Abstract
Objective
Postural restrictions after canalith repositioning maneuvers (CRM) for benign paroxysmal
positional vertigo of the posterior semicircular canal (p-BPPV) have no proven value
and therefore most physicians regard them as unnecessary. The aim of this study was
to assess the short-term efficacy of head and body movement limitations after a single
Epley maneuver. A review of the literature was performed to assess the current level
of evidence for the efficacy of postural restrictions.
Materials and methods
Sixty-four patients, median age 59 years (range 37–82 years), with p-BPPV, were allocated
either to instructions for movement restrictions or free movements for 48 h after a single Epley maneuver. The minimization method was used for allocation to
treatment. This procedure ‘minimizes’ the differences in the distribution of pre-specified
prognostic factors (e.g. sex and age) between the two groups of treatment. Minimization
was preferred over randomization which is not as effective in balancing baseline characteristics
when the number of participants is small. Outcome was assessed by physician and patient
reported measures (Dix-Hallpike test, subjective vertigo intensity in a 10-point scale,
patient's assessment of improvement) within 1 week after treatment by an independent
investigator. The level of statistical significance was 0.05.
Results
More patients with movement restrictions reported a subjective improvement after treatment
(p = 0.007). Ninety percent of patients with movement restrictions and 74.2% of patients
with free movements had a negative follow up Dix-Hallpike test but the difference
was not significant (p = 0.108). The mean pre-treatment vertigo intensity was reduced from 6.07 and 5.97 to
1.18 and 2.86, respectively but the difference was not significant (p = 0.122).
Conclusions
Postural restrictions do not increase the efficacy of the canal-repositioning maneuver
despite the fact that patients report a subjective improvement after post-procedural
instructions. In the review of the literature, all studies except one conclude that
postural restrictions are unnecessary. However, a number of methodological issues
such as inadequate sample size are not addressed and more conclusive evidence is required.
Based on current evidence, the use of postural restrictions after the canal-repositioning
maneuver is unjustified.
Keywords
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Article Info
Publication History
Accepted:
April 3,
2009
Received:
June 13,
2008
Identification
Copyright
© 2009 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
