Vestibular Physical Therapy for Patients with Meniere’s Disease
Date Issued
2013
Date
2013
Author(s)
Hu, Hsiao-Yun
Abstract
[Background] Meniere’s disease is one of the causes of vertigo and can lead to long term disability in some patients. Although the disease accounted for only 1-4% in patients visiting Department of Otolaryngology, patients with Meniere’s disease suffer from imbalance, poor postural control and poor quality of life due to long term symptoms and deteriorating vestibular function. A few articles had proposed the effect of vestibular physical therapy and postural control training on relieving symptoms and improving quality of life in patients of non-acute onset Meniere’s disease. However, evidence on minimum effective dosage and long term effects of vestibular physical therapy in patients with Meniere’s disease are scarce. This study aimed to investigate in patients with Meniere’s disease whether receiving one month of vestibular physical therapy is better than receiving medication treatment alone in aspects of postural control, gait, balance confidence and dizziness symptoms.
[Method] This study included a total of 10 qualified participants referred from the Department of Otolaryngology in National Taiwan University Hospital from July 2013 to October 2013. Five participants were randomized into the intervention group and 5 were randomized into the control group. The control group received medication treatment prescribed by doctors; the intervention group received individualized physical therapy sessions once a week lasting for one month in addition to medication treatment and patient education. After signing the informed consent, the demographic data and past medical history of each participant was collected and baseline assessment was given, and posttest and follow up assessment were performed respectively after one month and two month. Dynamic posturography of the Smart Balance Master system, Dynamic Gait Index (DGI), Activity-specific Balance Confidence scale (ABC scale) and Dizziness Handicapped Inventory (DHI) were chosen to be the assessment tools.
[Results] Mean age for the intervention group was 51, and for the control group, 69. There was statistically significant age difference between the two groups (P =0.032). Three participants in the intervention group have been diagnosed of Meniere’s disease 2 to 4 years ago, and the other two have been diagnosed 5 years ago; Two participants in the control group have been diagnosed of Meniere’s disease in past 3 months, and the other three have been diagnosed 5 years ago. There was no statistically significant difference between two groups in symptom duration. There were three patients (60%) with definite bilateral Meniere’s disease in the intervention group and two (40%) in the control group. All patients in the intervention group adhered to 90 percent of prescribed home exercise. There were no statistically significant between two groups in baseline assessment of Dynamic posturography of the Smart Balance Master system, DGI, ABC scale and DHI. After once a week and lasting one month of vestibular physical therapy, the patients with Meniere’s disease improved their performance in sensory organization test condition 5 from a score of 36.5 to 54.5 (P =0.02) and condition 6 from a score of 31.5 to 61.1 (P =0.04), and the velocity of rhythmic weight shift improved from 2.9 deg/sec to 3.6 deg/sec (P =0.04), and in ABC scale from a score of 74.3 to 88.1 (P =0.04). In addition, the intervention group reported decrease medication intake compared to control group during posttest and follow up. However, although the intervention group also improved endpoint excursion and maximum endpoint excursion in weight shift directions, improved DGI from a score of 21.6 to 22.6(P =0.17), and also improved the DHI from a score of 54.3 to 24.4 (P =0.17), no statistically significant difference was found in these three items.
[Conclusion] After once a week and a total of 1 month of individualized physical therapy, patients with Meniere’s disease improved their postural control ability which was demonstrated by improved postural stability under visual and sensory interference, increased anterior-posterior center of gravity displacement velocity, and improved balance confidence during daily activities. However, the intervention group did not experience significant improvements in increased displacement of center of gravity, in gait and in self-reported dizziness symptoms. This study was limited to short intervention time and ceiling effect of our measurement tools, and the results were also confounded by a patient with migraine, therefore leading to a slightly different results compared to previous studies. It is recommended that longer therapy duration and combining the mechanism of vestibular physical therapy would be beneficial to find out the critical point of therapy, thus leading to a more effective treatment.
Subjects
梅尼爾氏症
前庭物理治療
前庭運動
頭暈
平衡
Type
thesis
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