Vestibular rehabilitation in elderly patients with postural instability: reducing the number of falls-a randomized clinical trial.

Abstract

Our previous study had shown the effectiveness of vestibular rehabilitation (VR) in improving balance in elderly patients, assessed immediately afterwards. The main goal of the present study is to consider whether this improvement in balance assessment turns out in a reduction of the number of falls. 139 elderly patients with high risk of falls were included and randomized to one of the following study arms: computerized dynamic posturography (CDP) training, optokinetic stimulus, exercises at home or control group. Patients were assessed with objective outcome measures (sensorial organization test and limits of stability of CDP, number of falls and number of hospital admissions due to falls) and subjective outcome measures (dizziness handicap inventory and short falls efficacy scale-international) during a 12-month follow-up period. Average number of falls significantly declined from 10.96 (before VR) to 3.03 (12-month follow-up) in the intervention group (p < 0.001); meanwhile, in the control group, the average number of falls changed from 3.36 to 2.61 during a 12-month follow-up period (p = 0.166). The present study provides evidence that VR can decisively improve balance in elderly patients with instability, which can lead in turn to a significant reduction of falls. We recommend performing VR in any older person with high risk of falls.