Internet-based vestibular rehabilitation for older adults with chronic dizziness: A randomized controlled trial in primary care

Purpose: Vestibular Rehabilitation (VR) is an effective intervention for dizziness due to vestibular dysfunction, but is seldom provided. We aimed to determine the effectiveness of internet-based VR for older adults experiencing dizziness in primary care. Methods: A single centre, single blind randomised controlled trial comparing an internet-based VR intervention with usual primary care was conducted with patients from 54 primary care practices in southern England (ISRCTN: 86912968). Patients aged 50 years and over with current dizziness exacerbated by head movements were included in the trial. Patients accessed an automated internet-based intervention that taught VR exercises and suggested cognitive behavioural management strategies. Dizziness was measured by the Vertigo Symptom Scale Short-Form (VSS-SF) at baseline, 3 and 6 months. The primary outcome was VSS-SF score at 6 months. Results: A total of 296 patients were randomized into the trial (66% female, median age 67). The VSS-SF was completed by 250 participants at 3 months (84%: 123 intervention (77%), 127 usual care (93%)) and 230 participants at 6 months (78%: 112 intervention (70%), 118 usual care (87%)). At 3 and 6 months dizziness symptoms were significantly lower in the internet-based VR group compared to usual care (2.75, 95% CI, 1.39 to 4.12; p<0.001 and 2.26, 95% CI, 0.39 to 4.12; p=0.018 respectively). Dizziness-related disability was also significantly lower in the internet-based VR condition, at 3 (6.15 95% CI, 2.81 to 9.49; p<0.001) and 6 month (5.58, 95% CI, 1.19 to 10.0; p=0.013). Conclusions: Internet-based VR improves dizziness and reduces dizziness-based disability in older primary care patients without requiring clinical support, and has potential for wide application in community settings.