THE EFFECT OF PARTICLE REPOSITIONING MANOEUVRES ON SECONDARY SYMPTOMS OF BENIGN PAROXYSMAL POSITIONAL VERTIGO: A SYSTEMATIC REVIEW
Background Benign Paroxysmal Positional Vertigo (BPPV) is known for its intense symptoms of vertigo, nystagmus, and nausea. Particle repositioning manoeuvres (PRMs) are known to effectively relieve these symptoms. However, less is understood of the effects of PRMs on secondary symptoms of postural imbalance and gait disturbance, which can lead to falls, trauma, and ultimately admission to hospital. Objective Creation of a narrative synthesis of the current evidence-base regarding the effects of PRMs on the secondary symptoms of BPPV. Methods A robust search of several health science related databases was conducted. This was systematically performed by using MeSH term combinations in order to retrieve all the relevant articles. Articles were then screened against the inclusion/ exclusion criteria before being included or rejected by the author. Following this the articles for inclusion were subject to full text screening and entered into data extraction tables. Results of the review Eight studies met the inclusion criteria and were rated between moderate or weak methodological quality. The accepted studies used four different PRM types for short periods except one which lasted 12 months. There were numerous outcome measures used, five aimed at static balance, four at dynamic postural stability, two dynamic gait/balance. The results were heterogeneous. Two studies found static balance improvement, two observed partial improvement, and one with no improvement. Postural dynamic stability showed partial improvements in three studies, and good improvement in one. Partial improvements were seen in some aspects of the two studies measuring dynamic balance. This review identifies the variables of pathogenesis, duration of symptoms and age to vastly affect whether PRMs were successfully in relieving secondary BPPV symptoms. Conclusion Based on the current systematic review, the mostly moderate quality evidence suggests that PRMs could relieve secondary symptoms in younger patients (<60 years) with shorter durations of BPPV prior to PRMs, and with a canalolithiasis pathogenesis. Patients out-with these categories may need additional aftercare.