Vestibular Rehabilitation Using Dynamic Posturography: Objective and Patient-Reported Outcomes from a Randomized Trial

Abstract

Objective: Balance deficits are common and debilitating. Standard treatments have limitations in addressing symptoms and restoring dynamic balance function. This study compares a rehabilitative computerized dynamic posturography (CDP) protocol, computerized vestibular retraining therapy (CVRT), with a home exercise program (HEP) for patients with objectively confirmed unilateral vestibular deficits (UVDs). Study Design: Single-center, randomized, interventional trial, with 1-sided crossover. Setting: A tertiary neurotology clinic. Methods: Patients with UVDs and Dizziness Handicap Inventory (DHI) score >30 were randomized to receive either CVRT or HEP. After completion of treatment, the HEP group was crossed over to CVRT. Outcome measures were the sensory organization test (SOT) and 3 participants reported dizziness disability measures: the DHI, Activity-Specific Balance Confidence Scale (ABC) scale, and Falls Efficacy Score—International (FES-I). Results: We enrolled 37 patients: 18 participants completed CVRT and 12 completed HEP, 11 of whom completed the crossover. Seven participants withdrew. The CVRT group demonstrated a greater improvement in SOT composite score than the HEP group (P =.04). Both groups demonstrated improvement in participant-reported measures but there were no differences between groups (DHI: P =.2604; ABC: P =.3627; FES-I: P =.96). Following crossover to CVRT after HEP, SOT composite (P =.002), DHI (P =.03), and ABC (P =.006) improved compared to HEP alone. Conclusion: CVRT and HEP were both associated with improved participant-reported disability outcomes. CVRT was associated with greater improvement in objective balance than HEP. Adding CVRT after HEP was superior to HEP alone. Multimodal CDP-based interventions, such as CVRT, should be considered as an adjunct to vestibular physiotherapy for patients with UVD.