Evaluating the Effectiveness of an Integrated Treatment of Vestibular Rehabilitation and Cognitive Behavior Therapy for Chronic Dizziness in a Community-Based Population: A Randomized Controlled Trial.

Abstract

Importance Chronic dizziness is common in primary care. Cognitive strategies combined with vestibular rehabilitation (VR) may enhance outcomes, but evidence from randomized controlled trials with long-term follow-up is limited. Objective The objective was to evaluate whether a group-based intervention integrating vestibular rehabilitation and cognitive behavioral strategies (VR-CBT) provides added benefit beyond a single-session brief vestibular intervention (BI-VR) in individuals with chronic dizziness. Design A Single-blinded, randomized controlled trial with assessments at baseline, and after 6 and 12 months was conducted. Setting The study was conducted in a primary care setting. Participants One hundred five adults with chronic dizziness were included in the study. Intervention/exposure All participants received BI-VR prior to allocation to either intervention or control group. The intervention comprised of an 8-session group-based program (VR-CBT) and was compared to telephone follow-up (control). Main outcome(s) and measure(s) Primary outcomes were dizziness-related handicap (DHI-N) and preferred gait speed, in addition to several secondary outcomes. Between-group differences were estimated using linear mixed-effects models with Holm-Bonferroni adjustment. Results DHI-N improved in both groups over time with no statistically significant between-group differences 6 months (6.3 points, 95% CI = -12.7 to 0.2) or 12 months (7.0 points, 95% CI = -13.3 to -0.6). No between-group differences were observed in preferred gait speed at 6 months (MD = 0.05 m/s, 95% CI = -0.03 to 0.13) or 12 months (MD = 0.07 m/s, 95% CI = -0.01 to 0.15). A between-group difference was observed for dizziness intensity after head movement at both follow-ups. No other consistent between-group differences were found. Conclusion Both groups showed sustained improvement in dizziness-related handicap over 12 months, with no statistically significant between-group differences in the primary outcomes. Further research is needed to clarify the usefulness of combined vestibular rehabilitation and cognitive behavioral strategies. Relevance Both approaches were associated with improvement over time, while the added value of VR-CBT remains uncertain.