Different Vestibular Rehabilitation Modalities in Unilateral Vestibular Hypofunction: A Prospective Study.

OBJECTIVE: To assess the effectiveness of three vestibular rehabilitation protocols in patients with chronic unilateral vestibular hypofunction. STUDY DESIGN: Prospective randomized trial. SETTING: Audiology-neurootology laboratory in a general public hospital. PATIENTS: Eighty-one patients were randomly allocated into three groups: adaptation exercises (AEs), habituation exercises (HEs), and combined exercises (AE-HEs). INTERVENTIONS: Each patient completed an 8-week vestibular rehabilitation program with exercise, depending on their allocation group. MAIN OUTCOME MEASURES: Evaluations performed at baseline, 4 weeks, and 8 weeks with (a) Functional Gait Assessment (FGA), (b) Mini-BESTest, (c) Vestibular Rehabilitation Benefit Questionnaire, and (d) Dizziness Handicap Inventory. RESULTS: FGA and Mini-BESTest scores showed significant improvement between the baseline and 8-week scores in all groups (p < 0.001), except for the FGA score in the HE group. The AE-HE group showed better scores for all measurements at 4 weeks and had significantly better FGA and Mini-BESTest scores than the AE group and better FGA scores than the HE group. The Vestibular Rehabilitation Benefit Questionnaire and Dizziness Handicap Inventory scores in the AE-HE group were significantly better (p ≤ 0.001) than those in the HE group at 8 weeks. CONCLUSIONS: The AE-HE group showed faster improvement and significantly better outcomes for static balance, dynamic postural stability, and self-perceived disability than the single-exercise protocols in chronic unilateral vestibular hypofunction.

The Effect of Supervision in Vestibular Rehabilitation in Patients with Acute or Chronic Unilateral Vestibular Dysfunction: A Systematic Review.

OBJECTIVE: The investigation of supervised vestibular rehabilitation treatment role for individuals with dizziness and imbalance due to peripheral, unilateral vestibular disorders. DATABASES REVIEWED: Cochrane, PubMed, and Physiotherapy Evidence Database (PEDro) were utilized to identify relevant studies. METHODS: The key search terms used were "Vestibular Rehabilitation and Unilateral Vestibular Hypofunction," "Vestibular Rehabilitation and Unilateral Vestibular Loss," and "Vestibular Rehabilitation and Supervision." A manual search was performed by exploring the references of included articles to identify studies not captured through the computer-based searches. The quality of the studies was assessed according to the PEDro scale. Inclusion criteria were: 1) studies with patients, aged from 18 to 80 years, with acute or chronic dizziness and disequilibrium due to unilateral vestibular dysfunction, 2) randomized control trials (RCTs), 3) studies comparing supervised vestibular rehabilitation program with an unsupervised vestibular rehabilitation program or home-based training or standard care or placebo, and 4) articles written in the English language. Studies reporting cases of vertigo and imbalance due to possible recurrent pathologies, acute benign paroxysmal positional vertigo, or central neurological/orthopedic deficits, were excluded. RESULTS: A total of 448 articles were retrieved from the systematic database search strategy. Five of them were included in the systematic review after full-text analysis, plus one more after manual searching of their references. All studies involved supervised vestibular rehabilitation treatment programs compared with unsupervised home training, the performance of daily activities and, standard care. Based on PEDro's scoring system, one study rated as high-quality RCT, three studies were considered of fair quality and one scored as low-quality RCT. CONCLUSIONS: Although most RCTs report better outcomes with a supervised vestibular rehabilitation treatment program regarding the emotional status, dizziness, and balance improvement, this systematic review failed to provide a strong evidence that supervision is superior to unsupervised protocols in patients with UNH. The self-reported subjective measures used by the included RCTs represent a serious limitation of their results.

Knowledge of cardiopulmonary resuscitation among Greek physiotherapists.

High quality cardiopulmonary resuscitation (CPR) is crucial for influencing survival from cardiac arrest. Healthcare professionals are expected to know how to perform CPR as they may encounter emergency situations during their work. Physiotherapists, who use exercise as a therapeutic approach, should have good knowledge and skills in CPR not only to cope with possible adverse cardiac events during exercise but also because a widespread CPR application and early defibrillation can greatly reduce mortality due to heart attack. The aim of this study is to investigate knowledge of Greek physiotherapists in European Resuscitation Council guidelines for resuscitation. A secondary aim of this study was to assess and compare the knowledge score between those with and without previous training and/or lower self-confidence in CPR skills. Three hundred and fifty Greek physiotherapists who were working in hospitals and rehabilitation centres (face-to-face and e-mail contact) were randomly selected to complete an anonymous questionnaire containing demographic questions, CPR experience questions, and ten theoretical knowledge questions, based on European Resuscitation Council guidelines for resuscitation. The response ratio was 63% (n=220 physiotherapists). Respondents' total mean score for the theoretic knowledge questions was 4.1±2 (range 1-10); 21.4% of the respondents had participated in a CPR course, while only 0.9% had previous experience in CPR performance. The group of respondents who had attended a CPR course had a significantly higher score in CPR knowledge questions and higher confidence score (p<0.01). Moreover, the physiotherapists who attended refresher courses in CPR in the workplace scored significantly higher (p<0.01). Our results indicate that Greek physiotherapists have knowledge gaps in the European Resuscitation Council guidelines for resuscitation. The percentage of Greek physiotherapists who had CPR certification and recertification was low, thus the CPR training should be mandatory for all working physiotherapists.