Effect of vestibular rehabilitation therapy in patients with persistent postural perceptual dizziness: a systematic review and meta-analysis

Abstract

Background: Persistent Postural-Perceptual Dizziness (PPPD) is an increasingly recognized syndrome defined by enduring experiences of dizziness, unbalance, or non-vertiginous dizziness, generally persisting for a minimum of 3 months. This condition significantly impacts patients’ quality of life, highlighting the necessity for prompt and effective management. Vestibular rehabilitation therapy (VRT) has demonstrated efficacy in alleviating dizzy symptoms and enhancing balance. This meta-analysis seeks to assess the effectiveness of VRT in alleviating subjective dizzy symptoms and improving postural control in persons with PPPD. Methods: Two reviewers independently searched electronic databases (PubMed, EMBASE, SCOPUS, and the Cochrane Library) for pertinent studies investigating VRT for PPPD. Studies employing the Dizziness Handicap Inventory (DHI) as an assessment tool were included, provided they were extracted and presented in English from inception to March 7, 2025. Eight papers were included into this meta-analysis. Results: The aggregated weighted mean difference (WMD) indicated substantially improved outcomes for PPPD patients who underwent VRT compared to the control group in DHI-total scores (WMD = 21.84, 95% CI: [10.97, 32.71]). In subgroup analysis, DHI-total score improvements were observed in both customized VRT (WMD = 21.06, 95% CI: [5.65, 36.47]) and virtual reality-based VRT groups (WMD = 23.77, 95% CI: [8.09, 39.45]). Detailed data for DHI-Physical (DHI-P), Emotional (DHI-E), and Functional (DHI-F) scores from five trials (442 individuals) indicated a substantial reduction among PPPD patients receiving VRT (DHI-P: WMD = 17.92, 95% CI: [6.47, 29.38]; DHI-E: WMD = 10.51, 95% CI: [0.83, 20.19]; DHI-F: WMD = 15.00, 95% CI: [6.28, 23.72]). Conclusion: VRT can provide improvement for patients with PPPD, especially in DHI-total scores, DHI-P, DHI-E and DHI-F scores. Customized VRT demonstrated superior therapeutic efficacy compared with virtual reality-based VRT. However, additional randomized controlled trials are necessary to substantiate and inform the utilization of VRT in the treatment of PPPD.