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A randomized controlled trial of precision vestibular rehabilitation in adolescents following concussion: preliminary findings
Kontos AP, Eagle SR, Mucha A, Kochick V, Doman J, Moldolvan C, Holland CL, Blaney NA, Collins MW
The Journal of Pediatrics 2021 Dec;239:193-199
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; 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 a 4-week precision vestibular rehabilitation intervention compared with a behavioral management control intervention for adolescents with vestibular symptoms/impairment within 21 days of a concussion. STUDY DESIGN: This study utilized double-blind, randomized controlled trial design involving adolescent (12 to 18) patients with a diagnosed sport/recreation-related concussion with vestibular symptoms/impairment from a concussion-specialty clinic between October 2018 through February 2020. Eligible participants were randomized in a 1:1 ratio to either a 4-week vestibular intervention group (VESTIB) or a behavioral management group (control). Controls (N = 25) were prescribed behavioral management strategies (eg, physical activity, sleep, hydration, nutrition, stress management) and instructed to perform stretching/physical activity (eg, walking, stationary cycle) 30 minutes/day. VESTIB (N = 25) were prescribed precision vestibular rehabilitation exercises and instructed to perform at-home exercises for 30 minutes/day. Primary outcomes were improvement in Vestibular/Ocular Motor Screening (VOMS) vestibular items (ie, horizontal/vertical vestibular-ocular reflex, visual motion sensitivity) at 4-weeks post-enrollment. RESULTS: We screened 310 and enrolled a total of 55 (18%) adolescent patients who were randomized to one of the interventions. 50/55 (91%) participants completed all aspects of the study protocol. Participants in VESTIB improved significantly across the intervention period in horizontal (mean difference -1.628; 95% CI -3.20 to -0.06; p = 0.04) and vertical (mean difference-2.24; 95% CI -4.01 to -0.48; p = 0.01) vestibular-ocular reflex, but not visual motion sensitivity (mean difference -2.03; 95% CI -4.26 to 0.19) of the Vestibular/Ocular Motor Screening score compared with controls. CONCLUSIONS: Overall, the vestibular intervention group experienced greater clinical improvements in vestibular symptoms/impairment than controls across the 4-week intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT03555370.

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