Effectiveness of Otolith Repositioning Maneuvers and Vestibular Rehabilitation exercises in elderly people with Benign Paroxysmal Positional Vertigo: a systematic review

Abstract Introduction Benign Paroxysmal Positional Vertigo is highly prevalent in elderly people. This condition is related to vertigo, hearing loss, tinnitus, poor balance, gait disturbance, and an increase in risk of falls, leading to postural changes and quality of life decreasing. Objective To evaluate the outcomes obtained by clinical trials on the effectiveness of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises in the treatment of Benign Paroxysmal Positional Vertigo in elderly. Methods The literature research was performed using PubMed, Scopus, Web of Science and PEDro databases, and included randomized controlled clinical trials in English, Spanish and Portuguese, published during January 2000 to August 2016. The methodological quality of the studies was assessed by PEDro score and the outcomes analysis was done by critical revision of content. Results Six studies were fully reviewed. The average age of participants ranged between 67.2 and 74.5 years. The articles were classified from 2 to 7/10 through the PEDro score. The main outcome measures analyzed were vertigo, positional nystagmus and postural balance. Additionally, the number of maneuvers necessary for remission of the symptoms, the quality of life, and the functionality were also assessed. The majority of the clinical trials used Otolith Repositioning Maneuver (n = 5) and 3 articles performed Vestibular Rehabilitation exercises in addition to Otolith Repositioning Maneuver or pharmacotherapy. One study showed that the addition of movement restrictions after maneuver did not influence the outcomes. Conclusion There was a trend of improvement in Benign Paroxysmal Positional Vertigo symptomatology in elderly patients who underwent Otolith Repositioning Maneuver. There is sparse evidence from methodologically robust clinical trials that examined the effects of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises for treating Benign Paroxysmal Positional Vertigo in the elderly. Randomized controlled clinical trials with comprehensive assessment of symptoms, quality of life, function and long-term follow up are warranted.

摘要 引言：良性阵发性位置性眩晕（Benign Paroxysmal Positional Vertigo）在老年人群中高发。该病症可引发眩晕、听力损失、耳鸣、平衡障碍、步态紊乱，且会增加跌倒风险，进而导致姿势改变与生活质量下降。研究目的：评估耳石复位手法（Otolith Repositioning Maneuver）与前庭康复训练（Vestibular Rehabilitation exercises）治疗老年良性阵发性位置性眩晕的临床试验疗效。研究方法：本研究通过PubMed、Scopus、Web of Science及PEDro数据库开展文献检索，纳入2000年1月至2016年8月期间发表的英、西、葡语随机对照临床试验。采用PEDro量表评估研究的方法学质量，并通过内容批判性审查进行结局分析。研究结果：共纳入6项完整研究，受试者平均年龄介于67.2至74.5岁之间，PEDro评分范围为2~7/10。本研究分析的主要结局指标包括眩晕、位置性眼震（positional nystagmus）及姿势平衡；此外还评估了症状缓解所需的复位手法次数、生活质量及功能状态。多数临床试验采用耳石复位手法（n=5），另有3篇文献在耳石复位手法或药物治疗基础上联合了前庭康复训练。其中1项研究显示，手法治疗后附加活动限制并未对结局产生影响。研究结论：接受耳石复位手法治疗的老年患者，其良性阵发性位置性眩晕症状呈改善趋势。目前针对老年良性阵发性位置性眩晕采用耳石复位手法联合前庭康复训练的高质量方法学临床试验证据较为匮乏。未来需开展对症状、生活质量、功能状态进行全面评估且包含长期随访的随机对照临床试验。