteria. Have functional to normal range of motion of the neck and the back. Exclusion Criteria: Patients will not be eligible for this study if they: Have a history of prior ear surgery or prior treatment for BPPV. Have an orthopedic or connective tissue disorder that impairs functional neck or trunk range of motion. Have a significant neurological disorder or spinal cord damage. Are on vestibular suppressant medications. Have Meniere's disease or acoustic neuromas.

Ages Eligible for Study
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Minimum Age: 21 Years

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
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Canalith repositioning maneuver<br>Repositioning treatment for posterior canal BPPV | Behavioral: Canalith repositioning maneuver (Epley maneuver)<br>* Standard passive motion of the head: Dix-Hallpike maneuver, turn head to opposite side, roll over, sit up.<br>* Other names: Epley maneuver;|
| Experimental: Modified Epley maneuver<br> | Behavioral: Vestibular habituation exercises<br>* Head shaking exercises in pitch, roll, yaw and circumduction. Titrating from 2 repetitions per exercise to 20 repetitions per exercise, as tolerated.<br>|
| Sham Comparator: Sham<br>The subject sat in a chair; the head was passively tilted downward, turned away from the involved side, turned back to center, upward, away from the involved side, twice, slowly. | Behavioral: ShamManeuver<br>* Passive movement of the head<br>|
| Active Comparator: Liberatory maneuver<br>The standard liberatory maneuver (also known as the Semont maneuver) was used. | Behavioral: Semont maneuver<br>* Sidelying maneuver, flip over 180 deg, sit up.<br>* Other names: Liberatory maneuver;|
| Active Comparator: Brandt Daroff exercise<br>Modified Brandt Daroff exercise performed as a self-liberatory exercise. | Behavioral: Brandt-Daroff exercises<br>* Active exercise. Sidelying to involved side, sidelying to uninvolved side, sit up.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Vertigo |  | 6 month s | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Balance |  | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Physical Therapy, Vertigo, rehabilitation, occupational therapy