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Abstract of the Week

December Topic: Cognitive behavioral therapy + Vestibular Therapy for persistent dizziness

No 544: December 16, 2020

Efficacy of intergrating vestibular rehabilitation and cognitive behaviour therapy in persons with persistent dizziness in primary care- a study protocol for a randomised controlled trial

Kristiansen, L., Magnussen, L. H., Wilhelmsen, K. T., Mæland, S., Nordahl, S., Clendaniel, R., Hovland, A., & Juul-Kristensen, B. (2019). Efficacy of intergrating vestibular rehabilitation and cognitive behaviour therapy in persons with persistent dizziness in primary care- a study protocol for a randomised controlled trial. Trials, 20(1), 575. 
 
Abstract
 
Background: Dizziness is a common complaint, and the symptom often persists, together with additional complaints. A treatment combining Vestibular Rehabilitation (VR) and Cognitive Behaviour Therapy (CBT) is suggested. However, further research is necessary to evaluate the efficacy of such an intervention. The objective of this paper is to present the design of a randomised controlled trial aiming at evaluating the efficacy of an integrated treatment of VR and CBT on dizziness, physical function, psychological complaints and quality of life in persons with persistent dizziness.
 
Methods/design: The randomised controlled trial is an assessor-blinded, block-randomised, parallel-group design, with a 6- and 12-month follow-up. The study includes 125 participants from Bergen (Norway) and surrounding areas. Included participants present with persistent dizziness lasting for at least 3 months, triggered or exacerbated by movement. All participants receive a one-session treatment (Brief Intervention Vestibular Rehabilitation; BI-VR) with VR before being randomised into a control group or an intervention group. The intervention group will further be offered an eight-session treatment integrating VR and CBT. The primary outcomes in the study are the Dizziness Handicap Inventory and preferred gait velocity.
 
Discussion: Previous studies combining these treatments have been of varying methodological quality, with small samples, and long-term effects have not been maintained. In addition, only the CBT has been administered in supervised sessions, with VR offered as home exercises. The current study focusses on the integrated treatment, a sufficiently powered sample size, and a standardised treatment programme evaluated by validated outcomes using a standardised assessment protocol.
 
 
PMID: 31590692
 
This abstract can be found on http://www.ncbi.nlm.nih.gov/sites/entrez entering the PMID number listed above into the "Search" field

 

No 543: December 9, 2020

Multimodal treatment of persistent postural-perceptual dizziness

Axer, H., Finn, S., Wassermann, A., Guntinas-Lichius, O., Klingner, C. M., & Witte, O. W. (2020). Multimodal treatment of persistent postural-perceptual dizziness. Brain and behavior, e01864. Advance online publication. 
 
Abstract
 
Background: Persistent postural-perceptual dizziness (PPPD) is a chronic disorder with fluctuating symptoms of dizziness, unsteadiness, or vertigo for at least three months. Its pathophysiological mechanisms give theoretical support for the use of multimodal treatment. However, there are different therapeutic programs and principles available, and their clinical effectiveness remains elusive.
 
Methods: A database of patients who participated in a day care multimodal treatment program was analyzed regarding the therapeutic effects on PPPD. Vertigo Severity Scale (VSS) and Hospital Anxiety and Depression Scale (HADS) were assessed before and 6 months after therapy.
 
Results: Of a total of 657 patients treated with a tertiary care multimodal treatment program, 46.4% met the criteria for PPPD. PPPD patients were younger than patients with somatic diagnoses and complained more distress due to dizziness. 63.6% completed the follow-up questionnaire. All patients showed significant changes in VSS and HADS anxiety, but the PPPD patients generally showed a tendency to improve more than the patients with somatic diagnoses. The change in the autonomic-anxiety subscore of VSS only reached statistical significance when comparing PPPD with somatic diagnoses (p = .002).
 
Conclusions: Therapeutic principles comprise cognitive-behavioral therapy, vestibular rehabilitation exercises, and serotonergic medication. However, large-scale, randomized, controlled trials are still missing. Follow-up observations after multimodal interdisciplinary therapy reveal an improvement in symptoms in most patients with chronic dizziness. The study was not designed to detect diagnosis-specific effects, but patients with PPPD and patients with other vestibular disorders benefit from multimodal therapies.
 
