Demont A1,2,3, Gedda M1
1French Authority for Health, Saint-Denis, France, 2University of Paris Diderot, Faculty of Medicine, Paris, France, 3Physiotherapy Clinic of 9th Paris, Paris, France
Background: Benign paroxysmal positional vertigo (BPPV) is the most common of all forms of vertigo. It is a symptomatology characterized by brief and recurrent episodes of vertigo triggered by changes in head position according to the application of gravity. This symptomatology presents numerous clinical presentations according to the semicircular canal affected. The heterogeneity of treatments proposed by health professionals found in clinical practice has sparked the interest of developing recommendations to improve the quality of care and outcomes of patients with BPPV.
Purpose: To purpose an evidence-based clinical guidelines on the available literature regarding diagnosis, assessment and physiotherapy management of adult population with a potential diagnosis of BPPV, evaluated in any setting in which a patient would be identified, monitored or managed.
Methods: A literature review was conducted using the databases: Medline, The Cochrane Library, PEDro, National Guideline Clearinghouse, HTA Database and ScienceDirect. A manual search was performed on the websites related to the research subject. Studies in english and french languages from 1997 to June 2017 was selected on efficiency and safety of possible interventions for adult population with BPPV. Each article was screened by title and abstract and those deemed relevant were reviewed. Relevant articles were retrieved and read in full to determine inclusion or exclusion. The methodological quality of each study was apparaised utilizing the appropriate level-of-evidence tool. Discretionary and requisite recommendations were formulated based on the available research and proposed for revision to an expert panel representing the fields of othorhinolaryngology, neurology, family medicine, emergency medicine and physiotherapy.
Results: The systematic retrieval yielded 258 articles after removal of duplicates and included additional articles. Of these, 168 were excluded based on independent review of title and abstract. Data from the remaining 90 publications was extracted, appraisal of methodological quality and level of evidence evaluated, and recommendations were formulated. 20 reached level 1a-c level of evidence. Recommendations were categorized as: clinical diagnosis, physiotherapy assessment, therapeutic maneuvers for posterior, horizontal and anterior canal BPPV.
Conclusion(s): The diagnosis of BPPV is based solely on the patient´s history, duration of vertigo episodes, symptoms experienced and reproduced on clinical examination and the circumstances of onset of symptoms without imaging or other specialized tests in patients who meet the exclusive clinical criteria of this symptomatology. Imaging exams, vestibular and audiometric tests are only intended to continue new investigations in the presence of an atypical clinical picture of BPPV. More studies are needed to demonstrate the effectiveness of therapeutic maneuvers used for anterior canal BPPV as well as the tools commonly used in clinical practice such as the rotary chair and Frenzel glasses.
Implications: This work suggests that the identification of BPPV should be carried out as early as possible by health professionals trained and involved in the management of these patients. It therefore seems essential for undergraduated and postgraduated programs to be continually updated in the light of proven knowledge in order to promote a high level of practice and to limit the heterogeneous practices that affect optimal patient management.
Keywords: Benign paroxysmal positional vertigo, Maneuvers, Physiotherapy
Funding acknowledgements: None
Purpose: To purpose an evidence-based clinical guidelines on the available literature regarding diagnosis, assessment and physiotherapy management of adult population with a potential diagnosis of BPPV, evaluated in any setting in which a patient would be identified, monitored or managed.
Methods: A literature review was conducted using the databases: Medline, The Cochrane Library, PEDro, National Guideline Clearinghouse, HTA Database and ScienceDirect. A manual search was performed on the websites related to the research subject. Studies in english and french languages from 1997 to June 2017 was selected on efficiency and safety of possible interventions for adult population with BPPV. Each article was screened by title and abstract and those deemed relevant were reviewed. Relevant articles were retrieved and read in full to determine inclusion or exclusion. The methodological quality of each study was apparaised utilizing the appropriate level-of-evidence tool. Discretionary and requisite recommendations were formulated based on the available research and proposed for revision to an expert panel representing the fields of othorhinolaryngology, neurology, family medicine, emergency medicine and physiotherapy.
Results: The systematic retrieval yielded 258 articles after removal of duplicates and included additional articles. Of these, 168 were excluded based on independent review of title and abstract. Data from the remaining 90 publications was extracted, appraisal of methodological quality and level of evidence evaluated, and recommendations were formulated. 20 reached level 1a-c level of evidence. Recommendations were categorized as: clinical diagnosis, physiotherapy assessment, therapeutic maneuvers for posterior, horizontal and anterior canal BPPV.
Conclusion(s): The diagnosis of BPPV is based solely on the patient´s history, duration of vertigo episodes, symptoms experienced and reproduced on clinical examination and the circumstances of onset of symptoms without imaging or other specialized tests in patients who meet the exclusive clinical criteria of this symptomatology. Imaging exams, vestibular and audiometric tests are only intended to continue new investigations in the presence of an atypical clinical picture of BPPV. More studies are needed to demonstrate the effectiveness of therapeutic maneuvers used for anterior canal BPPV as well as the tools commonly used in clinical practice such as the rotary chair and Frenzel glasses.
Implications: This work suggests that the identification of BPPV should be carried out as early as possible by health professionals trained and involved in the management of these patients. It therefore seems essential for undergraduated and postgraduated programs to be continually updated in the light of proven knowledge in order to promote a high level of practice and to limit the heterogeneous practices that affect optimal patient management.
Keywords: Benign paroxysmal positional vertigo, Maneuvers, Physiotherapy
Funding acknowledgements: None
Topic: Professional practice: other; Professional practice: other; Service delivery/emerging roles
Ethics approval required: No
Institution: French National Authority for Health
Ethics committee: Transparency committee of the FAH
Reason not required: No ethics approval was required by the French Authority of Health (FAH).
All authors, affiliations and abstracts have been published as submitted.
