Challenges in conducting a randomized clinical trial of older people with chronic dizziness: before, during and after vestibular rehabilitation.

PURPOSE: This study aims to describe the process of conducting a randomized clinical trial of elderly with chronic dizziness subjected to vestibular rehabilitation (VR) and to verify its effectiveness on dizziness intensity. METHODS: Older adults (≥65 years) with chronic dizziness from vestibular disorders referred to VR were enrolled to the trial. The control group (n=40) was submitted to the Cawthorne & Cooksey protocol and the experimental group (n=42) to the modified Cawthorne & Cooksey protocol which included multiple components. Protocols were performed during individual 50-minute sessions, twice-weekly, for eight weeks. Main measures were: recruitment data (refusal and eligibility), baseline characteristics, dropout rate, session attendance, protocol adherence, adverse effects, exercise adaptation and follow-up events. The Visual Analog Scale (VAS) was used to measure dizziness intensity. RESULTS: 144 elderly were referred to VR, 26.4% declined to participate and 16.7% were ineligible. There were 51 session non-attendances, with disease being the most frequent reason. Regardless of VR protocol, VAS dizziness intensity diminished along sessions (p<0.001). 88.6% of the participants reported improvement after treatment, and 22.9% mentioned an increase in dizziness on follow-up. Home exercises were no longer being performed by 21.4% of the subjects after 3 months from discharge. The final dropout rate was 14.6%. There were no differences between VR protocols on recruitment, dropout, session's attendance, adherence to protocol and treatment effects. CONCLUSIONS: Our results revealed many challenges in conducting a rehabilitation trial with an elderly sample. The VR protocols showed to be feasible and suitable to reduce dizziness in older adults.

Evaluation of properties of the Vestibular Disorders Activities of Daily Living Scale (Brazilian version) in an elderly population

Background: The Vestibular Disorders Activities of Daily Living Scale (VADL) is considered an important subjective assessment to evaluate patients suffering from dizziness and imbalance. Although frequently used, its metric characteristics still require further investigation. Objective: This paper aims to analyze the psychometric properties of the Brazilian version of the VADL in an elderly population. Method: The sample comprises patients (≥65 years old) with chronic dizziness resulting from vestibular disorders. For discriminant analysis, patients were compared to healthy subjects. All subjects answered the VADL-Brazil by interview. To examine the VADL validity, patients filled out the Dizziness Handicap Inventory (DHI) and the ABC scale and were tested on the Dynamic Gait Index (DGI). To evaluate the VADL responsiveness, 20 patients were submitted to rehabilitation. Results: Patients (n=140) had a VADL total score of 4.1±1.6 points. Healthy subjects scored significantly less than patients in all the subscales and in the VADL total score. The VADL-Brazil was weakly correlated with the DHI and moderately to the ABC scale and the DGI. Instead of the original 3 subscales, factor analysis resulted in 6 factors. The VADL was capable of detecting changes after rehabilitation, which means that the instrument has responsiveness. Conclusions: This study provided more data about the psychometric properties and usefulness of the VADL-Brazil. The use of such a reliable and valid instrument increases the knowledge about disability in patients with vestibular disorders. .

Evaluation of properties of the Vestibular Disorders Activities of Daily Living Scale (Brazilian version) in an elderly population.

BACKGROUND: The Vestibular Disorders Activities of Daily Living Scale (VADL) is considered an important subjective assessment to evaluate patients suffering from dizziness and imbalance. Although frequently used, its metric characteristics still require further investigation. OBJECTIVE: This paper aims to analyze the psychometric properties of the Brazilian version of the VADL in an elderly population. METHOD: The sample comprises patients (≥ 65 years old) with chronic dizziness resulting from vestibular disorders. For discriminant analysis, patients were compared to healthy subjects. All subjects answered the VADL-Brazil by interview. To examine the VADL validity, patients filled out the Dizziness Handicap Inventory (DHI) and the ABC scale and were tested on the Dynamic Gait Index (DGI). To evaluate the VADL responsiveness, 20 patients were submitted to rehabilitation. RESULTS: Patients (n=140) had a VADL total score of 4.1 ± 1.6 points. Healthy subjects scored significantly less than patients in all the subscales and in the VADL total score. The VADL-Brazil was weakly correlated with the DHI and moderately to the ABC scale and the DGI. Instead of the original 3 subscales, factor analysis resulted in 6 factors. The VADL was capable of detecting changes after rehabilitation, which means that the instrument has responsiveness. CONCLUSIONS: This study provided more data about the psychometric properties and usefulness of the VADL-Brazil. The use of such a reliable and valid instrument increases the knowledge about disability in patients with vestibular disorders.

A systematic review about the effects of the vestibular rehabilitation in middle-age and older adults.

