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BMC Geriatrics

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Open Access 01-12-2020 | Physical Therapy | Research article

Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review

Authors: Verena Regauer, Eva Seckler, Martin Müller, Petra Bauer

Published in: BMC Geriatrics | Issue 1/2020

Abstract

Background

Vertigo, dizziness and balance disorders (VDB) are among the most relevant contributors to the burden of disability among older adults living in the community and associated with immobility, limitations of activities of daily living and decreased participation. The aim of this study was to identify the quality of evidence of physical therapy interventions that address mobility and participation in older patients with VDB and to characterize the used primary and secondary outcomes.

Methods

A systematic search via MEDLINE (PubMed), Cochrane Library, CINAHL, PEDro, forward citation tracing and hand search was conducted initially in 11/2017 and updated in 7/2019. We included individual and cluster-randomized controlled trials and trials with quasi-experimental design, published between 2007 and 2017/2019 and including individuals ≥65 years with VDB. Physical therapy and related interventions were reviewed with no restrictions to outcome measurement. Screening of titles, abstracts and full texts, data extraction and critical appraisal was conducted by two independent researchers. The included studies were heterogeneous in terms of interventions and outcome measures. Therefore, a narrative synthesis was conducted.

Results

A total of 20 randomized and 2 non-randomized controlled trials with 1876 patients met the inclusion criteria. The included studies were heterogeneous in terms of complexity of interventions, outcome measures and methodological quality. Vestibular rehabilitation (VR) was examined in twelve studies, computer-assisted VR (CAVR) in five, Tai Chi as VR (TCVR) in three, canal repositioning manoeuvres (CRM) in one and manual therapy (MT) in one study. Mixed effects were found regarding body structure/function and activities/participation. Quality of life and/or falls were assessed, with no differences between groups. VR is with moderate quality of evidence superior to usual care to improve balance, mobility and symptoms.

Conclusion

To treat older individuals with VDB, VR in any variation and in addition to CRMs seems to be effective. High-quality randomized trials need to be conducted to inform clinical decision making.

Trial registration

PROSPERO 2017 CRD42017080291.

Available only for authorised users

Mueller M, Strobl R, Jahn K, Linkohr B, Peters A, Grill E. Burden of disability attributable to vertigo and dizziness in the aged: results from the KORA-age study. Eur J Public Health. 2014;24:802–7. https://doi.org/10.1093/eurpub/ckt171 .CrossRefPubMed

Mueller M, Schuster E, Strobl R, Grill E. Identification of aspects of functioning, disability and health relevant to patients experiencing vertigo: a qualitative study using the international classification of functioning, disability and health. Health Qual Life Outcomes. 2012;10:75. https://doi.org/10.1186/1477-7525-10-75 .CrossRefPubMedPubMedCentral

Mueller M, Strobl R, Jahn K, Linkohr B, Ladwig KH, Mielck A, et al. Impact of vertigo and dizziness on self-perceived participation and autonomy in older adults: results from the KORA-age study. Qual Life Res. 2014;23:2301–8. https://doi.org/10.1007/s11136-014-0684-x .CrossRefPubMed

Verghese J, Ambrose AF, Lipton RB, Wang C. Neurological gait abnormalities and risk of falls in older adults. J Neurol. 2010;257:392–8. https://doi.org/10.1007/s00415-009-5332-y .CrossRefPubMed

Agrawal Y, van de Berg R, Wuyts F, Walther L, Magnusson M, Oh E, et al. Presbyvestibulopathy: diagnostic criteria consensus document of the classification committee of the Bárány society. J Vestib Res. 2019. https://doi.org/10.3233/VES-190672 .

de Moraes SA, WJdS S, Ferriolli E, Perracini MR. Prevalence and correlates of dizziness in community-dwelling older people: a cross sectional population based study. BMC Geriatr. 2013;13:4. https://doi.org/10.1186/1471-2318-13-4 .CrossRefPubMedPubMedCentral

Neuhauser HK, Radtke A, von Brevern M, Lezius F, Feldmann M, Lempert T. Burden of dizziness and vertigo in the community. Arch Intern Med. 2008;168:2118–24. https://doi.org/10.1001/archinte.168.19.2118 .CrossRefPubMed

Gassmann KG, Rupprecht R. Dizziness in an older community dwelling population: a multifactorial syndrome. J Nutr Health Aging. 2009;13:278–82.CrossRefPubMed

Gomez F, Curcio CL, Duque G. Dizziness as a geriatric condition among rural community-dwelling older adults. J Nutr Health Aging. 2011;15:490–7.CrossRefPubMed

10.

