Epley maneuver for vertigo pdf trial#

The theories that try to explain the pathophysiology of BPPV are based on clinical and histopathologic findings. The mean age of onset of BPPV is 49 years, its lifetime prevalence is approximately 2.4%, and its cumulative incidence reaches almost 10% at the age of 80 years. The three most common causes of vertigo (accounting for 93% of all patient presentations) are: acute peripheral vestibulopathy (vestibular neuritis and labyrinthitis), Ménière’s disease and benign paroxysmal positional vertigo (BPPV), the latter being the most frequent. It has been estimated that 45 to 54% of the patients who attend the primary care physician with dizziness are suffering from vertigo. Central vertigo is generally more serious, whereas peripheral vertigo is usually benign. Vertigo is divided into central and peripheral causes. Vertigo is a subtype of dizziness, defined as an illusion of motion caused by a mismatch of information from the visual, vestibular and proprioceptive systems. Approximately 3% of the visits to US emergency departments were accounted for by dizziness presentations according to data from a nationally representative study.

Epley maneuver for vertigo pdf trial#

Trial registrationĬ Identifier: NCT01969513.ĭizziness, a common complaint in patients presenting to the primary care office and the emergency department, is a disorder of spatial orientation.

Positive results from our study will highlight that treatment of benign paroxysmal positional vertigo can be performed by trained general practitioners (GPs) and, therefore, its widespread practice may contribute to improve the quality of life of BPPV patients.

Chi-square test or Fisher’s exact test will be conducted to compare categorical measures and Student’s t-test or Mann–Whitney U-test will be used for intergroup comparison variables. Groups will be compared using the intent-to-treat approach and either parametric or nonparametric tests, depending on the nature and distribution of the variables. We will use descriptive statistics of all variables collected. Outcome variables will be: response to the D-H test, patients’ report on presence or absence of vertigo during the previous week (dichotomous variable: yes/no), intensity of vertigo symptoms on a Likert-type scale in the previous week, total score on the Dizziness Handicap Inventory (DHI) and quantity of betahistine taken. All patients attending these two primary care centers, who are newly diagnosed with benign paroxysmal positional vertigo, will be invited to participate in the study and will be randomly assigned either to the treatment group (Epley’s maneuver) or to the control group (a sham maneuver). The study’s scope will include two urban primary care centers which provide care for approximately 49,400 patients. This study is a randomized clinical trial conducted in the primary care setting. The objective of this study is to evaluate the effectiveness of Epley’s maneuver performed by general practitioners (GPs) in the treatment of BPPV. The main cause of vertigo in primary care is benign paroxysmal positional vertigo (BPPV), which should be confirmed by a positive D-H positional test and treated with repositioning maneuvers. Vertigo is a common medical condition with a broad spectrum of diagnoses which requires an integrated approach to patients through a structured clinical interview and physical examination.