Assessing the synergistic effectiveness of intermittent theta burst stimulation and the vestibular ocular reflex rehabilitation protocol in the treatment of Mal de Debarquement Syndrome: a randomised controlled trial.

INTRODUCTION: Mal de Debarquement Syndrome (MdDS) is a rare central vestibular disorder characterised by a constant sensation of motion (rocking, swaying, bobbing), which typically arises after motion experiences (e.g. sea, air, and road travel), though can be triggered by non-motion events. The current standard of care is non-specific medications and interventions that only result in mild-to-moderate improvements. The vestibular ocular reflex (VOR) rehabilitation protocol, a specialised form of rehabilitation, has shown promising results in reducing symptoms amongst people with MdDS. Accumulating evidence suggests that it may be possible to augment the effects of VOR rehabilitation via non-invasive brain stimulation protocols, such as theta burst stimulation (TBS). METHODS: The aim of this randomised controlled trial was to evaluate the effectiveness of intermittent TBS (iTBS) over the dorsolateral prefrontal cortex in enhancing the effectiveness of a subsequently delivered VOR rehabilitation protocol in people with MdDS. Participants were allocated randomly to receive either Sham (n = 10) or Active (n = 10) iTBS, followed by the VOR rehabilitation protocol. Subjective outcome measures (symptom ratings and mental health scores) were collected 1 week pre-treatment and for 16 weeks post-treatment. Posturography (objective outcome) was recorded each day of the treatment week. RESULTS: Significant improvements in subjective and objective outcomes were reported across both treatment groups over time, but no between-group differences were observed. DISCUSSION: These findings support the effectiveness of the VOR rehabilitation protocol in reducing MdDS symptoms. Further research into iTBS is required to elucidate whether the treatment has a role in the management of MdDS. TRN: ACTRN12619001519145 (Date registered: 04 November 2019).

Can a professional development workshop with follow-up alter practitioner behaviour and outcomes for neck pain patients? A randomised controlled trial.

BACKGROUND: Continuing professional development (CPD) is a fundamental component of physiotherapy practice. Follow-up sessions provide opportunity for the refinement of skills developed during CPD workshops. However, it is necessary to identify if such opportunity translates to improved physiotherapist performance and patient outcomes. OBJECTIVES: To determine whether a traditional CPD workshop with a follow-up session with the educator is more likely to change physiotherapists' practice behaviour and patient outcomes than a traditional workshop with no opportunity for follow-up. DESIGN: A single-blind, randomised controlled trial. METHODS: Participants were stratified and randomly allocated to the intervention and control groups. The control group participated in a two-day workshop dedicated towards the management of neck disorders. The intervention group completed the two-day workshop and attended a five-hour follow-up session one month later. Outcome measures included self-reported physiotherapist practice behaviour and confidence, as well as patient clinical outcomes using the Neck Disability Index. RESULTS: While all participants exhibited changes in confidence and practice behaviours, between-group differences were not significant for any response (p > 0.05). There were also no significant differences between the groups in terms of patient outcomes (Neck Disability Index: F = 0.36, p = 0.56). CONCLUSION: A single follow-up session to a traditional workshop is insufficient to significantly influence practice behaviours or patient outcomes.