Web-based rehabilitation may improve dizziness symptoms

Patients in the intervention group accessed an automated, six-session intervention to be completed over six weeks that taught specific exercises, such as nodding and shaking the head, as well as cognitive behavioral management strategies.


An online vestibular rehabilitation program may reduce dizziness and dizziness-related disability in older primary care patients, a study found.

Researchers conducted a single-center, single-blind randomized controlled trial comparing an Internet-based vestibular rehabilitation intervention (Balance Retraining, available for free online) with usual primary care in patients from 54 primary care practices in southern England. The study enrolled 296 patients ages 50 years and older with dizziness over the last two years that was made worse by head movements; 66% were women, and the median age was 67 years.

Patients in the intervention group accessed an automated, six-session intervention to be completed over six weeks that taught vestibular rehabilitation exercises and suggested cognitive behavioral management strategies. Vestibular rehabilitation consisted of specific exercises including nodding and shaking the head. Patients randomized to the usual care group continued to receive primary care, which typically consisted of reassurance and medication for nausea. Results appeared in the May/June Annals of Family Medicine.

Dizziness was measured by the Vertigo Symptom Scale–Short Form (VSS-SF) at baseline, three months, and six months. The primary outcome was VSS-SF score at six months. Higher scores on the VSS-SF represent higher levels of dizziness.

The VSS-SF was completed by 250 patients (84%) at three months and 230 patients (78%) at six months. Compared with the usual care group, the intervention group had less dizziness on the VSS-SF at three months (difference, 2.75 points; 95% CI, 1.39 to 4.12 points; P<0.001) and at six months (difference, 2.26 points; 95% CI, 0.39 to 4.12 points; P=0.02). Dizziness-related disability was also lower in the Internet-based vestibular rehabilitation group at three months (difference, 6.15 points; 95% CI, 2.81 to 9.49 points; P<0.001) and six months (difference, 5.58 points; 95% CI, 1.19 to 10.0; P=0.01).

The intervention may have potential for wide application in community settings, the authors said.

“This trial has demonstrated that Internet-based vestibular rehabilitation is effective in reducing dizziness symptoms and dizziness-related disability in primary care patients,” the authors wrote. “Internet-based interventions may provide a promising means of greatly increasing the provision of evidence-based self-management strategies for older adults in primary care.”