Lucy Yardley, PhD; Margaret Donovan-Hall, MSc; Helen E. Smith, BSMS, DM; Bronagh M. Walsh, RN, PhD; Mark Mullee, MSc, CStat; Adolfo M. Bronstein, FRCP, PhD
Note: This trial is registered as ISRCTN63019017 on the metaRegister of Controlled Trials, National Health Service Research and Development Regional Programmes.
Acknowledgments: The authors thank Dr. John Beasley, who ensured that the generalizability of these findings was not lost because of international differences in health care delivery and terminology.
Grant Support: By grant SEO 083 from the Directorate of Health and Social Care South, London, United Kingdom.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Lucy Yardley, PhD, School of Psychology, University of Southampton, Highfield, Southampton SO17 1BK, United Kingdom; e-mail, L.Yardley@soton.ac.uk.
Current Author Addresses: Dr. Yardley and Ms. Donovan-Hall: School of Psychology, University of Southampton, Highfield, Southampton SO17 1BJ, United Kingdom.
Dr. Smith: Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Falmer, Brighton BN1 9PH, United Kingdom.
Dr. Walsh: School of Nursing and Midwifery, University of Southampton, Highfield, Southampton, SO17 1BJ, United Kingdom.
Mr. Mullee: Medical Statistics, Health Care Research Unit and Southampton Statistical Sciences Research Institute, University of Southampton, Highfield, Southampton SO17 1BJ, United Kingdom.
Dr. Bronstein: Division of Neuroscience and Psychological Medicine, Imperial College, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, United Kingdom.
Author Contributions: Conception and design L. Yardley, M. Donovan-Hall, H.E. Smith, B.M. Walsh.
Analysis and interpretation of data: L. Yardley, M. Donovan-Hall, H.E. Smith, M. Mullee, A.M. Bronstein.
Drafting of the article: L. Yardley, B.M. Walsh, M. Mullee, A.M. Bronstein.
Critical revision of the article for important intellectual content: L. Yardley, M. Donovan-Hall, H.E. Smith, B.M. Walsh, A.M. Bronstein.
Final approval of the article: L. Yardley, M. Donovan-Hall, H.E. Smith, B.M. Walsh, M. Mullee.
Provision of study materials or patients: L. Yardley, H.E. Smith.
Statistical expertise: L. Yardley, M. Mullee.
Obtaining of funding: L. Yardley, H.E. Smith, B.M. Walsh.
Administrative, technical or logistic support: L. Yardley, M. Donovan-Hall.
Collection and assembly of data: L. Yardley, M. Donovan-Hall.
Dizziness is a very common symptom and is usually managed in primary care. Vestibular rehabilitation for dizziness is a simple treatment that may be suitable for primary care delivery, but its effectiveness has not yet been determined.
To evaluate the effectiveness of nurse-delivered vestibular rehabilitation in primary care for patients with chronic dizziness.
Single-blind randomized, controlled trial.
20 general practices in southern England.
170 adult patients with chronic dizziness who were randomly assigned to vestibular rehabilitation (n = 83) or usual medical care (n = 87).
Each patient received one 30- to 40-minute appointment with a primary care nurse. The nurse taught the patient exercises to be carried out daily at home, with the support of a treatment booklet.
Primary outcome measures were baseline, 3-month, and 6-month assessment of self-reported spontaneous and provoked symptoms of dizziness, dizziness-related quality of life, and objective measurement of postural stability with eyes open and eyes closed.
At 3 months, improvement on all primary outcome measures in the vestibular rehabilitation group was significantly greater than in the usual medical care group; this improvement was maintained at 6 months. Of 83 treated patients, 56 (67%) reported clinically significant improvement compared with 33 of 87 (38%) usual care patients (relative risk, 1.78 [95% CI, 1.31 to 2.42]).
Psychological elements of the therapy may have contributed to outcomes, and the treatment may be effective only for well-motivated patients.
Vestibular rehabilitation delivered by nurses in general practice improves symptoms, postural stability, and dizziness-related handicap in patients with chronic dizziness.
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Yardley L, Donovan-Hall M, Smith HE, Walsh BM, Mullee M, Bronstein AM. Effectiveness of Primary Care–Based Vestibular Rehabilitation for Chronic Dizziness. Ann Intern Med. 2004;141:598-605. doi: 10.7326/0003-4819-141-8-200410190-00007
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Published: Ann Intern Med. 2004;141(8):598-605.
Geriatric Medicine, Neurology, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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