PMID: 32989916
 
This abstract can be found on http://www.ncbi.nlm.nih.gov/sites/entrez entering the PMID number listed above into the "Search" field

 

No 542: December 3, 2020

Acceptance and commitment therapy combined with vestibular rehabilitation for persistent postural-perceptual dizziness: A pilot study
 
 
Kuwabara, J., Kondo, M., Kabaya, K., Watanabe, W., Shiraishi, N., Sakai, M., Toshishige, Y., Ino, K., Nakayama, M., Iwasaki, S., & Akechi, T. (2020). Acceptance and commitment
therapy combined with vestibular rehabilitation for persistent postural-
perceptual dizziness: A pilot study. American journal of otolaryngology, 41(6), 102609
 
Abstract

Purpose: This study investigated the feasibility of acceptance and commitment therapy for persistent postural-perceptual dizziness and preliminarily verified the long-term effectiveness of the therapy.

 
Materials and methods: This study implemented the within-group pre-post comparison design. We enrolled 27 adult patients who met the criteria of persistent postural-perceptual dizziness. They underwent a treatment program including acceptance and commitment therapy combined with vestibular rehabilitation once a week for a total of six sessions. The primary outcome was changes in the Dizziness Handicap Inventory score 6 months posttreatment.
 
Results: All 27 patients completed the acceptance and commitment therapy + vestibular rehabilitation program, and 25 patients (92.6%) could be followed for 6 months posttreatment. For 27 participants, the scores from pretreatment to 6 months posttreatment significantly declined (P < .001), and the Dizziness Handicap Inventory effect size was 1.11 (95% confidence interval = 0.80-1.42). At 6 months posttreatment, 11 patients (40.7%) achieved remission (the score ≤ 14), 16 (59.3%) achieved treatment response (reduction in the score ≥ 18), and 20 (74.1%) achieved remission and/or treatment response.
 
Conclusions: Acceptance and commitment therapy is feasible for persistent postural-perceptual dizziness and might have long-term effectiveness. However, a randomized controlled trial is warranted.
 
PMID: 32615473
 
 
This abstract can be found onhttp://www.ncbi.nlm.nih.gov/sites/entrezentering the PMID number listed above into the "Search" field

 

November Topic: Current Concepts in Concussion

 

No 541: November 25, 2020

Objective clinical tests of dual-task dynamic postural control in youth athletes with concussion

Howell DR, Wilson JC, Brilliant AN, Gardner AJ, Iverson GL, Meehan WP 3rd. Objective clinical tests of dual-task dynamic postural control in youth athletes with concussion. J Sci Med Sport. 2019 May;22(5):521-525. doi: 10.1016/j.jsams.2018.11.014. Epub 2018 Nov 22. 
 
Abstract
 
Objectives: To prospectively evaluate single/dual-task timed-up-and-go (TUG) and tandem gait performance among children and adolescents with concussion and healthy controls.
 
Design: Repeated measures.
 
Methods: Participants with concussion (n=23; age=14.1±2.5years; 52% female) completed single/dual-task TUG, tandem gait, and symptom assessments 6.7±2.6 and 23.3±6.1days post injury. The control group (n=27; age=14.1±2.3years; 48% female) completed the same protocol initially and 10.7±16.1days later. All participants completed single-task (undivided attention) and dual-task (divided attention) tests. The primary outcome variable was test completion time.
 
Results: The concussion group completed single-task (concussion group mean=11.1±1.9 vs. control group mean 9.9±1.4s, p=0.027) and dual-task (concussion group mean=14.4±3.3 vs. control group mean 12.7±1.9s, p=0.047) TUG tests slower than the control group across both time points. The concussion group completed dual-task tandem gait tests slower than the control group at both time points (21.3±6.3 vs. 16.8±5.5s, p=0.006), and were slower in the single-task condition at the first test (19.8±5.4 vs. 13.8±4.4s, p=0.003). Symptoms were significantly worse for the concussion group compared to the control group at the first (34.1±21.4 vs. 3.9±9.1, p<0.001), but not the second test (9.1±12.0 vs. 2.2±6.8; p=0.08).
 
Conclusions: Slower dual-task TUG and tandem gait times were detected across both time points for the concussion group relative to the control group. In contrast, single-task tandem gait deficits appeared to improve in a similar fashion as symptoms, suggesting increased complexity from the addition of a cognitive task allows for the detection of persistent post-concussion deficits that might take longer to resolve.
 
