Vestibular Rehabilitation: Improving Symptomatic and Functional Outcomes of Persons With Vestibular Schwannoma: A Systematic Review

Overview

Journal Phys Ther

Publisher Oxford University Press

Specialty Rehabilitation Medicine

Date 2024 Jul 10

PMID 38982735

Authors

Jayden Yap

Gretta Palmer

Kate Graving

Shona Stone

Elise M Gane

Affiliations

Soon will be listed here.

Abstract

Objective: Persons with vestibular schwannoma suffer from dizziness, imbalance, and decreased function leading to reduced quality of life. Other forms of peripheral vestibular hypofunction show improvements in these signs and symptoms with vestibular rehabilitation; however, the efficacy of this intervention for those with vestibular schwannoma is unknown. Therefore, the aim of this systematic review was to determine the effect of vestibular physical therapy on subjective and objective measures of vestibular symptoms and function in people with vestibular schwannoma.

Methods: Four electronic databases were searched: PubMed, CINAHL, EMBASE, and Cochrane. Included studies were experimental or observational in design and featured patients with vestibular schwannoma who had undergone vestibular physical therapy. Screening and quality assessment was completed independently by 2 researchers. Risk of bias was assessed with a tool appropriate for study design (eg, Cochrane Risk of Bias 2.0 tool for randomized trials). The Grading of Recommendations Assessment, Development and Evaluation approach was used to synthesize findings.

Results: Twenty-three studies were included. Overall, the effect of vestibular physical therapy for patients with vestibular schwannoma was uncertain. Outcomes of dizziness, static and dynamic balance, and vestibular function all showed very low certainty on the Grading of Recommendations Assessment, Development and Evaluation assessment. Multimodal physical therapist interventions consistent with clinical practice guidelines (eg, gaze stability, habituation, balance training, gait training) demonstrated potential for improvement in dizziness, balance, and vestibular function, respectively. Results were mostly insignificant when a single modality was used.

Conclusion: There may be benefit in multimodal vestibular physical therapy for people with vestibular schwannoma to improve symptoms and function. More high-quality studies specific to vestibular schwannoma prehabilitation and rehabilitation are needed to increase the certainty in the evidence.

Impact: Physical therapists are encouraged to use multimodal vestibular rehabilitation for vestibular schwannoma in clinical practice in line with clinical guidelines for peripheral vestibular hypofunction.

References

Hruba S, Chovanec M, cada Z, Balatkova Z, Fik Z, Slaby K . The evaluation of vestibular compensation by vestibular rehabilitation and prehabilitation in short-term postsurgical period in patients following surgical treatment of vestibular schwannoma. Eur Arch Otorhinolaryngol. 2019; 276(10):2681-2689. DOI: 10.1007/s00405-019-05503-8. View

Magnusson M, Kahlon B, Karlberg M, Lindberg S, Siesjo P, Tjernstrom F . Vestibular "PREHAB". Ann N Y Acad Sci. 2009; 1164:257-62. DOI: 10.1111/j.1749-6632.2009.03778.x. View

Tjernstrom F, Fransson P, Kahlon B, Karlberg M, Lindberg S, Siesjo P . PREHAB vs. REHAB - presurgical treatment in vestibular schwannoma surgery enhances recovery of postural control better than postoperative rehabilitation: Retrospective case series. J Vestib Res. 2018; 27(5-6):313-325. DOI: 10.3233/VES-170626. View

Erbele I, MacDowell S, Arriaga M . Can Dizziness Handicap Inventory and Activities-Specific Balance Confidence Scores Assess Vestibular Loss After Vestibular Schwannoma Excision?. Otol Neurotol. 2020; 41(10):1427-1432. DOI: 10.1097/MAO.0000000000002842. View

cada Z, Balatkova Z, Chovanec M, cakrt O, Hruba S, Jerabek J . Vertigo Perception and Quality of Life in Patients after Surgical Treatment of Vestibular Schwannoma with Pretreatment Prehabituation by Chemical Vestibular Ablation. Biomed Res Int. 2017; 2016:6767216. PMC: 5178333. DOI: 10.1155/2016/6767216. View

