Yardley L, Donovan-Hall M, Smith HE, et al: Effectiveness of primary care-based vestibular rehabilitation for chronic dizziness. Ann Intern Med 2004;141(8):598-605.
Dieterich M: Easy, inexpensive, and effective: Vestibular exercises for balance control. Ann Intern Med 2004;141(8):641-3 (editorial).
Dizziness occurs in 5% to 10% of all patients seen in general practice and in 10% to 20% of all patients seen by neurologists and otolaryngologists. In this single-blinded, randomized, controlled trial, vestibular exercises were compared to usual care in 170 patients with a mean age of 62 years and a mean duration of symptoms of over 8 years. Vestibular rehabilitation includes a program of graded exercises that consist of eye, head, and body movements designed to stimulate the vestibular system. In this study, nurses in primary care received one half-day of training and then explained the exercises to each patient individually for 30 to 40 minutes. An additional educational telephone call was made 1 and 3 weeks after the single teaching session. After 3 months, dizziness symptoms and objective measurements of postural stability were significantly improved in the vestibular rehabilitation group compared to the usual medical care group, and the improvement was maintained at 6 months. Of 83 treated patients, 56 (67%) reported clinically significant improvement compared with 33 of 87 (38%) of usual care patients (relative risk 1.78 [95% CI, 1.31-2.42]). These results have special implications for people with age-related disequilibrium who should be encouraged to engage in physical exercise and balance training to improve compensatory mechanisms for postural stability.