Is a tailored web-based system of self-diagnosis and self-treatment effective in treating recurrent benign paroxysmal positional vertigo?
An online system providing video instructions for vestibular maneuvers tailored to the likely affected canal was more effective than a more general video based on the initial diagnosis.
Randomized controlled trial (double-blinded)
These researchers randomized adults with clinician-diagnosed benign paroxysmal positional vertigo (BPPV) responsive to repositioning maneuvers to use a tailored web-based management system (n = 292) or to view a control web-based video (n = 293). Each group of patients used a web-based system to guide their self-management. The tailored system used a validated questionnaire to guide the self-diagnosis of a BPPV attack and determine its subtype, and then provided a video of maneuvers effective for the attack type. The control system showed a video of the maneuver that matched their baseline assessment. After each attack, an investigator unaware of group assignment assessed the effectiveness of treatment. During the 2 years of follow-up, 58 patients in the intervention group (19.9%) experienced an attack compared with 70 patients in the control group (23.9%). Although 80% of the participants were successful in using the web-based system, 19 participants were unable to access it when they needed it and were seen in a clinic. More participants in the tailored intervention than in the control group had symptom resolution (72.4% vs 42.9%; number needed to treat = 4; 95% CI 3 - 9).
Henry C. Barry, MD, MS
Michigan State University
East Lansing, MI