Multimodal Physiotherapy for Balance and Vertigo in BPPV Patients

Effects of Multimodal Physiotherapy Approach on Balance, Vertigo, Fear of Fall, and Quality of Life in Patients With Benign Paroxysmal Positional Vertigo

This study aims to evaluate the effects of a multimodal physiotherapy approach on balance, vertigo, fear of falling, and quality of life in patients with benign paroxysmal positional vertigo (BPPV). BPPV is a common vestibular disorder that causes dizziness and balance problems, leading to an increased risk of falls and reduced quality of life. In this randomized controlled trial, participants will be assigned to two groups: one receiving a multimodal physiotherapy program including patient education, Epley maneuver, and balance training, and the other receiving standard Epley maneuver treatment. The intervention will be conducted over four weeks. Outcomes will be assessed using standardized tools for balance, vertigo, fear of falling, and quality of life. The study aims to determine whether a combined physiotherapy approach provides better outcomes than standard treatment alone.

Study Overview

• Status: Active, not recruiting
• Conditions: Vertigo; Benign Paroxysmal Positional Vertigo; Balance Disorder
• Intervention / Treatment: Behavioral: Multimodal Physiotherapy; Procedure: Epley Maneuver

Detailed Description

Benign paroxysmal positional vertigo (BPPV) is one of the most common vestibular disorders, characterized by brief episodes of vertigo triggered by changes in head position. It significantly affects balance, mobility, and quality of life, and increases the risk of falls, especially in older adults. Although repositioning maneuvers such as the Epley maneuver are considered the standard treatment, many patients continue to experience residual dizziness, imbalance, and fear of falling.

A multimodal physiotherapy approach that combines patient education, vestibular rehabilitation, and balance training may provide a more comprehensive strategy to address these residual impairments. This approach targets both the vestibular and functional components of recovery, potentially improving overall patient outcomes.

This study is a single-blinded randomized controlled trial designed to evaluate the effects of a multimodal physiotherapy approach compared to standard treatment in patients with BPPV. Participants aged 22 to 79 years diagnosed with BPPV will be recruited using a non-probability convenience sampling technique. Participants will be randomly allocated into two groups: the intervention group receiving patient education, Epley maneuver, and balance training, and the control group receiving only the Epley maneuver. The intervention will be administered three times per week for four weeks.

Outcome measures will include the Dynamic Gait Index for balance, Dizziness Handicap Inventory for vertigo, Falls Efficacy Scale-International for fear of falling, and SF-36 for quality of life. Assessments will be conducted at baseline and after completion of the intervention.

The results of this study will provide evidence on whether a multimodal physiotherapy approach is more effective than standard treatment in improving balance, reducing vertigo symptoms, decreasing fear of falling, and enhancing quality of life in patients with BPPV.

• Study Type: Interventional
• Enrollment (Estimated): 46
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Faisalabad, Punjab Province, Pakistan
      • Allied Hospital I & II

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Age group between (22-79). Both the genders Male and Female were included. Diagnosed with posterior canal benign paroxysmal positional vertigo (PC-BPPV) confirmed by a positive Dix-Hall pike maneuver.

Onset of symptoms within the past 3 months. Dynamic Balance impairment by DGI > 21. All patients had history of at least two or more attacks of BPPV over 6 months.

Exclusion Criteria:

Patients with a history of cervical spine injuries. Patients taking anti-vertigo medication. Patients with a previous diagnosis of Meniere's disease, migraine, or vestibular neuritis Patients with a previous history of neurological diseases. Cases with bilateral involvement. Absence of systemic diseases without medical control and absence of functional limitations that impede independent walking.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Multimodal Physiotherapy; participants will receive a multimodal physiotherapy program including patient education, Epley maneuver, and balance training, administered three times per week for four weeks.	Behavioral: Multimodal Physiotherapy; A combined rehabilitation approach including vestibular rehabilitation, patient education, and balance training aimed at improving balance, reducing vertigo, decreasing fear of falling, and enhancing quality of life.; Other Names: Multimodal Physiotherapy Approach (MPA); Procedure: Epley Maneuver; A repositioning technique involving sequential head and body movements to relocate displaced otoconia within the semicircular canals to relieve symptoms of benign paroxysmal positional vertigo.
Active Comparator: epley Maneuver; Participants will receive standard treatment using the Epley maneuver, administered three times per week for four weeks.	Procedure: Epley Maneuver; A repositioning technique involving sequential head and body movements to relocate displaced otoconia within the semicircular canals to relieve symptoms of benign paroxysmal positional vertigo.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Balance	Balance will be assessed using the Dynamic Gait Index (DGI), a validated tool that evaluates gait, stability, and functional mobility in individuals with balance disorders.	Baseline and Week 4

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Wajeeha Zia, phd, Riphah International University

Study record dates

Study Major Dates

• Study Start (Actual): June 5, 2025
• Primary Completion (Estimated): July 6, 2026
• Study Completion (Estimated): August 6, 2026

Study Registration Dates

• First Submitted: May 4, 2026
• First Submitted That Met QC Criteria: May 4, 2026
• First Posted (Actual): May 8, 2026

Study Record Updates

• Last Update Posted (Actual): May 8, 2026
• Last Update Submitted That Met QC Criteria: May 4, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Balance; Quality of Life; Benign Paroxysmal Positional Vertigo; Vertigo; Fear of fall; Multimodal Physiotherapy Approach
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Otorhinolaryngologic Diseases; Ear Diseases; Labyrinth Diseases; Vestibular Diseases; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Vertigo; Benign Paroxysmal Positional Vertigo
• Other Study ID Numbers: M.Usama Latif

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: There is no plan to share individual participant data. All data will be kept confidential and used solely for academic and research purposes.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No