The Effectiveness of Vestibular Rehabilitation Interventions in Treating Unilateral Peripheral Vestibular Disorders: A Systematic Review.

BACKGROUND AND PURPOSE: Various types of vestibular rehabilitation therapy are routinely used in clinical practice to treat unilateral peripheral vestibular hypofunction. The purpose of this systematic review was to compare the effectiveness of vestibular rehabilitation interventions (adaptation, substitution and habituation) in people with unilateral peripheral vestibular hypofunction, exclusionary of benign paroxysmal positional vertigo and Meniere's disease. METHODS: A search of the literature was conducted using PubMed, CINAHL and Scopus. Studies were eligible for inclusion if they were 1) a randomized controlled trial or randomized clinical trial; 2) written in English; 3) of participants with a unilateral, peripheral vestibular hypofunction; 4) of a conservative treatment approach only; and 5) with human subjects. Quality was assessed by two authors using the Physiotherapy Evidence Database scale. Effect size was calculated to determine the effect of treatment within each study group. RESULTS: Seven papers were selected for inclusion. Physiotherapy Evidence Database scores ranged from 2/10 to 7/10. Interventions within the selected studies included combinations of adaptation, habituation, substitution or substitution by itself. Calculated effect sizes, or significance values, revealed that all interventions demonstrated effectiveness. Two studies reported improvements on the dynamic gait index, and a large difference was seen between intervention groups of the two studies. DISCUSSION: Results suggest that vestibular therapy for unilateral peripheral vestibular hypofunction is effective. When considering all seven studies included in the review, it is difficult to determine the superiority of one intervention over another in treating unilateral peripheral vestibular hypofunction except when patient outcomes are captured by the dynamic gait index or dizziness handicap inventory. Many studies in this review demonstrate notable biases, suggesting that results should be used with caution. Future research should aim to use a common set of measures to capture outcomes. Copyright © 2015 John Wiley & Sons, Ltd.

The relationship between adherence behaviors and recovery time in adolescents after a sports-related concussion: an observational study.

BACKGROUND: Adherence to rehabilitation is widely accepted as vital for recovery and return to play following sports injuries. Medical management of concussion is centered around physical and cognitive rest, a theory largely based on expert opinion, not empirical evidence. Current research on this topic focuses on factors that are predictive of adherence to rehabilitation, but fails to examine if patient adherence leads to a better outcome. The purpose of this study was to determine the adherence tendencies of adolescents to treatment recommendations provided by a sports-medicine physician after a concussion and to determine if adherence to each recommendation was a predictor of treatment duration. STUDY DESIGN: Observational. METHODS: Participants were enrolled in the study at their initial visit to the Sports-Medicine Center for medical care after a sports-related concussion. Individual treatment recommendations provided by a sports-medicine physician for concussion were recorded over the course of each participant's care. Once released from medical care, each participant was contacted to complete an online questionnaire to measure self-reported adherence tendencies to each treatment recommendation. Adherence was measured by two constructs: 1) the reported receptivity to the recommendation and 2) the frequency of following the recommendation. Exploratory univariate Poisson regression analyses were used to describe the relationship between adherence behaviors and the number of days of treatment required before the participant was returned to play. RESULTS: Fifty-six questionnaires were completed, by 30 male and 26 female adolescent athletes. The self-reported adherence tendencies were very high. None of the measures of adherence to the treatment recommendations were significant predictors of the number of days of treatment; however, there was a clear tendency in five of the six rest parameters (physical rest, cognitive rest with restrictions from electronics, and cognitive rest with restrictions from school), where high levels of adherence to rest resulted in an increased average number of days of treatment (slower recovery) and those who reported being less adherent recovered faster. CONCLUSIONS: Adolescents were generally adherent to the physician recommendations. Those participants who reported being less adherent to physical and cognitive rest generally recovered faster than those who reported higher levels of adherence to these recommendations. As time progresses after the initial injury, physical and mental rest may be less effective to hasten recovery than more active treatment recommendations. LEVEL OF EVIDENCE: Level 2.