Internet-based Vestibular Rehabilitation for Adults Aged 50 Years and Over: a Protocol for a Randomised Controlled Trial

Overview

Journal BMJ Open

Specialty General Medicine

Date 2014 Jul 24

PMID 25052178

Citations 15

Authors

Adam W A Geraghty

Sarah Kirby

Rosie Essery

Paul Little

Adolfo Bronstein

David Turner

Beth Stuart

Gerhard Andersson

Per Carlbring

Lucy Yardley

Affiliations

Soon will be listed here.

Abstract

Introduction: Dizziness is highly prevalent in older adults and can lead to falls, fear of falling, loss of confidence, anxiety and depression. Vestibular rehabilitation (VR) exercises are effective in reducing dizziness due to vestibular dysfunction, but access to trained therapists is limited. Providing dizzy patients with booklets teaching them how to carry out VR exercises has been shown to be a cost-effective way of managing dizziness in primary care. Internet-based intervention delivery has many advantages over paper-based methods, including the provision of video instructions, automated tailoring and symptom-related feedback. This trial will examine whether an internet-based VR intervention is (1) effective in reducing dizziness and (2) a cost-effective primary care treatment option.

Methods/analysis: This will be a single blind, randomised controlled trial carried out in UK primary care. A stand-alone internet-based VR intervention will be compared with routine care in 262 dizzy patients aged 50 years and over. Measures will be taken at baseline, 3 and 6 months. Our primary outcome measure will be the effectiveness of the intervention in reducing dizziness symptoms compared with routine care at 6 months. Cost-effectiveness will be examined along with the effect of the intervention on dizziness-related disability and symptoms of depression and anxiety. Psychological process variables including expectancy, self-efficacy and acceptance will be explored in relation to adherence and symptom reduction.

Ethics/dissemination: This trial has undergone ethical scrutiny and been approved by an NHS Research Ethics Committee, Southampton A REC Reference: 13/SC/0119. The findings of this trial will be disseminated to the scientific community through presentations at national and international conferences, and by publishing in peer review journals. Findings will be disseminated to the public through targeted press releases. This trial will provide valuable information on the role of internet interventions in facilitating self-management in older adults.

Trial Registration Number Isrctn: 86912968.

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References

Andersson G, Asmundson G, Denev J, Nilsson J, Larsen H . A controlled trial of cognitive-behavior therapy combined with vestibular rehabilitation in the treatment of dizziness. Behav Res Ther. 2005; 44(9):1265-73. DOI: 10.1016/j.brat.2005.09.008. View

Hillier S, Hollohan V . Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev. 2007; (4):CD005397. DOI: 10.1002/14651858.CD005397.pub2. View

Yardley L, Masson E, Verschuur C, Haacke N, Luxon L . Symptoms, anxiety and handicap in dizzy patients: development of the vertigo symptom scale. J Psychosom Res. 1992; 36(8):731-41. DOI: 10.1016/0022-3999(92)90131-k. View

Hanley K, O Dowd T . Symptoms of vertigo in general practice: a prospective study of diagnosis. Br J Gen Pract. 2002; 52(483):809-12. PMC: 1316083. View

Bennett G, Glasgow R . The delivery of public health interventions via the Internet: actualizing their potential. Annu Rev Public Health. 2009; 30:273-92. DOI: 10.1146/annurev.publhealth.031308.100235. View

Burker E, Wong H, Sloane P, Mattingly D, Preisser J, Mitchell C . Predictors of fear of falling in dizzy and nondizzy elderly. Psychol Aging. 1995; 10(1):104-10. DOI: 10.1037//0882-7974.10.1.104. View

Myers S, Phillips R, Davis R, Cherkin D, Legedza A, Kaptchuk T . Patient expectations as predictors of outcome in patients with acute low back pain. J Gen Intern Med. 2007; 23(2):148-53. PMC: 2359167. DOI: 10.1007/s11606-007-0460-5. View

Naber C, Water-Schmeder O, Bohrer P, Matonak K, Bernstein A, Merchant M . Interdisciplinary treatment for vestibular dysfunction: the effectiveness of mindfulness, cognitive-behavioral techniques, and vestibular rehabilitation. Otolaryngol Head Neck Surg. 2011; 145(1):117-24. DOI: 10.1177/0194599811399371. View

Yardley L . Overview of psychologic effects of chronic dizziness and balance disorders. Otolaryngol Clin North Am. 2000; 33(3):603-16. DOI: 10.1016/s0030-6665(05)70229-2. View

10.

Tijou I, Yardley L, Sedikides C, Bizo L . Understanding adherence to physiotherapy: findings from an experimental simulation and an observational clinical study. Psychol Health. 2010; 25(2):231-47. DOI: 10.1080/08870440802372431. View

11.

Colledge N, Lewis S, Sellar R, Wilson J . Evaluation of investigations to diagnose the cause of dizziness in elderly people: a community based controlled study. BMJ. 1996; 313(7060):788-92. PMC: 2352174. DOI: 10.1136/bmj.313.7060.788. View

12.

Sloane P, Coeytaux R, Beck R, Dallara J . Dizziness: state of the science. Ann Intern Med. 2001; 134(9 Pt 2):823-32. DOI: 10.7326/0003-4819-134-9_part_2-200105011-00005. View

13.

Sloane P, Blazer D, George L . Dizziness in a community elderly population. J Am Geriatr Soc. 1989; 37(2):101-8. DOI: 10.1111/j.1532-5415.1989.tb05867.x. View

14.

Bond F, Hayes S, Baer R, Carpenter K, Guenole N, Orcutt H . Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: a revised measure of psychological inflexibility and experiential avoidance. Behav Ther. 2011; 42(4):676-88. DOI: 10.1016/j.beth.2011.03.007. View

15.

Andersson G . Using the Internet to provide cognitive behaviour therapy. Behav Res Ther. 2009; 47(3):175-80. DOI: 10.1016/j.brat.2009.01.010. View

16.

Yardley L, Beech S, Weinman J . Influence of beliefs about the consequences of dizziness on handicap in people with dizziness, and the effect of therapy on beliefs. J Psychosom Res. 2001; 50(1):1-6. DOI: 10.1016/s0022-3999(00)00202-6. View

17.

Yardley L, Donovan-Hall M, Smith H, Walsh B, Mullee M, Bronstein A . Effectiveness of primary care-based vestibular rehabilitation for chronic dizziness. Ann Intern Med. 2004; 141(8):598-605. DOI: 10.7326/0003-4819-141-8-200410190-00007. View

18.

Agrawal Y, Carey J, Della Santina C, Schubert M, Minor L . Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001-2004. Arch Intern Med. 2009; 169(10):938-44. DOI: 10.1001/archinternmed.2009.66. View

19.

Hanley K, ODowd T, Considine N . A systematic review of vertigo in primary care. Br J Gen Pract. 2001; 51(469):666-71. PMC: 1314080. View

20.

Resnick B, Palmer M, Jenkins L, Spellbring A . Path analysis of efficacy expectations and exercise behaviour in older adults. J Adv Nurs. 2000; 31(6):1309-15. DOI: 10.1046/j.1365-2648.2000.01463.x. View