Research Reports - Can vestibular rehabilitation exercises help patients with concussion?

Br J Sports Med. 2016 Sep 21. pii: bjsports-2016-096081. doi:
10.1136/bjsports-2016-096081. [Epub ahead of print]

Murray DA(1), Meldrum D(2), Lennon O(1).

OBJECTIVE: Concussion symptoms normally resolve within 7-10 days but vertigo,
dizziness and balance dysfunction persist in 10-30% of cases causing significant
morbidity. This study systematically evaluated the evidence supporting the
efficacy, prescription and progression patterns of vestibular rehabilitation
therapy (VRT) in patients with concussion.
DESIGN: Systematic Review, guided by PRISMA guidelines and presenting a best
evidence synthesis.
DATA SOURCES: Electronic databases PubMed (1949 to May 2015), CINAHL (1982 to May
2015), EMBASE (1947 to May 2015), SPORTDiscus (1985 to May 2015), Web of Science
(1945 to May 2015) and PEDRO (1999 to May 2015), supplemented by manual searches
and grey literature.
ELIGIBILITY CRITERIA FOR STUDY SELECTION: Article or abstract of original
research, population of patients with concussion/mild traumatic brain injury
(mTBI) with vestibular symptoms, interventions detailing VRT, measurement of
outcomes pre-VRT/post-VRT. Study type was not specified.
RESULTS: Following a double review of abstract and full-text articles, 10 studies
met the inclusion criteria: randomised controlled trial (n=2), uncontrolled
studies (n=3) and case studies (n=5). 4 studies evaluated VRT as a single
intervention. 6 studies incorporated VRT in multimodal interventions (including
manual therapy, strength training, occupational tasks, counselling or
medication). 9 studies reported improvement in outcomes but level I evidence from
only 1 study was found that demonstrated increased rates (OR 3.91; 95% CI 1.34 to
11.34; p=0.002) of medical clearance for return to sport within 8 weeks, when VRT
(combined with cervical therapy) was compared with usual care. Heterogeneity in
study type and outcomes precluded meta-analysis. Habituation and adaptation
exercises were employed in 8 studies and balance exercises in 9 studies.
Prescription and progression patterns lacked standardisation.
CONCLUSIONS: Current evidence for optimal prescription and efficacy of VRT in
patients with mTBI/concussion is limited. Available evidence, although weak,
shows promise in this population. Further high-level studies evaluating the
effects of VRT in patients with mTBI/concussion with vestibular and/or balance
dysfunction are required. 

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