Effectiveness of a Vestibular Rehabilitation Protocol to Improve the Health-Related Quality of Life and Postural Balance in Patients with Vertigo

Tsukamoto, Heloísa Freiria; Costa, Viviane de Souza Pinho; Silva Junior, Rubens Alexandre da; Pelosi, Gislaine Garcia; Marchiori, Luciana Lozza de Moraes; Vaz, Cláudia Regina Sanches; Fernandes, Karen Barros Parron

doi:10.1055/s-0035-1547523

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International Archives of Otorhinolaryngology

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Sumário

Original Research • Int. Arch. Otorhinolaryngol. 19 (3) • July-Sept 2015 • https://doi.org/10.1055/s-0035-1547523 copy

Effectiveness of a Vestibular Rehabilitation Protocol to Improve the Health-Related Quality of Life and Postural Balance in Patients with Vertigo

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction

Dizziness can be characterized as a balance disorder that causes discomfort, leading to several functional limitations. Currently, vestibular rehabilitation has been highlighted as a possible treatment.

Objective

Analyze the effects of completing a vestibular rehabilitation treatment protocol on quality of life and postural balance in patients with vestibular complaints, as well as to compare these effects between the patients taking or not taking antivertigo drugs.

Methods

A nonrandomized controlled trial was performed with 20 patients previously diagnosed with vestibular diseases. Information regarding vertigo symptoms, quality of life as assessed through the Dizziness Handicap Inventory, visual analog scale of dizziness, and stabilometry using force platform was collected. Patients were treated for 12 weeks by a customprotocol. The sample was divided into two groups according to the use (medicated group, n = 9) or not (control group, n = 11) of antivertigo drugs.

Results

There was improvement in quality of life (p < 0.001) and intensity of dizziness (p = 0.003) with the intervention. An improvement of postural balance was observed through functional tests. However, no statistically significant difference was noted in stabilometry. When both groups were compared, no statistically significant differences between the variations of the variables analyzed were found in the re-evaluation session.

Conclusion

Quality of life and postural balance are improved with intervention. However, this improvement is not associated with pharmacologic treatment.

dizziness; rehabilitation; quality of life; postural balance; medicines

Measure	Categories	Absolute frequency (n)	Relative frequency (%)
Gender	Female	19	95
	Male	1	5
Age (y)	20–40	2	10
	41–60	7	35
	61–80	9	45
	>80	2	10
Time of clinical evolution (y)	<1	7	35
	1–10	10	50
	10–20	1	5
	>20	2	10
Main complaint	Dizziness	10	50
	Dizziness and tinnitus	4	20
	Dizziness and heavy head	6	30
Period of dizziness	Anytime	12	60
	Morning/afternoon	5	25
	Evening/dawn	3	15
Periodicity of dizziness	Daily	12	60
	Weekly	4	20
	Monthly/sporadic	4	20
Duration of dizziness	Seconds/minutes	9	45
	Hours/days	11	55
Characteristics of dizziness	Unbalance	7	35
	Vertigo	5	25
	Unbalance and vertigo	5	25
	Unbalance and obscured vision	3	15
Associated symptoms	Yes	19	95
	No	1	5

Test	Baseline			Posttreatment (12 wk)
Test	Median	1° q	3° q	Median	1° q	3° q	p
DHI total	41.0	27.0	58.5	17.0	10.5	37.0	<0.001^a p< 0.05.
DHI physical aspects	18.0	14.0	21.5	9.0	4.5	15.5	0.001^a p< 0.05.
DHI functional aspects	18.0	10.0	22.0	8.0	4.5	15.5	0.004^a p< 0.05.
DHI emotional aspects	10.0	4.0	17.0	4.0	0.5	7.5	0.001^a p< 0.05.
VAS of dizziness	4.0	2.00	6.00	1.0	0.25	3.0	0.003^a p< 0.05.
TUG (s)	6.45	5.85	7.57	5.68	5.34	6.53	0.010^a p< 0.05.
FRT (cm)	31.31	24.98	32.39	33.79	29.70	37.24	0.010^a p< 0.05.
Single leg stance test EO (s)	30.00	14.62	30.00	30.00	26.25	30.00	0.028^a p< 0.05.
Single leg stance test EC (s)	6.84	3.00	11.37	8.44	4.12	14.91	0.034^a p< 0.05.