Tinetti ME, Williams CS, Gill TM. Dizziness among older adults: a possible geriatric syndrome. Ann Intern Med. 2000;132:337–44. https://doi.org/10.7326/0003-4819-132-5-200003070-00002 .CrossRefPubMed

11.

Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults: data from the National Health and nutrition examination survey, 2001-2004. Arch Intern Med. 2009;169:938–44. https://doi.org/10.1001/archinternmed.2009.66 .CrossRefPubMed

12.

Hauer KA, Kempen GIJM, Schwenk M, Yardley L, Beyer N, Todd C, et al. Validity and sensitivity to change of the falls efficacy scales international to assess fear of falling in older adults with and without cognitive impairment. Gerontology. 2011;57:462–72. https://doi.org/10.1159/000320054 .CrossRefPubMed

13.

Jung JY, Kim J-S, Chung PS, Woo SH, Rhee CK. Effect of vestibular rehabilitation on dizziness in the elderly. Am J Otolaryngol. 2009;30:295–9. https://doi.org/10.1016/j.amjoto.2008.06.013 .CrossRefPubMed

14.

Redfern MS, Yardley L, Bronstein AM. Visual influences on balance. J Anxiety Disord. 2001;15:81–94.CrossRefPubMed

15.

Iwasaki S, Yamasoba T. Dizziness and imbalance in the elderly: age-related decline in the vestibular system. Aging Dis. 2015;6:38–47. https://doi.org/10.14336/AD.2014.0128 .CrossRefPubMed

16.

Wood JM, Lacherez PF, Black AA, Cole MH, Boon MY, Kerr GK. Postural stability and gait among older adults with age-related maculopathy. Invest Ophthalmol Vis Sci. 2009;50:482–7. https://doi.org/10.1167/iovs.08-1942 .CrossRefPubMed

17.

Hirsch L, Jette N, Frolkis A, Steeves T, Pringsheim T. The incidence of Parkinson's disease: a systematic review and meta-analysis. Neuroepidemiology. 2016;46:292–300.CrossRefPubMed

18.

Ebenbichler GR. Sensomotorik im Alter. Man Med. 2011;49:414–7. https://doi.org/10.1007/s00337-011-0885-0 .CrossRef

19.

Spiegel R, Rust H, Baumann T, Friedrich H, Sutter R, Göldlin M, et al. Treatment of dizziness: an interdisciplinary update. Swiss Med Wkly. 2017;147:w14566. https://doi.org/10.4414/smw.2017.14566 .CrossRefPubMed

20.

Fernández L, Breinbauer HA, Delano PH. Vertigo and dizziness in the elderly. Front Neurol. 2015. https://doi.org/10.3389/fneur.2015.00144 .

21.

Howe TE, Rochester L, Neil F, Skelton DA, Ballinger C. Exercise for improving balance in older people. Cochrane Database Syst Rev. 2011:CD004963. https://doi.org/10.1002/14651858.CD004963.pub3 .

22.

Whitney SL, Alghwiri A, Alghadir A. Physical therapy for persons with vestibular disorders. Curr Opin Neurol. 2015;28:61–8. https://doi.org/10.1097/WCO.0000000000000162 .CrossRefPubMed

23.

Schädler S. Gleichgewicht und Schwindel: Grundlagen Untersuchung Therapie. München: Urban et Fischer in Elsevier; 2016.

24.

