Feasibility of integrating vestibular rehabilitation and cognitive behaviour therapy for people with persistent dizziness

Lene Kristiansen, L H Magnussen, B Juul-Kristensen, S Mæland, S H G Nordahl, A Hovland, T Sjøbø, K T Wilhelmsen, Lene Kristiansen, L H Magnussen, B Juul-Kristensen, S Mæland, S H G Nordahl, A Hovland, T Sjøbø, K T Wilhelmsen

Abstract

Purpose: To evaluate the feasibility of integrating vestibular rehabilitation and cognitive behaviour therapy (VR-CBT) for people with persistent dizziness in primary care.

Design: Prospective single-group pre- and post-test study.

Participants: Adults (aged 18-70) with acute onset of dizziness and symptoms lasting a minimum 3 months, recruited from Bergen municipality.

Methods: Participants attended eight weekly group sessions of VR-CBT intervention. Feasibility outcomes consisted of recruitment and testing procedures, intervention adherence, and participant feedback, besides change in primary outcomes. The primary outcomes were Dizziness Handicap Inventory (DHI) and preferred gait velocity.

Results: Seven participants were recruited for the study. All participants completed the pre-treatment tests, five participants completed the intervention and answered post-treatment questionnaires, and three completed post-treatment testing. Of the five participants, three attended at least 75% of the VR-CBT sessions, and two 50% of the sessions. Participants reported that the VR-CBT was relevant and led to improvement in function. DHI scores improved beyond minimal important change in two out of five participants, and preferred gait velocity increased beyond minimal important change in two out of three participants.

Conclusion: The current tests and VR-CBT treatment protocols were feasible. Some changes are suggested to optimise the protocols, before conducting a randomised controlled trial.

Trial registration: NCT02655575. Registered 14 January 2016-retrospectively registered.

Keywords: Cognitive behaviour therapy; Dizziness; Dizziness handicap inventory; Gait velocity; Persistent dizziness; Rehabilitation; Vestibular rehabilitation.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart for recruitment, inclusion, treatment, and follow-up of participants in feasibility study

