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Effectiveness of conventional versus virtual reality-based balance exercises in vestibular rehabilitation for unilateral peripheral vestibular loss: results of a randomised controlled trial
Meldrum D, Herdman S, Vance R, Murray D, Malone K, Duffy D, Glennon A, McConn-Walsh R
Archives of Physical Medicine and Rehabilitation 2015 Jul;96(7):1319-1328
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To compare the effectiveness of virtual reality based vestibular rehabilitation to conventional vestibular rehabilitation, in patients with unilateral peripheral vestibular loss (UVL). DESIGN: Assessor blind, randomised controlled trial. SETTING: Two acute care university teaching hospitals PARTICIPANTS: Patients with UVL who had dizziness/vertigo, and gait and balance impairment. INTERVENTIONS: 71 patients with UVL were randomised to 6 weeks of either conventional (n = 36) or virtual reality based (n = 35) vestibular rehabilitation. The virtual reality group received a Nintendo Wii Fit Plus for home exercise and the conventional group received a foam balance mat. Treatment comprised weekly visits to a physiotherapist and a daily home exercise program. MAIN OUTCOME MEASURE(S): The primary outcome was self-preferred gait speed. Secondary outcomes included other gait parameters and tasks, Sensory Organisation Test (SOT), dynamic visual acuity, Hospital Anxiety and Depression Scale, Vestibular Rehabilitation Benefits Questionnaire, and Activities Balance Confidence Questionnaire. Subjective experience of vestibular rehabilitation was measured with a questionnaire. RESULTS: Both groups improved but there were no significant differences in gait speed between the groups post intervention (mean difference -0.03 m/sec; 95% CI -0.09 to 0.02m/sec). There were also no significant differences between the groups in SOT scores, mean difference; +0.82%; 95% CI -5.00 to 6.63%) or on any of the other secondary outcomes (p > 0.05). In both groups, adherence to exercise was high (approximately 77%) but the virtual reality based vestibular rehabilitation group reported significantly more enjoyment (p = 0.001), less difficulty with (p = 0.009), and less tiredness after (p = 0.03) exercises. At six months there were no significant between group differences in physical outcomes. Conclusion virtual reality based vestibular rehabilitation was not superior to conventional vestibular rehabilitation but may provide a more enjoyable method of retraining after balance peripheral vestibular loss.

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