Baseline	Posttreatment (12 wk)
Baseline	Slight	Moderate	Severe	Total
Slight	7	0	0	7
Moderate	4	3	0	7
Severe	4	1	1	6
Total	15	4	1	20

Test	Baseline			Posttreatment (12 wk)
Test	Median	1°q	3° q	Median	1° q	3° q	p
BEO
COP (cm²)	1.30	0.80	3.83	1.21	0.91	2.10	0.41
VEL A/P (cm/s)	0.83	0.64	1.20	0.76	0.66	0.95	0.36
VEL M/L (cm/s)	0.61	0.50	0.75	0.58	0.51	0.72	0.51
AMP A/P (cm)	1.97	1.40	2.98	1.78	1.29	2.08	0.03^a p< 0.05.
AMP M/L (cm)	1.09	0.77	2.10	1.18	0.82	1.45	0.94
FM A/P (Hz)	0.34	0.24	0.51	0.32	0.24	0.49	0.92
FM M/L (Hz)	0.38	0.27	0.60	0.50	0.33	0.53	0.39
BHR
COP (cm²)	2.90	1.73	5.47	3.10	1.70	4.60	0.85
VEL A/P (cm/s)	1.16	0.96	1.49	1.10	0.91	1.32	0.26
VEL M/L (cm/s)	0.90	0.69	1.13	0.86	0.75	0.98	0.52
AMP A/P (cm)	2.17	1.99	3.38	2.39	1.96	2.80	0.43
AMP M/L (cm)	1.95	1.17	2.17	1.87	1.51	2.39	0.88
FM A/P (Hz)	0.43	0.33	0.51	0.48	0.35	0.57	0.12
FM M/L (Hz)	0.44	0.32	0.54	0.41	0.36	0.49	0.50
STEO
COP (cm²)	4.24	3.11	7.13	3.07	2.21	5.42	0.13
VEL A/P (cm/s)	1.43	1.19	1.84	1.31	1.14	1.52	0.76
VEL M/L (cm/s)	1.26	1.14	1.48	1.22	1.11	1.37	0.95
AMP A/P (cm)	2.53	2.26	3.52	2.24	1.84	2.73	0.04^a p< 0.05.
AMP M/L (cm)	2.90	2.36	3.52	2.78	2.28	3.04	0.38
FM A/P (Hz)	0.55	0.46	0.67	0.61	0.57	0.68	0.07
FM M/L (Hz)	0.40	0.37	0.46	0.42	0.38	0.50	0.46
STEC
COP (cm²)	6.99	3.80	13.10	4.99	3.69	8.16	0.23
VEL A/P (cm/s)	2.00	1.62	2.80	1.79	1.51	2.58	>0.99
VEL M/L (cm/s)	1.80	1.54	2.52	1.88	1.70	2.38	0.21
AMP A/P (cm)	3.40	2.42	4.67	2.70	2.32	3.81	0.11
AMP M/L (cm)	3.84	3.01	4.74	3.42	2.89	4.45	0.26
FM A/P (Hz)	0.63	0.45	0.75	0.60	0.52	0.79	0.62
FM M/L (Hz)	0.48	0.39	0.52	0.48	0.41	0.60	0.06

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[TFN01] Abbreviations: 1° q, first quartile (25%); 3° q, third quartile (75%); DHI, Dizziness Handicap Inventory; EC, eyes closed; EO, eyes open; FRT, Functional Reach test; TUG, Timed Up and Go test; VAS, visual analog scale.

[TFN02] p< 0.05.