References

    1. Bösner S, Schwarm S, Grevenrath P, et al. Prevalence, aetiologies and prognosis of the symptom dizziness in primary care–a systematic review. BMC Fam Pract. 2018;19(1):33. doi: 10.1186/s12875-017-0695-0.
    1. Heinrichs N, Edler C, Eskens S, et al. Predicting continued dizziness after an acute peripheral vestibular disorder. Psychosom Med. 2007;69(7):700. doi: 10.1097/PSY.0b013e318151a4dd.
    1. Godemann F, Siefert K, Hantschke-Bruggemann M, et al. What accounts for vertigo one year after neuritis vestibularis - anxiety or a dysfunctional vestibular organ? J Psychiatr Res. 2005;39(5):529. doi: 10.1016/j.jpsychires.2004.12.006.
    1. Lahmann C, Henningsen P, Brandt T, et al. Psychiatric comorbidity and psychosocial impairment among patients with vertigo and dizziness. J Neurol Neurosurg Psychiatry. 2014. 10.1136/jnnp-2014-307601.
    1. Wilhelmsen K, Ljunggren AE, Goplen F, et al. Long-term symptoms in dizzy patients examined in a university clinic. BMC Ear Nose Throat Disord. 2009;2009(9):2. doi: 10.1186/1472-6815-9-2.
    1. Wilhelmsen K, Kvåle A. Examination and treatment with focus on the musculoskeletal system: a case series. Phys Ther. 2014;94(7):1024. doi: 10.2522/ptj.20130070.
    1. Edelman S, Mahoney AE, Cremer PD. Cognitive behavior therapy for chronic subjective dizziness: a randomized, controlled trial. Am J Otolaryngol. 2012;33(4):395. doi: 10.1016/j.amjoto.2011.10.009.
    1. Yardley L, Owen N, Nazareth I, et al. Prevalence and presentation of dizziness in a general practice community sample of working age people. Br J Gen Pract. 1998;48(429):1131.
    1. Kvale A, Wilhelmsen K, Fiske HA. Physical findings in patients with dizziness undergoing a group exercise programme. Physiother Res Int. 2008;13(3):162. doi: 10.1002/pri.402.
    1. McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev. 2015. 10.1002/14651858.CD005397.
    1. Herdman SJ, Whitney SL. Physical therapy treatment of vestibular hypofunction. In: Herdman SJ, Clendaniel RA, editors. Vestibular rehabilitation. Contemporary perspectives in rehabilitation. 4. Philadelphia: F.A. Davis; 2014. pp. 394–431.
    1. Beidel DC, Horak FB. Behavior therapy for vestibular rehabilitation. J Anxiety Disord. 2001;15(1–2):121. doi: 10.1016/S0887-6185(00)00046-3.
    1. Pavlou M, Newham D. The principles of balance treatment and rehabilitation. In: Bronstein AM, editor. The Oxford textbook of vertigo and imbalance. Oxford: Oxford University Press; 2013. pp. 179–195.
    1. Whitney SL, Herdman S. Physical therapy assessment of vestibular hypofunction. In: Herdman S, Clendaniel RA, editors. Vestibular Rehabilitation. 4. Philadelphia: F.A. Davis Company; 2014. pp. 359–393.
    1. Bunkan B. Kropp, respirasjon og kroppsbilde. 4. Oslo: Gyldendal Akademiske; 2008.
    1. Wilhelmsen K, Nordahl SH, Moe-Nilssen R. Attenuation of trunk acceleration during walking in patients with unilateral vestibular deficiencies. JVestibRes. 2010;20(6):439. doi: 10.3233/VES-2010-0388.
    1. Schmid G, Henningsen P, Dieterich M, et al. Psychotherapy in dizziness: a systematic review. J Neurol Neurosurg Psychiatry. 2011;82(6):601. doi: 10.1136/jnnp.2010.237388.
    1. Mahoney AEJ, Edelman S, Cremer PD. Cognitive behavior therapy for chronic subjective dizziness: longer-term gains and predictors of disability. Am J Otolaryngol. 2013;34(2):115. doi: 10.1016/j.amjoto.2012.09.013..
    1. Craig P, Dieppe P, Macintyre S, et al. Developing and evaluating complex interventions: the new Medical Research Council guidance. Int J Nurs Stud. 2013;50(5):587. doi: 10.1016/j.ijnurstu.2012.09.010.
    1. Craig P, Dieppe P, Macintyre S, et al. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655. doi: 10.1136/bmj.a1655.
    1. Eldridge SM, Chan CL, Campbell MJ, et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot Feasibility Stud. 2016;2(1):64. doi: 10.1186/s40814-016-0105-8.