PMID: 30509865
 
 
This abstract can be found on http://www.ncbi.nlm.nih.gov/sites/entrez entering the PMID number listed above into the "Search" field

 

No 540: November 18, 2020

Integrated linear and nonlinear trunk dynamics identify residual concussion deficits

Bonnette S, Diekfuss JA, Grooms D, Myer GD, Meehan WP 3rd, Howell DR. Integrated linear and nonlinear trunk dynamics identify residual concussion deficits. Neurosci Lett. 2020 Jun 11;729:134975. doi: 10.1016/j.neulet.2020.134975. Epub 2020 Apr 13.
 
Abstract
 
Postural sway is significantly affected by a mild traumatic brain injury, or concussion, and myriad methods have been developed to quantify the severity of concussion symptoms. The current manuscript quantifies postural sway-as measured by an inertial sensor-in youth athletes with concussion (n = 43, age = 14.4 ± 2.3 years, 56% female, tested median 7 days post-concussion) and healthy controls (n = 38, age = 14.9 ± 2.0 years, 55% female) during single-task and dual-task postural sway. A nonlinear analysis (i.e., recurrence quantification analysis [RQA]) and several common linear measures were used to quantify postural sway. Respectively, the two complementary types of analyses describe the structure and magnitude of postural sway. We hypothesized that participants who recently experienced a concussion would display differing postural sway dynamics (i.e., different in structure and magnitude) than control participants who had not experienced a concussion. Additionally, a logistic regression was performed to determine which combination of variables (nonlinear and linear) and task (single and dual) would best differentiate concussion and control participants. Significant differences between concussion and control participants were found in percent determinism, laminarity, and standard deviation of postural sway acceleration in both the single and the dual task. In the single task alone, mean diagonal line length and trapping time were additionally significantly different between groups. Moreover, the logistic regression model revealed that a mixture of linear and nonlinear measures across both single and dual tasks best classified concussed and non-concussed participants. Additionally, history of concussion was found to be a significant covariate in the model. These results extend past observations by demonstrating that a combination of posture sway tasks and measurements best differentiate participants with a concussion. These results highlight the need for future studies to replicate the findings in different populations and further determine which combinations of postural sway tasks and measurements best classify participants with concussions.
PMID: 32298725
 
 
This abstract can be found on http://www.ncbi.nlm.nih.gov/sites/entrez entering the PMID number listed above into the "Search" field
 
 
No 540: November 5, 2020
 
Youth With Concussion Have Less Adaptable Gait Patterns Than Their Uninjured Peers: Implications for Concussion Management
 
Howell DR, Bonnette S, Diekfuss JA, Grooms DR, Myer GD, Meehan WP 3rd. Youth With Concussion Have Less Adaptable Gait Patterns Than Their Uninjured Peers: Implications for Concussion Management. J Orthop Sports Phys Ther. 2020 Aug;50(8):438-446. doi: 10.2519/jospt.2020.9133. Epub 2020 May 22. 32441192.
 
Abstract
 
Objective: To compare cross-recurrence quantification analysis measurements obtained during gait between adolescents who sustained a diagnosed concussion within 14 days of assessment and healthy adolescents.
 
Design: Cross-sectional study.
 
Methods: Youth athletes with concussion (n = 43; mean ± SD age, 14.4 ± 2.3 years; 56% female; tested median, 7 days post concussion) and healthy controls (n = 38; age, 14.9 ± 2.0 years; 55% female) completed a single-task and dual-task gait protocol while wearing a set of inertial sensors. We used cross-recurrence quantification analysis techniques to quantify the similarity between accelerations obtained from the sensor on the dorsum of each foot. Four outcome variables were compared between groups: percent determinism, average diagonal-line length, laminarity, and trapping time.
 
Results: Athletes with concussion had significantly higher percent determinism, laminarity, and trapping time than the control group in single-task and dual-task conditions (P<.05). Gait patterns, when simultaneously completing a secondary cognitive task (dual task), were no different from gait patterns under a single-task condition.
 
Conclusion: Higher percent determinism, laminarity, and trapping time among athletes with concussion suggest that concussion may be associated with a more stuck and predictable gait pattern. These altered movement patterns may be one reason for underlying slower gait speeds that have been observed following concussion.
 
PMID: 32441192
 
This abstract can be found on http://www.ncbi.nlm.nih.gov/sites/entrez entering the PMID number listed above into the "Search" field.

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