Tjernström F, Zur O, Jahn K. Current concepts and future approaches to vestibular rehabilitation. J Neurol. 2016;263(Suppl 1):S65–70. https://doi.org/10.1007/s00415-015-7914-1 .CrossRefPubMed

25.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097. https://doi.org/10.1371/journal.pmed.1000097 .CrossRefPubMedPubMedCentral

26.

Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ. 2020;368:l6890. https://doi.org/10.1136/bmj.l6890 .CrossRefPubMedPubMedCentral

27.

Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]; 2011. www.handbook.cochrane.org. Accessed 26 Jul 2019.

28.

The Nordic Cochrane Centre. Review manager (RevMan) [computer program]. Version 5.3. Copenhagen; 2014.

29.

Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to meta-analysis. Chichester: Wiley; 2010.

30.

Acarer A, Karapolat H, Celebisoy N, Ozgen G, Colakoglu Z. Is customized vestibular rehabilitation effective in patients with Parkinson's? NeuroRehabilitation. 2015;37:255–62. https://doi.org/10.3233/NRE-151258 .CrossRefPubMed

31.

APdR A, Moriguti JC, Moreno NS. Condutas pós-manobra de Epley em idosos com VPPB de canal posterior. Braz J Otorhinolaryngol (Impr). 2010;76:300–5. https://doi.org/10.1590/S1808-86942010000300005 .CrossRef

32.

Au-Yeung SSY, Hui-Chan CWY, Tang JCS. Short-form tai chi improves standing balance of people with chronic stroke. Neurorehabil Neural Repair. 2009;23:515–22. https://doi.org/10.1177/1545968308326425 .CrossRefPubMed

33.

Chen EW, Fu ASN, Chan KM, Tsang WWN. The effects of tai chi on the balance control of elderly persons with visual impairment: a randomised clinical trial. Age Ageing. 2012;41:254–9. https://doi.org/10.1093/ageing/afr146 .CrossRefPubMed

34.

Gandolfi M, Geroin C, Dimitrova E, Boldrini P, Waldner A, Bonadiman S, et al. Virtual reality Telerehabilitation for postural instability in Parkinson's disease: a multicenter, single-blind, randomized, controlled trial. Biomed Res Int. 2017;2017:7962826. https://doi.org/10.1155/2017/7962826 .CrossRefPubMedPubMedCentral

35.

Geraghty AWA, Essery R, Kirby S, Stuart B, Turner D, Little P, et al. Internet-based vestibular rehabilitation for older adults with chronic dizziness: a randomized controlled trial in primary care. Ann Fam Med. 2017;15:209–16. https://doi.org/10.1370/afm.2070 .CrossRefPubMedPubMedCentral

36.

Hansson EE, Månsson N-O, Ringsberg KA, Håkansson A. Falls among dizzy patients in primary healthcare: an intervention study with control group. Int J Rehabil Res. 2008;31:51–7. https://doi.org/10.1097/MRR.0b013e3282f28e2c .CrossRefPubMed

37.

Hansson EE, Dahlberg LE, Magnusson M. Vestibular rehabilitation affects vestibular asymmetry among patients with fall-related wrist fractures - a randomized controlled trial. Gerontology. 2015;61:310–8. https://doi.org/10.1159/000366556 .CrossRef

38.

Liao Y-Y, Yang Y-R, Wu Y-R, Wang R-Y. Virtual reality-based Wii fit training in improving muscle strength, sensory integration ability, and walking abilities in patients with Parkinson's disease: a randomized control trial. Int J Gerontol. 2015;9:190–5. https://doi.org/10.1016/j.ijge.2014.06.007 .CrossRef

39.

Maciaszek J, Osinski W. Effect of tai chi on body balance: randomized controlled trial in elderly men with dizziness. Am J Chin Med. 2012;40:245–53. https://doi.org/10.1142/S0192415X1250019X .CrossRefPubMed

40.

Reid SA, Rivett DA, Katekar MG, Callister R. Comparison of mulligan sustained natural apophyseal glides and Maitland mobilizations for treatment of cervicogenic dizziness: a randomized controlled trial. Phys Ther. 2014;94:466–76. https://doi.org/10.2522/ptj.20120483 .CrossRefPubMed

41.