Halliday J, Rutherford S, McCabe M, Evans D . An update on the diagnosis and treatment of vestibular schwannoma. Expert Rev Neurother. 2017; 18(1):29-39. DOI: 10.1080/14737175.2018.1399795. View

Thai N, Mai N, Vuong N, Tin N, Karam D, Refaey M . Treatment for vestibular schwannoma: Systematic review and single arm meta-analysis. Am J Otolaryngol. 2022; 43(2):103337. DOI: 10.1016/j.amjoto.2021.103337. View

Meli A, Zimatore G, Badaracco C, De Angelis E, Tufarelli D . Vestibular rehabilitation and 6-month follow-up using objective and subjective measures. Acta Otolaryngol. 2006; 126(3):259-66. DOI: 10.1080/00016480500388885. View

Balshem H, Helfand M, Schunemann H, Oxman A, Kunz R, Brozek J . GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011; 64(4):401-6. DOI: 10.1016/j.jclinepi.2010.07.015. View

10.

El-Kashlan H, Shepard N, Arts H, Telian S . Disability from vestibular symptoms after acoustic neuroma resection. Am J Otol. 1998; 19(1):104-11. View

11.

Millar J, Gimmon Y, Roberts D, Schubert M . Improvement After Vestibular Rehabilitation Not Explained by Improved Passive VOR Gain. Front Neurol. 2020; 11:79. PMC: 7044341. DOI: 10.3389/fneur.2020.00079. View

12.

Murad M, Mustafa R, Schunemann H, Sultan S, Santesso N . Rating the certainty in evidence in the absence of a single estimate of effect. Evid Based Med. 2017; 22(3):85-87. PMC: 5502230. DOI: 10.1136/ebmed-2017-110668. View

13.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

14.

Carlson M, Link M . Vestibular Schwannomas. N Engl J Med. 2021; 384(14):1335-1348. DOI: 10.1056/NEJMra2020394. View

15.

Nonaka Y, Fukushima T, Watanabe K, Friedman A, Sampson J, McElveen Jr J . Contemporary surgical management of vestibular schwannomas: analysis of complications and lessons learned over the past decade. Neurosurgery. 2012; 72(2 Suppl Operative):ons103-15. DOI: 10.1227/NEU.0b013e3182752b05. View

16.

Gupta V, Thakker A, Gupta K . Vestibular Schwannoma: What We Know and Where We are Heading. Head Neck Pathol. 2020; 14(4):1058-1066. PMC: 7669921. DOI: 10.1007/s12105-020-01155-x. View

17.

Schubert M, Migliaccio A, Clendaniel R, Allak A, Carey J . Mechanism of dynamic visual acuity recovery with vestibular rehabilitation. Arch Phys Med Rehabil. 2008; 89(3):500-7. PMC: 2951478. DOI: 10.1016/j.apmr.2007.11.010. View

18.

Marinelli J, Beeler C, Carlson M, Caye-Thomasen P, Spear S, Erbele I . Global Incidence of Sporadic Vestibular Schwannoma: A Systematic Review. Otolaryngol Head Neck Surg. 2021; 167(2):209-214. DOI: 10.1177/01945998211042006. View

19.

Levo H, Blomstedt G, Pyykko I . Postural stability after vestibular schwannoma surgery. Ann Otol Rhinol Laryngol. 2005; 113(12):994-9. DOI: 10.1177/000348940411301210. View

20.

Tjernstrom F, Fransson P, Kahlon B, Karlberg M, Lindberg S, Siesjo P . Vestibular PREHAB and gentamicin before schwannoma surgery may improve long-term postural function. J Neurol Neurosurg Psychiatry. 2009; 80(11):1254-60. DOI: 10.1136/jnnp.2008.170878. View