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Ekvall Hansson E1, Pessah-Rasmussen H1, Bring A2, Vahlberg B3, Persson L1
1Lund University, Department of Health Sciences, Lund, Sweden, 2Uppsala University, Department of Neuroscience, Uppsala, Sweden, 3Uppsala University Hospital, Department of Public Health and Caring Science, Clinical Nutrition and Metabolism, Uppsala, Sweden
Background: Dizziness is common among patients with first time stroke and it affects self perceived health negatively as well as increases the risk of falls. Vestibular rehabilitation was developed to treat dizziness caused by acute peripheral loss of function in the inner ear. Research has shown that vestibular rehabilitation also is effective for treating dizziness among persons with other diagnoses such as multisensory dizziness and dizziness concomitant to Multiple Sclerosis.
Purpose: The aim of this study was therefore to test the feasibility of vestibular rehabilitation among patients with stroke.
Methods: At the regular visit to physiotherapist, patients with first-time stroke were asked a question whether they had experienced any dizziness. Those who answered yes to this question was invited to participate in the study. All participants in the study was assessed with the Berg Balance Scale and the Activity Specific Balance Scale for measuring balance, function was measured with the generic instrument EuroQol-5D and self-rated health was measured by a visual analogue scale, included in the EuorQol-5D.
Participants were randomly allocated to intervention group or control group after measurements at baseline. The intervention comprised of four different vestibular rehabilitation exercises, adapted to the individual participant, as addition to usual rehabilitation. The control comprised of usual rehabilitation without the addition of vestibular rehabilitation exercises. All participants trained twice a week for three months. After three months, the same assessments was performed again.
Criteria for feasibility was:
A sample size of 30% of the required sample size for a randomized controlled trial, i.e. 12 participants in each group, a drop-out rate of no more than 30% and adherence to intervention with more than 80% .
Results: In total, 32 persons were included in the study, 19 women and 13 men aged 32 to 85 years (mean 68). The majority had been dizzy since the stroke and two persons had been dizzy before the stroke. The most common type of dizziness was unsteadiness (n=25), while only four persons had rotational or spinning type of dizziness and three persons had a combination of both. There were at total of 10 dropouts (31%), which sums up to 28% of the required sample size. Adherence to the intervention was high, all the participants in the intervention group fulfilled more than 90% of the sessions. Both groups improved in self-rated health, measured with EQ5D VAS (p=0.00 and 0.04). There were no other significant differences between baseline and follow up in any of the groups (p=0.15-0.48).
Conclusion(s): This study shows that adherence to vestibular rehabilitation for persons with stroke and concomitant dizziness was high. However, drop-out rate was high and it was very difficult to achieve large enough sample size even for a feasibility study.
Implications: Physiotherapist in Sweden already uses vestibular rehabilitation for this group of patients and therefore din not want their patients to be included in a study were the patient was at risk of being allocated to a control group and not receiving active treatment.
Keywords: Stroke, Dizziness, Vestibular Rehabilitation
Funding acknowledgements: The study was funded by the Swedish Stroke Association and Färs and Frosta Sparbank.
Purpose: The aim of this study was therefore to test the feasibility of vestibular rehabilitation among patients with stroke.
Methods: At the regular visit to physiotherapist, patients with first-time stroke were asked a question whether they had experienced any dizziness. Those who answered yes to this question was invited to participate in the study. All participants in the study was assessed with the Berg Balance Scale and the Activity Specific Balance Scale for measuring balance, function was measured with the generic instrument EuroQol-5D and self-rated health was measured by a visual analogue scale, included in the EuorQol-5D.
Participants were randomly allocated to intervention group or control group after measurements at baseline. The intervention comprised of four different vestibular rehabilitation exercises, adapted to the individual participant, as addition to usual rehabilitation. The control comprised of usual rehabilitation without the addition of vestibular rehabilitation exercises. All participants trained twice a week for three months. After three months, the same assessments was performed again.
Criteria for feasibility was:
A sample size of 30% of the required sample size for a randomized controlled trial, i.e. 12 participants in each group, a drop-out rate of no more than 30% and adherence to intervention with more than 80% .
Results: In total, 32 persons were included in the study, 19 women and 13 men aged 32 to 85 years (mean 68). The majority had been dizzy since the stroke and two persons had been dizzy before the stroke. The most common type of dizziness was unsteadiness (n=25), while only four persons had rotational or spinning type of dizziness and three persons had a combination of both. There were at total of 10 dropouts (31%), which sums up to 28% of the required sample size. Adherence to the intervention was high, all the participants in the intervention group fulfilled more than 90% of the sessions. Both groups improved in self-rated health, measured with EQ5D VAS (p=0.00 and 0.04). There were no other significant differences between baseline and follow up in any of the groups (p=0.15-0.48).
Conclusion(s): This study shows that adherence to vestibular rehabilitation for persons with stroke and concomitant dizziness was high. However, drop-out rate was high and it was very difficult to achieve large enough sample size even for a feasibility study.
Implications: Physiotherapist in Sweden already uses vestibular rehabilitation for this group of patients and therefore din not want their patients to be included in a study were the patient was at risk of being allocated to a control group and not receiving active treatment.
Keywords: Stroke, Dizziness, Vestibular Rehabilitation
Funding acknowledgements: The study was funded by the Swedish Stroke Association and Färs and Frosta Sparbank.
Topic: Disability & rehabilitation; Neurology: stroke
Ethics approval required: Yes
Institution: Lund University
Ethics committee: Regional Ethical Review Board in Lund
Ethics number: 2012/816
All authors, affiliations and abstracts have been published as submitted.
