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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.
Resumo Introdução A vertigem posicional paroxística benigna é altamente prevalente em idosos. Essa condição está relacionada a vertigem, perda auditiva, zumbido, equilíbrio precário, distúrbios da marcha e aumento do risco de quedas, levando a mudanças posturais e redução da qualidade de vida. Objetivo Avaliar os desfechos obtidos por ensaios clínicos sobre a eficácia da manobra de reposicionamento de otólitos e de exercícios de reabilitação vestibular no tratamento de vertigem posicional paroxística benigna em idosos. Método A pesquisa da literatura foi feita nos bancos de dados do PubMed, Scopus, Web of Science e PEDro e incluiu ensaios clínicos controlados randomizados em inglês, espanhol e português, publicados de janeiro de 2000 a agosto de 2016. A qualidade metodológica dos estudos foi avaliada pelo escore PEDro e a análise dos desfechos foi feita por revisão crítica do conteúdo. Resultados Seis estudos foram totalmente revisados. A idade média dos participantes variou entre 67,2-74,5 anos. Os artigos foram classificados de 2 a 7/10 pelo escore PEDro. As principais medidas de desfecho analisadas foram vertigem, nistagmo posicional e equilíbrio postural. Além disso, o número de manobras necessárias para a remissão dos sintomas, a qualidade de vida e a funcionalidade também foram avaliados. A maioria dos ensaios clínicos usou manobra de reposicionamento de otólitos (n = 5) e três artigos fizeram exercícios de RV, além de manobra de reposicionamento de otólitos ou farmacoterapia. Um estudo mostrou que a adição de restrições de movimento após a manobra não influenciou os resultados. Conclusão Houve uma tendência de melhoria na sintomatologia da vertigem posicional paroxística benigna em pacientes idosos submetidos à manobra de reposicionamento de otólitos. Existem evidências escassas de ensaios clínicos metodologicamente robustos que examinaram os efeitos dos exercícios de manobra de reposicionamento de otólitos e reabilitação vestibular para o tratamento da vertigem posicional paroxística benigna nos idosos. Ensaios clínicos controlados randomizados com avaliação abrangente de sintomas, qualidade de vida, função e acompanhamento de longo prazo são necessários.
RESUMEN
Abstract Introduction Benign Paroxysmal Positional Vertigo is the most common cause of dizziness in elderly people. Recent studies have shown that the elderly present higher Benign Paroxysmal Positional Vertigo recurrence and that vertiginous symptomatology remission varies according to comorbidities and the therapeutic techniques applied. Objective To assess the short-term effectiveness of Vestibular Rehabilitation in addition to Canalith Repositioning Maneuver on positive to negative Dix-Hallpike test, on recurrence and number of maneuvers to achieve a negative test in elderly patients with chronic Benign Paroxysmal Positional Vertigo. Methods In this randomized controlled trial, 7 older adults (median age: 69 years, range 65-78) underwent Canalith Repositioning Maneuver and Vestibular Rehabilitation for thirteen weeks. Seven older adults (median age: 73 years, range 65-76) in the control group received only Canalith Repositioning Maneuver. The participants were assessed at baseline (T0), one (T1), five (T5), nine (T9), and thirteen weeks (T13). We assessed the differences between the groups by Mann-Whitney and Fisher exact tests, and used the Friedman and Wilcoxon tests to determine the intragroup differences. Results No significant differences were found between groups for the positive to negative Dix-Hallpike test, recurrence, and number of maneuvers to achieve a negative test. The number of maneuvers to achieve negative Dix-Hallpike test was lower in intragroup comparisons in the experimental group. Conclusion The findings suggest that additional Vestibular Rehabilitation did not influence the positive to negative Dix-Hallpike test, recurrence, or number of maneuvers to achieve a negative test in elderly patients with chronic Benign Paroxysmal Positional Vertigo.