Effects of Structured Exercise Program in Bilateral Vestibular Hypofunction

Study Overview
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Brief Summary
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Background: The vestibular rehabilitation is an exercise-based method, aiming to maximize central nervous system(CNS) compensation at vestibular nuclear and other CNS levels for vestibular pathology. A minimal number of studies have documented the impact of Vestibular rehabilitation on the recovery rate of patients with Bilateral Vestibular Hypofunction(BVH). Objective: The purpose of this study was to investigate the effectiveness of structured vestibular rehabilitation (VR) programs on severity of dizziness, kinesiophobia, balance, fatigue, quality of sleep, activities of daily living( ADL) and quality of life(QoL) in subjects with chronic BVH. Method: Twenty-five participants diagnosed with BVH were included in the study. A structured VR program was applied in 50-minute sessions once a week and as a home exercise program 3 days a week over 8 weeks. Participants were evaluated for severity of dizziness with the Visual Analog Scale (VAS), for kinesiophobia with the Tampa Scale of Kinesiophobia (TSK), for balance with the Semitandem, tandem, and standing tests, for quality of sleep with the Pittsburgh Sleep Quality Index (PSQI), for ADL with the Vestibular Disorders Activities of Daily Life (VADL), for QoL with Dizziness Handicap Inventory (DHI) and for fatigue with the Fatigue Severity Scale (FSS) at the baseline (T0), at 4th week (T1), 8th week (T2), and 20th week (T3) after study started.

Official Title
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Effects of Structured Exercise Program on Severity of Dizziness, Kinesiophobia, Balance, Fatigue, Quality of Sleep, Activities of Daily Living and Quality Of Life in Bilateral Vestibular Hypofunction

Conditions
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Bilateral Vestibular Hypofunction

Intervention / Treatment
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* Other: structured vestibular rehabilitation program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Being between 20-80 years old Diagnosed with bilateral peripheral vestibular hypofunction by videonystagmography Have symptoms for more than three months from onset of illness Exclusion Criteria: having no symptoms of bilateral peripheral vestibular hypofunction having Meniere's disease, vestibular migraine and other undulating vestibular disorders, cognitive, visual, neurological or general motor impairment having previously received vestibular rehabilitation

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: T0-T1 period<br>It was a control period. Participants were asked to continue their routine activities for 4 weeks. | |
| Experimental: T1-T2 period (structured vestibular rehabilitation program)<br>A structured vestibular rehabilitation program was applied in 50-minute sessions under the supervision of a physiotherapist once a week and as a home exercise program 3 days a week over 4 weeks. | Other: structured vestibular rehabilitation program<br>* The structured Vestibular rehabilitation protocol consisted of a structured vestibular rehabilitation program that included vestibular adaptation exercises, oculomotor exercises, static and dynamic balance exercises, and posture exercises.<br>|
| Active Comparator: T2-T3 period<br>A structured vestibular rehabilitation program was applied in 50-minute sessions under the supervision of a physiotherapist once a week and as a home exercise program 3 days a week over 4 weeks. Afterwards, participants participated in the home program with telerehabilitation for 8 weeks. | Other: structured vestibular rehabilitation program<br>* The structured Vestibular rehabilitation protocol consisted of a structured vestibular rehabilitation program that included vestibular adaptation exercises, oculomotor exercises, static and dynamic balance exercises, and posture exercises.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual Analog Scale | It is a validated, subjective scale used to measure the intensity or frequency of various symptoms. Scores are based on self-reported measures of symptoms that are recorded with a single handwritten mark placed at one point along the length of a 10-cm line that represents a continuum between the two ends of the scale-no symptom on the left end (0 cm) of the scale and the worst symptom on the right end of the scale (10 cm). We used this scale to measure the severity of dizziness | Change from Baseline Systolic Blood Pressure at 4 / 8 / 12 / 16 weeks | 
| Tampa Scale of Kinesiophobia | It is a 17 items self-reporting questionnaire based on evaluation of fear of movement, fear of physical activity, and fear avoidance. The total score of the scale ranges from 17- 68, where 17 means no kinesiophobia, 68 means severe kinesiophobia, and score ± 37 indicates there is kinesiophobia | Change from Baseline Systolic Blood Pressure at 4 / 8 / 12 / 16 weeks | 
| Semitandem, Tandem, and Standing tests | Semitandem, Tandem, and Standing tests were used to evaluate balance. Semitandem test 30 , Tandem test 30 , Standing tests 30 Equilibrium times (sec) with eyes open-closed were recorded on hard and soft surfaces | Change from Baseline Systolic Blood Pressure at 4 / 8 / 12 / 16 weeks | 
| Pittsburgh Sleep Quality Index | It is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. The seven component scores consist of subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Each scored 0 (no difficulty) to 3 (severe difficulty). The component scores are summed to produce a global score (range 0 to 21). Higher scores indicate worse sleep quality | Change from Baseline Systolic Blood Pressure at 4 / 8 / 12 / 16 weeks | 
| Dizziness Handicap Inventory | It is used to assess the impact of dizziness on quality of life. It consists of 25 clauses which determine the aggravating factors associated with dizziness and shakiness and also the emotional and functional results of vestibular system diseases. The inventory consists of 3 sub-dimensions, intended to determine physical, emotional and functional effects of the vestibular system diseases | Change from Baseline Systolic Blood Pressure at 4 / 8 / 12 / 16 weeks | 
| Fatigue Severity Scale | It was used to assess fatigue. There are 9 questions in the scale and each question consists of 7 points. An increase in the scale score indicates an increase in the level of fatigue. It detects the state of fatigue in the last month | Change from Baseline Systolic Blood Pressure at 4 / 8 / 12 / 16 weeks | 
| Vestibular Disorders Activities of Daily Life | This scale is used to determine the degree of independence of patients with vestibular disorders, perceived inadequacies and vestibular complaints in daily activities. The scale consists of 28 items. The subscales are evaluated under three sub-headings as Functional-F- Ambulation-A- and Instrumental-E | Change from Baseline Systolic Blood Pressure at 4 / 8 / 12 / 16 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Bilateral Vestibular Hypofunction, Dizziness, Kinesiophobia, Balance, Quality of Sleep, Quality of Life, Structured Exercise