| Authors | Smith, Rebecca M., Burgess, Caroline, Beattie, Jenna,, Newdick, Abby, Sahu, Bithi, Golding, John F., Tahtis, Vassilios, Marsden, Jonathan and Seemungal, Barry M.S. |
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| Abstract | Background: Benign paroxysmal positional vertigo (BPPV) affects approximately half of acute, moderate-severe traumatic brain injury (TBI) patients. To date, there have been no rigorous studies of BPPV assessment or treatment in this cohort. We aimed to determine the safety, practicability, and efficacy of BPPV management in acute TBI and the feasibility of a larger, effectiveness trial. Methods: This was a multi-centre, three-arm, parallel-groups, randomised, feasibility trial. Recruitment was via convenience sampling. Main inclusion criteria were age over 18-years and a confirmed, non-penetrating, acute TBI. Following assessment, BPPV-positive patients were randomly allocated to one of three interventions (repositioning manoeuvres, Brandt-Daroff exercises or advice) using minimisation criteria. Outcome assessors were blinded to the intervention. Results: Of 2014 patients screened for inclusion, 180 were assessed for BPPV. Of those assessed, 34% (62/180) had BPPV, and 58 patients received an intervention. Of those 58 treated, 39 were male (67%). Mean age was 53.5 (± 17.7) years. No serious adverse events were reported. Six adverse events of vomiting were reported during the trial. Intervention fidelity data noted treatments were delivered accurately and consistently between sites. 35/58 (60%) patients’ BPPV had resolved by 12 weeks. Resolution rate was highest after repositioning manoeuvres (78%), then after advice (53%) then Brandt-Daroff exercises (42%). 10 patients experienced recurrence. This was observed more frequently in those with skull fracture and bilateral or mixed BPPV. Conclusions: Trial progression criteria were met indicating that a larger trial is warranted. Therapist-led management of BPPV in acute TBI is safe and practicable. Repositioning manoeuvres seemingly yielded superior treatment effect. However, given the high recurrence rate of post-traumatic BPPV, the optimal time to treat according to patients’ specific recurrence risk, requires further investigation. |
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