1. 85% of individuals randomized to receive web-based self-administered therapy treatment successfully navigated the platform and received the intervention.
2. Significantly more patients reported resolution of vertigo symptoms in the intervention group compared to the control group.
Evidence level assessment: 1 (excellent)
Research overview: Benign paroxysmal positional vertigo (BPPV) is a common and troublesome cause for primary care physicians and otorhinolaryngologists. BPPV is treated with bedside canalicular repositioning maneuvers, with reported success rates of 80% on one attempt and 92% on repeat. A previous study by Kim et al. developed and validated a questionnaire that allowed a patient to diagnose with high accuracy which semicircular canals were likely to be affected during her episode of BPPV. This randomized controlled trial sought to determine the efficacy of her web-based platform in guiding patients through self-treatment of BPPV.
585 patients were randomized into the trial, 292 in the intervention group and 293 in the control group. During the trial he found that 128 patients experienced her episode of BPPV, with no difference between groups. 72.4% of patients in the intervention group and 42.9% of patients in the control group reported resolution of symptoms after one session of self-treatment. Patients in the treatment arm who received correction of posterior canal BPPV had the highest success rate. The web-based program was well received by patients, with over 80% successfully using it at home without the help of research staff or family members.
This randomized controlled trial demonstrated that self-diagnosis and treatment using a web-based platform and questionnaire may prove effective in reducing the recurrence rate of BPPV. rice field. The trial’s effect size and randomized, double-blind design enhance the internal validity of the reported results. Limitations of this work include limited external validity (i.e., results are obtained from monoethnic patients and patients with access to a web-based platform) and subjectivity of primary outcome measures. This trial certainly demonstrates the potential for self-treatment of BPPV and further applications of her web-based patient management in the future.
Click here to read this study in JAMA Neurology
Related reading: Diagnosis of benign paroxysmal positional vertigo by questionnaire
detail [randomized controlled trial]: A multicenter, double-blind, randomized controlled trial was conducted. Patients were recruited from his four hospitals in South Korea. Eligible patients must be 20 years of age or older, diagnosed with univascular BPPV at an in-person physician visit, successfully treated for her BPPV using a canalicular repositioning procedure, and participating in a digital educational program. I was able to access the device for 1:1 block randomization was applied.
All patients were instructed to visit the study website – Stop! BPPV – if dizziness recurs. Patients in the intervention group received a validated questionnaire and were instructed by video to perform canalicular repositioning specific to the affected semicircular canals. People in the control group received video instructions for repositioning maneuvers performed at the first doctor’s visit. The primary outcome was resolution of her BPPV assessed in a telephone interview with a blinded investigator after attempting self-treatment.
21.9% of enrolled patients experienced a recurrent episode of BPPV, with no difference between treatment and control groups (19.9% vs. 23.9%, 95% confidence interval [CI], –0.11 to 0.03). The mean time to recurrent episode was 179.8 days. His 14.5% of patients were unable to access his web-based system. Proportions were similar between treatment and control groups. Significantly more patients in the intervention group than in the control group reported symptom resolution after one attempt at home repositioning (72.4% vs 42.9%; χ2 test: 95% CI, 0.13- 0.46). In the treatment group, posterior canal BPPV resolved in 96.4% of cases and horizontal canal BPPV resolved in 72.2% of cases. 80.7% of patients who successfully used the web-based system did so without assistance. Patients who needed help navigating the platform were older than those who did not (mean age 68.2 vs 58.0, p=0.001).
Image: PD
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