Feasibility of integrating vestibular rehabilitation and cognitive behaviour therapy for people with persistent dizziness

Lene Kristiansen,K T Wilhelmsen,S H G Nordahl,B Juul-Kristensen,T Sjøbø,L H Magnussen,S Mæland,A Hovland

doi:10.1186/s40814-019-0452-3

Abstract

PurposeTo evaluate the feasibility of integrating vestibular rehabilitation and cognitive behaviour therapy (VR-CBT) for people with persistent dizziness in primary care.DesignProspective single-group pre- and post-test study.ParticipantsAdults (aged 18–70) with acute onset of dizziness and symptoms lasting a minimum 3 months, recruited from Bergen municipality.MethodsParticipants attended eight weekly group sessions of VR-CBT intervention. Feasibility outcomes consisted of recruitment and testing procedures, intervention adherence, and participant feedback, besides change in primary outcomes. The primary outcomes were Dizziness Handicap Inventory (DHI) and preferred gait velocity.ResultsSeven participants were recruited for the study. All participants completed the pre-treatment tests, five participants completed the intervention and answered post-treatment questionnaires, and three completed post-treatment testing. Of the five participants, three attended at least 75% of the VR-CBT sessions, and two 50% of the sessions. Participants reported that the VR-CBT was relevant and led to improvement in function. DHI scores improved beyond minimal important change in two out of five participants, and preferred gait velocity increased beyond minimal important change in two out of three participants.ConclusionThe current tests and VR-CBT treatment protocols were feasible. Some changes are suggested to optimise the protocols, before conducting a randomised controlled trial.Trial registrationNCT02655575. Registered 14 January 2016—retrospectively registered

Highlights

Introduction toVestibular rehabilitation (VR), CBT, and treatment manual- Individual- and group-based skill training using gaze stability, habituation, and balancePreparation prior3h to VR-CBT treatment- VR-CBT manual content of each treatment session- Skill training: role-play using CBT according to VR-CBT manualOrganised PT reflection 1 h sessions- Mentoring with clinical psychologist after each of the first two VR-CBT sessionsH hours, VR-CBT group intervention integrating vestibular rehabilitation and cognitive behaviour therapy, VR vestibular rehabilitation, CBT cognitive behaviour therapy, PT physiotherapist purpose of brief intervention vestibular rehabilitation (BI-VR) was to provide the participants with an understanding of their dizziness and give them practical advice on how to improve their daily functioning
Seven participants were included and completed all pre-treatment tests in the study
The dizziness complaints had been present from 6 to 503 months, with six out of seven participants presenting dizziness for 17 months or more. Five of these participated in the VR-CBT intervention and completed the questionnaires post-intervention

Summary

Introduction

Introduction toVR, CBT, and treatment manual- Individual- and group-based skill training using gaze stability, habituation, and balancePreparation prior3h to VR-CBT treatment- VR-CBT manual content of each treatment session- Skill training: role-play using CBT according to VR-CBT manualOrganised PT reflection 1 h (each between treatment session) sessions- Mentoring with clinical psychologist after each of the first two VR-CBT sessionsH hours, VR-CBT group intervention integrating vestibular rehabilitation and cognitive behaviour therapy, VR vestibular rehabilitation, CBT cognitive behaviour therapy, PT physiotherapist purpose of BI-VR was to provide the participants with an understanding of their dizziness and give them practical advice on how to improve their daily functioning. The aim of the VR-CBT intervention was to address both physical and psychological challenges of dizziness This was done by providing opportunities for the participants to practise exercises in a safe environment, accompanied by reflections on dizziness and safety and avoidance behaviours. The CBT was based on a model used for anxiety and panic disorders [27,28,29], addressing catastrophic misinterpretations, safety and avoidance behaviours, and the fight or flight response, topics covered in a previous study on people with persistent dizziness [7] All sessions included both VR and CBT, with the first three sessions mostly emphasising CBT, while the subsequent five sessions mostly emphasised VR.

Methods

Results

Discussion

Conclusion