Ribeiro KMOBF, Freitas RVM, Ferreira LMBM, Deshpande N, Guerra RO. Effects of balance vestibular rehabilitation therapy in elderly with benign paroxysmal positional vertigo: a randomized controlled trial. Disabil Rehabil. 2017;39:1198–206. https://doi.org/10.1080/09638288.2016.1190870 .CrossRefPubMed

42.

Ricci NA, Aratani MC, Caovilla HH, Ganança FF. Effects of vestibular rehabilitation on balance control in older people with chronic dizziness: a randomized clinical trial. Am J Phys Med Rehabil. 2016;95:256–69. https://doi.org/10.1097/PHM.0000000000000370 .CrossRefPubMed

43.

Smaerup M, Laessoe U, Grönvall E, Henriksen J-J, Damsgaard EM. The use of computer-assisted home exercises to preserve physical function after a vestibular rehabilitation program: a randomized controlled study. Rehabil Res Pract. 2016;2016:7026317. https://doi.org/10.1155/2016/7026317 .CrossRefPubMedPubMedCentral

44.

Yang XJ, Hill K, Moore K, Williams S, Dowson L, Borschmann K, et al. Effectiveness of a targeted exercise intervention in reversing older people's mild balance dysfunction: a randomized controlled trial. Phys Ther. 2012;92:24–37. https://doi.org/10.2522/ptj.20100289 .CrossRefPubMed

45.

Yen C-Y, Lin K-H, Hu M-H, Wu R-M, Lu T-W, Lin C-H. Effects of virtual reality-augmented balance training on sensory organization and attentional demand for postural control in people with Parkinson disease: a randomized controlled trial. Phys Ther. 2011;91:862–74. https://doi.org/10.2522/ptj.20100050 .CrossRefPubMed

46.

Barcala L, Grecco LAC, Colella F, Lucareli PRG, Salgado ASI, Oliveira CS. Visual biofeedback balance training using wii fit after stroke: a randomized controlled trial. J Phys Ther Sci. 2013;25:1027–32. https://doi.org/10.1589/jpts.25.1027 .CrossRefPubMedPubMedCentral

47.

Fil-Balkan A, Salci Y, Keklicek H, Armutlu K, Aksoy S, Kayihan H, et al. Sensorimotor integration training in Parkinson’s disease. Neurosciences (Riyadh). 2018;23:208–15. https://doi.org/10.17712/nsj.2018.3.20180021 .CrossRef

48.

Kyrdalen IL, Moen K, Røysland AS, Helbostad JL. The Otago exercise program performed as group training versus home training in fall-prone older people: a randomized controlled trial. Physiother Res Int. 2014;19:108–16. https://doi.org/10.1002/pri.1571 .CrossRefPubMed

49.

Stam H, van der Wouden JC, Hugtenburg JG, Twisk JWR, van der Horst HE, Maarsingh OR. Effectiveness of a multifactorial intervention for dizziness in older people in primary care: a cluster randomised controlled trial. PLoS One. 2018;13:e0204876. https://doi.org/10.1371/journal.pone.0204876 .CrossRefPubMedPubMedCentral

50.

Zambare PD, Soni N, Sharma P. Effect of Cawthorne and Cooksey exercise program on balance and likelihood of fall in older women. Ind J Physioth Occupat Therapy - An Inter J. 2015;9:55. https://doi.org/10.5958/0973-5674.2015.00095.7 .CrossRef

51.

Rossi-Izquierdo M, Gayoso-Diz P, Santos-Pérez S, Del-Río-Valeiras M, Faraldo-García A, Vaamonde-Sánchez-Andrade I, et al. Vestibular rehabilitation in elderly patients with postural instability: reducing the number of falls-a randomized clinical trial. Aging Clin Exp Res. 2018;30:1353–61. https://doi.org/10.1007/s40520-018-1003-0 .CrossRefPubMed

52.

McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev. 2015;1:CD005397. https://doi.org/10.1002/14651858.CD005397.pub4 .CrossRefPubMed

53.

