Healthcare, Vol. 11, Pages 90: Effectiveness of Vestibular Rehabilitation after Concussion: A Systematic Review of Randomised Controlled Trial

Soberg H.L. et al. (2021) [26]Single blind RCTn = 64 (19 males, 45 females). Mean age was 39.4 (SD 13.0). There was a measure at the baseline (T0) then at the first follow-up (T1) at 2.7 (SD 0.8) months after the baseline. The second follow-up (T2) was 4.4 (SD 1.0) months after the baseline.Both groups received the TAU
Intervention Group: TAU combined with an individualised group-based VR programme, 16 sessions in 8 weeks. VR exercises were tailored and described in another study (27).
Control group: only TAU.QOLIBRI and HRQL were the main outcome measures. RPQ,
VSS-SF, and HADS are the secondary outcome measures. Significant group effect in favour of the intervention group in HRQL on the QOLIBRI. The score at T0 of the QOLIBRI was between 45.4 and 66.7 (SD between 19.2 and 22.7), while at T2, the score was between 55.3 and 66.6 (SD between 20.3 and 24.7). The p-value for the QOLIBRI was <0.02.Reneker J.C. et al. (2017) [25]Double-blind RCTn = 41. The population included athletes, participating in sports aged 10–23 years with an acute concussion and dizziness diagnosed with PCS. The intervention group (n = 22) with a mean age of 16.5,
control group (n = 19) with a mean age of 15.9.
The follow-up was made after a 4-week period. Group 1: The PT designed an individualised and progressive treatment plan. VR included different techniques (including habituation and adaptation), oculomotor control, neuromotor control (including proprioceptive and kinesthetic awareness), and balance exercises were added to each subject’s treatment regimen as indicated Generally, each intervention session lasted between 30 and 60 minutes.
Group 2: The PT delivered interventions that ranged from sham, sub-therapeutic, and non-progressive therapeutic techniques to minimally progressive therapeutic techniques.Primary outcomes: symptomatic recovery with PCS and medical clearance for RTP.
The median time for medical release was 10.5 days sooner in the experimental group than in the control group. The median time for PCS recovery was 3.5 days sooner in the experimental group than in the control group. Considering Cox proportional hazards regression for time until medical release for RTP, the experimental group demonstrated a hazard ratio of 2.91 compared to the control group. (95% CI: 1.01, 8.43).Jafarzadeh, S, et al. (2018) [24]RCTn = 20 adult patients (aged 18–60 years). Patients had a mean age of 44.2 (SD 12.6). The follow-up was after 4 weeks of rehabilitation.Participants were randomly divided into two groups.
Control Group: received the usual medical therapy (Betaserc 8 mg pills; at least three pills per day).
Intervention Group: received medical therapy and VR after a 4-week period. Different VR techniques were proposed considering the baseline condition of the patients. Different gaze stabilisation and adaptation exercises were used in all patients, although substitution exercises including standing and walking exercise were used only in patients with unsteadiness. More detailed data were summarized in the study. DHIEarly vestibular rehabilitation programme can decrease vertigo symptoms and increase stability and balance performance. Medical therapy group at week one was 1.8 (SD = 10.9) while at week four was 0.2 (SD = 7.8). The medical therapy and vestibular rehabilitation group at week 1 was −2.0 (SD = 8.7) while at week four was 20.0 (SD = 11.0) with p = 0.000.Kleffelgaard I. et al. (2019) [23]RCTn = 65 with TBI (45 females and 19 males). Intervention group (n = 32) with a mean age of 37.6 (SD 12.3) and control group (n = 31) with a mean age of 41.2 (SD 13.6).
Baseline at 3.5 (mean) months after injury. First follow-up at a mean of 2.7 months. Second follow-up at two months after the end of the intervention.Control group: (n = 32) did not receive any rehabilitation intervention.
Intervention group: (n = 33) received a group-based vestibular rehabilitation. VR exercises were tailored and described in another study (27). The intervention was twice weekly for eight weeks.
