Dizziness has been reported in up to 58 per cent of women and 30 per cent of men over 65, with prevalence increasing with age.
| Study title: Effects of nonpharmacological interventions for dizziness in older people: A systematic review Authors: Kendall JC, Hartvigsen J, Azari MF & French SD Publication information:Physical Therapy 2016; 96: 641-649. |
Dizziness has been reported in up to 58 per cent of women and 30 per cent of men over 65, with prevalence increasing with age. Dizziness is associated with an increased risk of falls, leading to an increase in disability, morbidity and mortality, and a decrease in independence. Typically, older people are under-referred and under-treated for dizziness.
Dizziness can often be multifactorial in nature, but it has been categorized as being caused by: frailty, psychological disorders, cardiovascular disorders, presyncope (lightheadedness, weakness, blurred vision and feeling faint) and nonspecific disorders or disorders of the ear, nose and throat. It can also be associated with anxiety, spinal pain and increased medication use, including inappropriate prescriptions and polypharmacy.
Given the increased risk of falls associated with polypharmacy, it is important to examine the effectiveness of nonpharmacological therapies for dizziness in older people.
This was a systematic review that searched nine databases from inception to May 2014, using appropriate search terms for each database. Reference lists of included articles and relevant systematic reviews were screened for additional resources. Two authors independently screened titles and abstracts for inclusion. Two authors then independently applied the inclusion criteria to the full texts of the articles that remained following screening to determine which studies to include in the review.
Inclusion criteria
The study included ontrolled trials published in English. Study participants had to be over 60 years of age and have dizziness related to presbyastasis (age-related vestibular dysfunction), cervicogenic dizziness associated with osteoarthritis, nonspecific dizziness or dizziness with unspecified origin (other specific causes were excluded).
Interventions consisting of exercise, manual therapy, CBT and/or acupuncture were included in the review. Comparisons could include placebo, sham therapy, no treatment or another active intervention.
Primary outcome measures could be any self-reported measures of dizziness. Objective measures (such as balance, number of falls, or quality of life) could also be included.
Two authors independently extracted data from the included studies related to participant characteristics, interventions and outcomes. Two authors then independently assessed each included article for risk of bias according to the Cochrane 12-item criteria. In addition to evaluating the methodology, two authors assessed the clinical relevance of each included study using the five-item clinical relevance assessment of the Cochrane Back Review Group. Due to the heterogeneity of the included studies, meta-analysis of the data could not be performed and thus a narrative synthesis was completed.
Results
A total of 1,966 records were identified, 1,435 titles and abstracts were screened and 51 records were identified for full-text analysis. Forty were eventually reviewed (11 could not be translated). Seven studies met the inclusion criteria.
All included studies contained some form of exercise (vestibular rehabilitation, balance exercise or tai chi) as the main intervention.
Self-reported dizziness and balance were the most commonly used outcome measures.
With respect to studies showing significant differences, two studies favoured the interventions for self-reported dizziness and four studies favoured the intervention with respect to balance.
Application, conclusions
This review highlights the significant methodological flaws in the body of evidence studying nonpharmacological therapies for dizziness in those over 65 and the critical need for more clinically relevant studies.
The studies included in this review suggest the following may be beneficial:
- individual or group vestibular rehabilitation
- individualized or group strength and balance training
- Tai chi
- head-neck balance exercises based on the Cawthorne-Cooksey protocol
Importantly, the limited findings of this study will hopefully highlight the need for high quality research regarding the effectiveness of individual and combined therapies, and the optimal dose for prescribing them.
Dr. Shawn Thistle is the founder and CEO of RRS Education (rrseducation.com), which helps busy clinicians integrate current research evidence rationally into practice. He also maintains a practice in Toronto, lectures at CMCC and provides chiropractic medicolegal consulting services. Reach him at: shawn@rrseducation.com
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