Web-based Rehab After Acute Vertigo

Internet-based Vestibular Rehabilitation Versus Standard Care After Acute Onset Vertigo

Acute onset vertigo is common and entails much suffering with persisting symptoms at 3 months after onset in up to half of those afflicted. Vestibular rehabilitation to aid recovery is not readily available. The purpose of this study is to investigate the effects on vertigo symptoms of a 6-week online vestibular rehabilitation tool compared with standard care (written instructions leaflet) after acute onset vertigo.

Study Overview

• Status: Completed
• Conditions: Acute Vestibular Syndrome
• Intervention / Treatment: Device: Online vestibular rehabilitation tool; Other: Standard care (written instructions leaflet)

• Study Type: Interventional
• Enrollment (Actual): 184
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Sweden
  • Borås, Sweden
    • Södra Älvsborg Hospital
  • Göteborg, Sweden
    • Sahlgrenska University Hospital
  • Linköping, Sweden
    • University Hospital Linköping
  • Sollefteå, Sweden
    • Sollefteå Hospital
  • Stockholm, Sweden
    • Karolinska University Hospital
  • Stockholm, Sweden
    • Capio Sankt Görans Hospital
  • Sundsvall, Sweden
    • Sundsvall Hospital
  • Södra Sunderbyn, Sweden
    • Sunderby Hospital
  • Umeå, Sweden
    • University Hospital Umeå

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• ≥18 years old; and
• The subject has given written consent to participate in the study; and
• New acute onset dizziness or vertigo since ≥24 hours with pathological spontaneous or gaze-evoked nystagmus (i.e. an acute vestibular syndrome, AVS). The nystagmus as described above must be present at investigation between 24 hours and 7 days from onset, spontaneously, gaze-evoked or head-shake evoked and documented; and
• Screening and inclusion within 7 days of onset of continuous symptoms; and
• Symptomatic at inclusion

Exclusion Criteria:

• Pre-existing vestibular disease or neurological disease anticipated to affect the ability to participate in the study or the effect of the intervention. N.B: Recurring AVS with no set diagnosis before inclusion is accepted, as is past transient neurological diseases such as TIA or migraine; or
• Inability to use the online rehabilitation tool, e.g. due to not having access to a computer, tablet or smartphone, not having access to the internet or lacking in experience with such tools; or
• Mental inability, reluctance or language difficulties that result in difficulty understanding the meaning of study participation; or
• Medical and/or physical contraindications to making the required head movements (e.g. vertebral dissection) or otherwise participating in the training and testing exercises or data collection; or
• Medication or other substance intake which can affect the ability to participate in the study or the reliability of the measurement methods. These medications include regular use of: Anticonvulsants, antiemetics/motion sickness medications, benzodiazepines, neuroleptics. Transient corticosteroid and/or antiemetic treatment related to the current vertigo is accepted.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention group	Device: Online vestibular rehabilitation tool; For those randomized to the intervention group, a 6 weeks duration vestibular rehabilitation will be delivered using an online tool (YrselTräning)
Active Comparator: Control group	Other: Standard care (written instructions leaflet); For those randomized to the control group, a 6 weeks duration standard vestibular rehabilitation will be delivered using a written instructions leaflet

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The between group mean Vertigo Symptom Scale Short Form (VSS-SF) score difference	VSS-SF uses a five-point Likert scale: 0 (never), 1 (a few times), 2 (several times), 3 (quite often [every week]), and 4 (very often [most days]). The score ranges from 0 to 60. A higher score indicates worse symptoms.	6 weeks after vertigo onset

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The between groups mean Dizziness Handicap Inventory (DHI) score	The Dizziness Handicap Inventory (DHI) uses a three-point scale to rate each item: 0 (no), 2 (sometimes), and 4 (always). The score ranges from 0 to 100. A higher overall score indicates more severe handicap.	6 weeks and 3 months after vertigo onset
The between groups changes in timed 25-foot walk test (T25-FW)); body sway during standing and walking; and the mobility		From baseline to 6 weeks and 3 months
The between groups changes in video head impulse test (vHIT, site-dependent)		6 weeks and 3 months after vertigo onset
The between groups changes in video head impulse test (vHIT, site-dependent) measured lateral canal VOR gain and saccades		From baseline to 6 weeks and 3 months
The between groups mean vertigo symptom scale short form (VSS-SF) score	VSS-SF uses a five-point Likert scale: 0 (never), 1 (a few times), 2 (several times), 3 (quite often [every week]), and 4 (very often [most days]). The score ranges from 0 to 60. A higher score indicates worse symptoms.	12 months after vertigo onset
The between group pedometer-derived mean weekly number of steps walked since last visit		3 months after vertigo onset
The between groups mean number of weekly training sessions		6 weeks after vertigo onset
Register-based search for health economic effects on all levels of care (primary, specialized) and society (sick leave)		12 months
The difference in kinematic output between measurement systems (i.e., multi-sensor and mobile app)		Three months after symptom onset
The reliability of the Swedish VSS-SF translation		Six weeks after symptom onset
The frequency of BPPV at 6 weeks and 3 months after AVS onset using a BPPV specific questionnaire and positional nystagmus tests		6 weeks and 3 months after vertigo onset

Other Outcome Measures

Outcome Measure	Time Frame
The proportion of participants who has experienced falls/fractures since study start	6 weeks, 3 months and 12 months
The number of falls/fractures in each study arm	6 weeks, 3 months and 12 months

Collaborators and Investigators

• Sponsor: Umeå University
• Collaborators: Karolinska University Hospital; Sundsvall Hospital; Sunderby Hospital; University Hospital, Linkoeping; University Hospital, Umeå; Västernorrland County Council, Sweden; Capio Sankt Görans Hospital; Södra Älvsborg Hospital; Sahlgrenska University Hospital
• Investigators: Principal Investigator: Jonatan Salzer, MD, PhD, Umeå University

Publications and helpful links

General Publications

• Surano S, Faergemann E, Granasen G, Salzer J. The reliability and validity of the Swedish translation of the Vertigo Symptom Scale - short form in a cohort with acute vestibular syndrome. Ann Med. 2025 Dec;57(1):2457517. doi: 10.1080/07853890.2025.2457517. Epub 2025 Feb 10.
• Surano S, Grip H, Ohberg F, Karlsson M, Faergemann E, Bjurman M, Davidsson H, Ledin T, Lindell E, Mathe J, Tjernstrom F, Tomanovic T, Granasen G, Salzer J. Internet-based vestibular rehabilitation versus standard care after acute onset vertigo: a study protocol for a randomized controlled trial. Trials. 2022 Jun 16;23(1):496. doi: 10.1186/s13063-022-06460-0.

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2021
• Primary Completion (Actual): February 1, 2024
• Study Completion (Actual): March 12, 2025

Study Registration Dates

• First Submitted: September 7, 2021
• First Submitted That Met QC Criteria: September 15, 2021
• First Posted (Actual): September 24, 2021

Study Record Updates

• Last Update Posted (Actual): March 30, 2025
• Last Update Submitted That Met QC Criteria: March 25, 2025
• Last Verified: August 1, 2024

More Information

Terms related to this study

• Keywords: vertigo; vestibular rehabilitation; acute vestibular syndrome
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Otorhinolaryngologic Diseases; Sensation Disorders; Ear Diseases; Labyrinth Diseases; Vestibular Diseases; Vertigo; Dizziness
• Other Study ID Numbers: Web-based vertigo rehab; CIV-21-05-036744 (Other Identifier: Swedish Medical Products Agency)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No