    1. Cawthorne T. The physiological basis for head exercises. Chart Soc Physiother. 1945;30:106.
    1. Cooksey FS. Rehabilitation in vestibular injuries. Proc R Soc Med. 1946;39:273.
    1. Indahl A, Haldorsen EH, Holm S, et al. Five-year follow-up study of a controlled clinical trial using light mobilization and an informative approach to low back pain. Spine. 1998;23(23):2625. doi: 10.1097/00007632-199812010-00018.
    1. Hall CD, Herdman SJ, Whitney SL, et al. Vestibular rehabilitation for peripheral vestibular hypofunction: an evidence-based clinical practice guideline: from the American physical therapy association neurology section. J Neurol Phys Ther. 2016;40(2):124. doi: 10.1097/NPT.0000000000000120.
    1. Losnegård AB. Svimmel- Finne balansen. Oslo; 2008. Available from: .
    1. Clark DM. A cognitive approach to panic. Behav Res Ther. 1986;24(4):461. doi: 10.1016/0005-7967(86)90011-2.
    1. Clark DM, Salkovskis PM, Hackmann A, et al. A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. Br J Psychiatry. 1994;164(6):759. doi: 10.1192/bjp.164.6.759.
    1. Clark DM, Salkovskis PM, Hackmann A, et al. Brief cognitive therapy for panic disorder: a randomized controlled trial. J Consult Clin Psychol. 1999;67(4):583. doi: 10.1037/0022-006X.67.4.583.
    1. Jacobson GP, Newman CW. The development of the Dizziness Handicap Inventory. ArchOtolaryngolHead Neck Surg. 1990;116(4):424. doi: 10.1001/archotol.1990.01870040046011.
    1. Tamber AL, Wilhelmsen KT, Strand LI. Measurement properties of the Dizziness Handicap Inventory by cross-sectional and longitudinal designs. Health Qual Life Outcomes. 2009. 10.1186/1477-7525-7-101.
    1. Whitney SL, Wrisley DM, Brown KE, et al. Is perception of handicap related to functional performance in persons with vestibular dysfunction. OtolNeurotol. 2004;25(2):139.
    1. Yardley L, Beech S, Zander L, et al. A randomized controlled trial of exercise therapy for dizziness and vertigo in primary care. Br J Gen Pract. 1998;48(429):1136.
    1. Yardley L, Burgneay J, Andersson G, et al. Feasibility and effectiveness of providing vestibular rehabilitation for dizzy patients in the community. Clin Otolaryngol Allied Sci. 1998;23(5):442. doi: 10.1046/j.1365-2273.1998.00179.x.
    1. Wilhelmsen K, Strand LI, Nordahl SH, et al. Psychometric properties of the Vertigo symptom scale - short form. BMCEar Nose Throat Disord. 2008 2008;8:2.
    1. Zigmond A, Snaith R. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Chambless DL, Caputo GC, Bright P, et al. Assessment of fear of fear in agoraphobics: the body sensations questionnaire and the agoraphobic cognitions questionnaire. J Consult Clin Psychol. 1984;52(6):1090–7.
    1. Piker EG, Kaylie DM, Garrison D, et al. Hospital anxiety and depression scale: factor structure, internal consistency and convergent validity in patients with dizziness. Audiology and Neurotology. 2015;20(6):394. doi: 10.1159/000438740.
    1. Radziej K, Probst T, Limburg K, et al. The longitudinal effect of vertigo and dizziness symptoms on psychological distress: symptom-related fears and beliefs as mediators. J Nerv Ment Dis. 2018;206(4):277.
    1. Hovland A, Johansen H, Sjøbø T, et al. A feasibility study on combining internet-based cognitive behaviour therapy with physical exercise as treatment for panic disorder—treatment protocol and preliminary results. Cogn Behav Ther. 2015;44(4):275. doi: 10.1080/16506073.2015.1022596.
    1. Herdman M, Gudex C, Lloyd A, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L) Qual Life Res. 2011;20(10):1727. doi: 10.1007/s11136-011-9903-x.
    1. Kim TH, Jo M-W, Lee S-i, et al. Psychometric properties of the EQ-5D-5L in the general population of South Korea. Qual Life Res. 2013;22(8):2245. doi: 10.1007/s11136-012-0331-3.
    1. Eriksen HR, Ihlebaek C, Ursin H. A scoring system for subjective health complaints (SHC) Scand J Public Health. 1999;27(1):63. doi: 10.1177/14034948990270010401.