OBJECTIVE: to summarize the results of clinical trials on vestibular rehabilitation (VR) in middle-aged and elderly people with vestibular disorders. METHODS: a search for relevant trials was performed in the databases LILACS, EMBASE, MEDLINE, SciELO, Cochrane, ISI Web of Knowledge and virtual libraries of theses and dissertations. Randomized controlled trials published in the last 10 years and written in English, Portuguese or Spanish were included. The methodological quality of the studies was assessed by the PEDro scale. Results from the included studies were analyzed through a critical review of content. RESULTS: nine studies were included in the review. Four studies reported on participants aged over 40 years (middle-aged and elderly) and five studies consisted exclusively of elderly subjects (over 60 years). Findings of vestibular dysfunction were diverse and the most common complaints were body imbalance or postural instability (3 studies), and vertigo or dizziness (3 studies). The Visual Analogue Scale (VAS) was the most commonly used instrument to assess subjective perception of symptoms of vestibular dysfunction (4 studies). According to the PEDro scale, four studies were considered to be of good quality. The most common experimental intervention was the Cawthorne & Cooksey protocol (4 studies). For most outcome measures, the studies comparing VR with another type of intervention showed no differences between the groups after the therapy. CONCLUSIONS: the studies included in this review provide evidence for the positive effects of VR in elderly and middle-aged adults with vestibular disturbances.

Revisão sistemática sobre os efeitos da reabilitação vestibular em adultos de meia-idade e idosos / A systematic review about the effects of the vestibular rehabilitation in middle-age and older adults

OBJETIVO: Sistematizar os resultados de ensaios clínicos sobre reabilitação vestibular (RV) em indivíduos de meia-idade e idosos com distúrbios vestibulares. MÉTODOS: A busca de publicações sobre a RV em indivíduos com distúrbios vestibulares foi realizada nas bases de dados LILACS, EMBASE, MEDLINE, SciELO, Cochrane, ISI Web of Knowledge e bibliotecas virtuais de teses e dissertações. Foram selecionados ensaios clínicos aleatórios e controlados dos últimos 10 anos em língua inglesa, portuguesa e espanhola. A qualidade metodológica dos estudos foi avaliada pela escala PEDro. A análise dos resultados dos estudos foi feita por meio de revisão crítica dos conteúdos. RESULTADOS: Nove estudos foram revisados na íntegra, sendo a faixa etária dos participantes acima de 40 anos (n=4) e composta exclusivamente por idosos (n=5). Os achados de disfunção vestibular foram diversificados, sendo os mais comuns queixa de desequilíbrio corporal ou instabilidade postural (n=3) e queixa de vertigem ou tontura (n=3). A Escala Visual Analógica (EVA) foi o instrumento mais utilizado para avaliar a percepção subjetiva da sintomatologia da disfunção vestibular (n=4). A escala PEDro revelou que quatro dos artigos apresentaram delineamento de boa qualidade para a condução do estudo experimental. A proposta de intervenção mais utilizada foi o protocolo de Cawthorne & Cooksey (n=4). Os estudos que compararam a RV com outro tipo de intervenção não apresentaram, na maioria dos desfechos analisados, diferença entre os grupos após a terapia. CONCLUSÃO: Estudos aleatorizados controlados disponibilizaram evidências de efeitos positivos da RV em idosos e adultos de meia-idade com distúrbios vestibulares.

OBJECTIVE: To summarize the results of clinical trials on vestibular rehabilitation (VR) in middle-aged and elderly people with vestibular disorders. METHODS: A search for relevant trials was performed in the databases LILACS, EMBASE, MEDLINE, SciELO, Cochrane, ISI Web of Knowledge and virtual libraries of theses and dissertations. Randomized controlled trials published in the last 10 years and written in English, Portuguese or Spanish were included. The methodological quality of the studies was assessed by the PEDro scale. Results from the included studies were analyzed through a critical review of content. RESULTS: Nine studies were included in the review. Four studies reported on participants aged over 40 years (middle-aged and elderly) and five studies consisted exclusively of elderly subjects (over 60 years). Findings of vestibular dysfunction were diverse and the most common complaints were body imbalance or postural instability (3 studies), and vertigo or dizziness (3 studies). The Visual Analogue Scale (VAS) was the most commonly used instrument to assess subjective perception of symptoms of vestibular dysfunction (4 studies). According to the PEDro scale, four studies were considered to be of good quality. The most common experimental intervention was the Cawthorne & Cooksey protocol (4 studies). For most outcome measures, the studies comparing VR with another type of intervention showed no differences between the groups after the therapy. CONCLUSIONS: The studies included in this review provide evidence for the positive effects of VR in elderly and middle-aged adults with vestibular disturbances.