Deutsches Schwindel- und Gleichgewichtszentrum. Die häufigsten Schwindeldiagnosen. http://www.klinikum.uni-muenchen.de/Deutsches-Schwindelzentrum-IFB-LMU/de/Patienten/Informationen_zu_Schwindel_und_Gleichgewicht/Diagnose/index.html. Accessed 22 Jul 2019.

54.

Pardasaney PK, Latham NK, Jette AM, Wagenaar RC, Ni P, Slavin MD, et al. Sensitivity to change and responsiveness of four balance measures for community-dwelling older adults. Phys Ther. 2012;92:388–97. https://doi.org/10.2522/ptj.20100398 .CrossRefPubMed

55.

Lacour M, Bernard-Demanze L. Interaction between vestibular compensation mechanisms and vestibular rehabilitation therapy: 10 recommendations for optimal functional recovery. Front Neurol. 2014. https://doi.org/10.3389/fneur.2014.00285 .

56.

Martins AC, Santos C, Silva C, Baltazar D, Moreira J, Tavares N. Does modified Otago exercise program improves balance in older people? A systematic review. Prev Med Rep. 2018;11:231–9. https://doi.org/10.1016/j.pmedr.2018.06.015 .CrossRefPubMedPubMedCentral

57.

Hinman RS, Nelligan RK, Bennell KL, Delany C. "sounds a bit crazy, but it was almost more personal:" a qualitative study of patient and clinician experiences of physical therapist-prescribed exercise for knee osteoarthritis via Skype. Arthritis Care Res (Hoboken). 2017;69:1834–44. https://doi.org/10.1002/acr.23218 .CrossRef

58.

Lacroix A, Kressig RW, Muehlbauer T, Gschwind YJ, Pfenninger B, Bruegger O, et al. Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: a randomized controlled trial. Gerontology. 2016;62:275–88. https://doi.org/10.1159/000442087 .CrossRefPubMed

59.

Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012:CD007146. https://doi.org/10.1002/14651858.CD007146.pub3 .

60.

Lee LYK, Lee DTF, Woo J. The psychosocial effect of tai chi on nursing home residents. J Clin Nurs. 2010;19:927–38. https://doi.org/10.1111/j.1365-2702.2009.02793.x .CrossRefPubMed

61.

Whedon JM, Mackenzie TA, Phillips RB, Lurie JD. Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare part B beneficiaries aged 66 to 99 years. Spine. 2015;40:264–70. https://doi.org/10.1097/BRS.0000000000000725 .CrossRefPubMedPubMedCentral

62.

Hawk C, Schneider MJ, Haas M, Katz P, Dougherty P, Gleberzon B, et al. Best practices for chiropractic Care for Older Adults: a systematic review and consensus update. J Manipulative Physiol Ther. 2017;40:217–29. https://doi.org/10.1016/j.jmpt.2017.02.001 .CrossRefPubMed

63.

Magnusson M, Malmström E-M. The conundrum of cervicogenic dizziness. Handb Clin Neurol. 2016;137:365–9. https://doi.org/10.1016/B978-0-444-63437-5.00026-1 .CrossRefPubMed

64.

Collins ME, Misukanis TM. Chiropractic Management of a Patient with post traumatic vertigo of complex origin. J Chiropr Med. 2005;4:32–8. https://doi.org/10.1016/S0899-3467(07)60110-4 .CrossRefPubMedPubMedCentral

65.

Lystad RP, Bell G, Bonnevie-Svendsen M, Carter CV. Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: a systematic review. Chiropr Man Therap. 2011;19:21. https://doi.org/10.1186/2045-709X-19-21 .CrossRefPubMedPubMedCentral

Title: Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review
Authors: Verena Regauer
Eva Seckler
Martin Müller
Petra Bauer
Publication date: 01-12-2020
Publisher: BioMed Central
Keyword: Physical Therapy
Published in: BMC Geriatrics / Issue 1/2020
Electronic ISSN: 1471-2318
DOI: https://doi.org/10.1186/s12877-020-01899-9

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