Both groups received usually multidisciplinary outpatient care. Primary outcome: DHI
Secondary Outcome: HiMAT, VSSV, VSSa, RP3, RPQ13, HADSa, HADSd, and BESS First follow-up, statistically significant mean differences in favour of the intervention were found in DHI (−8.7 points, 95% CI: –16.6 to −0.9) and HiMAT (3.7 points, 95% CI: 1.4–6.0).
The p-value was significant for first follow-up: the DHI p = 0.03 and the HiMAT p = 0.002. No significant difference in other outcomes.Schneider M.J. et al. (2014) [29]RCTTreatment group (n = 15): 11 males, 4 females. Median age: 15 (SD 12–27).
Control group (n = 16): 7 males, 9 females. Median age: 15 (SD 13–30).Both groups performed non-provocative range of motion exercises, stretching, and postural education.
Treatment group: in addition, received an individual designed vestibular rehabilitation and cervical spine physiotherapy. VR includes an individualised programme of habituation, gaze stabilisation, adaptation exercises, standing balance exercises, dynamic balance exercises, and canalith repositioning manoeuvres.(1) Number of days until medical clearance to return to sport.
(2) 11-point Numeric Pain Rating Scale score, ABC scale, DHI, SCAT2, DVA, head thrust test, modified motion sensitivity test, FGA, CFE, and JPE.Return to Sport: OR 10.27, p < 0.001 for return to sport in 8 weeks for the intervention group. Intention to treat analysis: OR 3.91 (95% CI 1.34 to 11.34) for the treatment group to be medically cleared to return to sport compared with the control group, (p = 0.002). No between-group analyses for secondary outcomes were reported.Kontos A.P. et al. (2021)
[27]RCTTreatment group (n = 25): 16 females, 9 males. Median age: 15.3 (SD 1.6).
Control group (n = 25): 15 females, 10 males. Median age: 15.3 (SD 1.7).
The outcomes were recorded at 2 and 4 weeks post-intervention. The participants who were recovered by 2 or 4 weeks stopped the intervention and completed the clinical outcomes.Both groups performed a behavioural management.
Treatment group performed also individual VR and home VR exercises for 30 minutes per day.
Control group: performed stretching and physical activity for 30 minutes per day.VOMS: to assess the VOR, DHI, mBESS, and PCSSThere was a medium treatment effect size for horizontal VOR and VMS (0.09–0.11) and large for vertical VOR (0.16).
The subscales of DHI-F demonstrated a medium treatment effect size (0.06–0.1), whereas all other secondary outcomes demonstrated a small treatment effect (0.01–0.06).
Significant statistical difference was shown only for horizontal VOR (p = 0.04) and vertical VOR (p = 0.01). No other significantly differences were shown.Langevin P. et al. (2022)
[28]RCTTreatment group: (n = 30): 20 females, 10 males. Mean age: 38.9 (SD 14.56)
Control group (n = 30): 21 females, 9 males. Mean age: 39.07 (SD 12.63).
The outcomes were recorded at baseline, and after 3, 6, 12, and 26 weeks.Both groups received education and advice about exercise tolerance and concussion.
Control group received 8 sessions in 6 weeks of supervised cardiovascular exercise.
Treatment group received the same treatment as control group +1 to 8 sessions of cervicovestibular treatment. The treatment consisted in manual and therapeutic exercises for cervical spine and repositioning manoeuvre, vestibular adaptation, ocular motor exercise, balance, and habituation exercisePCSS, DHI, NPRS, clearance to return to function, VOMS, and head impulse test (HIT).No group by time interaction difference was observed for PCSS, DHI, NPRS, and return to function. All the groups demonstrated a statistically significant difference from the baseline. A group by time interaction was observed for horizontal and vertical VOR in favour of the treatment group at 6 weeks (p < 0.01). A difference for group interactions was observed for HIT (p < 0.01).

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