    1. Hall CD, Herdman SJ. Reliability of clinical measures used to assess patients with peripheral vestibular disorders. JNeurolPhysTher. 2006;30(2):74–81.
    1. Perera S, Mody SH, Woodman RC, et al. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc. 2006;54(5):743. doi: 10.1111/j.1532-5415.2006.00701.x.
    1. Whitney SL, Marchetti GF, Schade A, et al. The sensitivity and specificity of the Timed “Up & Go” and the Dynamic Gait Index for self-reported falls in persons with vestibular disorders. J Vestib Res. 2004;14(5):397.
    1. Steffen TM, Hacker TA, Mollinger L. Age-and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Phys Ther. 2002;82(2):128. doi: 10.1093/ptj/82.2.128.
    1. Nordin E, Moe-Nilssen R, Ramnemark A, et al. Changes in step-width during dual-task walking predicts falls. Gait Posture. 2010;32(1):92. doi: 10.1016/j.gaitpost.2010.03.012.
    1. Tusa RJ. History and clinical examination. In: Herdman S, Clendaniel RA, editors. Vestibular rehabilitation. 4 ed. Philadelphia: F.A. Davis Company; 2014: 160–177.
    1. Rine RM, Braswell J. A clinical test of dynamic visual acuity for children. Int J Pediatr Otorhinolaryngol. 2003;67(11):1195. doi: 10.1016/j.ijporl.2003.07.004.
    1. Bohannon RW. Muscle strength: clinical and prognostic value of hand-grip dynamometry. Curr Opin Clin Nutr Metab Care. 2015;18(5):465. doi: 10.1097/MCO.0000000000000202.
    1. Smidt N, van der Windt DA, Assendelft WJ, et al. Interobserver reproducibility of the assessment of severity of complaints, grip strength, and pressure pain threshold in patients with lateral epicondylitis. Arch Phys Med Rehabil. 2002;83(8):1145. doi: 10.1053/apmr.2002.33728.
    1. Shumway-Cook A, Horak FB. Assessing the influence of sensory interaction on balance: suggestion from the field. Phys Ther. 1986;66(10):1548. doi: 10.1093/ptj/66.10.1548.
    1. Franchignoni F, Tesio L, Martino M, et al. Reliability of four simple, quantitative tests of balance and mobility in healthy elderly females. Aging Clin Exp Res. 1998;10(1):26. doi: 10.1007/BF03339630.
    1. Hageman PA, Leibowitz JM, Blanke D. Age and gender effects on postural control measures. Arch Phys Med Rehabil. 1995;76(10):961. doi: 10.1016/S0003-9993(95)80075-1.
    1. De Vet HC, Terwee CB, Mokkink LB, et al. Measurement in medicine. Cambridge: Cambridge University Press; 2011.
    1. Holmberg J, Karlberg M, Harlacher U, et al. Experience of handicap and anxiety in phobic postural vertigo. Acta Otolaryngol. 2005;125(3):270. doi: 10.1080/00016480410023001.
    1. Viccaro LJ, Perera S, Studenski SA. Is timed up and go better than gait speed in predicting health, function, and falls in older adults? J Am Geriatr Soc. 2011;59(5):887. doi: 10.1111/j.1532-5415.2011.03336.x.
    1. Fong E, Li C, Aslakson R, et al. A systematic review of patient-reported outcome measures in clinical vestibular research. Arch Phys Med Rehabil. 2014. 10.1016/j.apmr.2014.09.017.
    1. Giray M, Kirazli Y, Karapolat H, et al. Short-term effects of vestibular rehabilitation in patients with chronic unilateral vestibular dysfunction: a randomized controlled study. Arch Phys Med Rehabil. 2009;90(8):1325. doi: 10.1016/j.apmr.2009.01.032.
    1. Pollak L, Stryjer R. Fatigue during an episode of benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol. 2015;272(9):2129. doi: 10.1007/s00405-014-3041-3.
    1. Popkirov S, Staab JP, Stone J. Persistent postural-perceptual dizziness (PPPD): a common, characteristic and treatable cause of chronic dizziness. Pract Neurol. 2017. 10.1136/practneurol-2017-001809.
    1. Meldrum D, Herdman S, Vance R, et al. Effectiveness of conventional versus virtual reality–based balance exercises in vestibular rehabilitation for unilateral peripheral vestibular loss: results of a randomized controlled trial. Arch Phys Med Rehabil. 2015;96(7):1319. doi: 10.1016/j.apmr.2015.02.032.

Source: PubMed

3
Abonner