Internet-based rehab safe, effective for chronic vestibular syndrome, study finds

Patients with chronic vestibular syndrome were randomly assigned to a six-week internet-based intervention with weekly online sessions and 10 to 20 minutes of exercise a day, the internet-based intervention plus in-person physiotherapy support with home visits in weeks 1 and 3, or usual care.


Internet-based vestibular rehabilitation, alone and in combination with in-person physiotherapy, appeared safe and effective for adults with chronic vestibular syndrome in a recent study.

Researchers in the Netherlands performed a pragmatic, three-armed, parallel-group, individually randomized controlled trial to determine the clinical effectiveness and safety of internet-based vestibular rehabilitation in patients with chronic vestibular syndrome. Between June 2017 and July 2018, patients from 59 general practices were randomly assigned to stand-alone rehab, a six-week internet-based intervention with weekly online sessions and 10 to 20 minutes of exercise a day; blended rehab, the internet-based intervention plus in-person physiotherapy support with home visits in weeks 1 and 3; or usual care, standard care from a general practitioner with no restrictions.

The study's primary outcome was vestibular symptoms after six months according to the Vertigo Symptom Scale-Short Form (VSS-SF), which has a range of 0 to 60, with a difference of at least 3 points considered clinically relevant. Impairment related to dizziness, anxiety, depressive symptoms, subjective improvement in symptoms after three and six months, and adverse events were secondary outcomes. Study results were published on Nov. 5 by The BMJ.

Three hundred twenty-two adults ages 50 years and older were included in the study, 98 in the stand-alone group, 104 in the blended group, and 120 in the usual care group. Mean age was 67.0 years, and 61% of patients were women. At three and six months, complete follow-up data were available for 292 (91%) and 286 (89%) of patients, respectively. In the intention-to-treat analysis, VSS-SF scores were lower at six months in the stand-alone group (adjusted mean difference, −4.1 points; 95% CI, −5.8 to −2.5 points) and blended group (adjusted mean difference, −3.5 points; 95% CI, −5.1 to −1.9 points) than in the usual care group. Similar differences from usual care were seen at three-month follow-up (adjusted mean differences, −4.3 points [95% CI, −5.9 to −2.6 points] and −3.9 points [95% CI, −5.5 to −2.3 points], respectively). Patients in the stand-alone and blended groups were less likely than those in the usual care group to have dizziness-related impairment and anxiety and were more likely to have subjective improvement of vestibular symptoms at three and six months. Sixteen serious adverse events were reported during the trial, but none appeared to be related to the online intervention.

The researchers noted that fewer than 10% of those invited to participate enrolled in the trial and that harms may have been underreported, among other limitations. They concluded that internet-based vestibular rehabilitation is safe and effective for adults ages 50 years and older who have chronic vestibular syndrome. “Although further research is needed to determine if certain participants might benefit more from either stand alone or blended VR [vestibular rehabilitation], this trial shows that both forms of internet based VR can reduce vestibular syndromes,” the authors wrote. “By providing general practitioners with an easily accessible, low cost form of treatment, online VR has the potential to substantially improve care for a largely undertreated group of patients with a chronic vestibular syndrome in general practice.”