Effects of high-intensity virtual reality therapy on coordination and quality of life in BPPV patients: A randomized clinical trial

Introduction: Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disease. The canalith repositioning procedures (CRP) are primary treatments for BPPV. Sometimes after successful CRP, residual symptoms appear, i.e., feeling of uncertainty, disorientation, fogginess or drowsiness. These symptoms are also called residual dizziness (RD). The most commonly used medicine for RD is betahistine-dihydrocloride. Individualized vestibular rehabilitation (VR) exercises could help BPPV patients’ residual symptoms. Purpose: To assess the effectiveness of VR as well as high-intensity and high-frequency agility programs for the treatment of RD. Material and methods: In the betahistin group (BET), we used traditional drug therapy (24mg/day) The vestibular rehabilitation group (VES) received therapy for 1 h/day, and the patients in the virtual reality exergaming group (EXE) performed high-intensity agility therapy 1h/day. Patients in the control group (CON) received no treatment after acute care. The first examination was 1-2 days after admission to the study, the post-intervention testingoccurred after 3 weeks, and testingat follow-up occurred 5 weeks after post-intervention testing (i.e., 8 weeks after start of study). Statistical tests were performed using 1-way parametric, Kruskal-Wallis analysis of variance, ANOVA followed by post-hoc Tukey HSD test. Results: In the primary outcome, the differences in changes in BET vs. VES and BET-EXE were significant, while the differences in changes in BET-CON group were not. The differences in changes in VES-EXE groups were non-significant, while the differences in changes in EXE vs. CON and VES-CON group were significant. In the secondary outcomes there were significant improvements observed in MMSE, EQ5D, 6MWT, and DGI scores. Specifically, in the VES and EXE groups, there were significant improvements, while in the BET group, the improvements were not significant for Beck Depression Inventory, Berg Balance Scale (BBS), and Falls number. Conclusion: VR and high-intensity, high-frequency agility program significantly improved the clinical symptoms, mobility and functional stamina of patients with BPPV and RD.