Are postural restrictions after an Epley maneuver unnecessary? First results of a controlled study and review of the literature.
Identifieur interne : 000290 ( Main/Corpus ); précédent : 000289; suivant : 000291Are postural restrictions after an Epley maneuver unnecessary? First results of a controlled study and review of the literature.
Auteurs : Georgios Fyrmpas ; Demitrios Rachovitsas ; Anna Bettina Haidich ; Jiannis Constantinidis ; Stefanos Triaridis ; Victor Vital ; Meltiadis TsalighopoulosSource :
- Auris, nasus, larynx [ 1879-1476 ] ; 2009.
English descriptors
- KwdEn :
- Adult (MeSH), Aged (MeSH), Aged, 80 and over (MeSH), Female (MeSH), Head Movements (physiology), Humans (MeSH), Immobilization (MeSH), Male (MeSH), Middle Aged (MeSH), Otolithic Membrane (physiopathology), Posture (physiology), Prognosis (MeSH), Prospective Studies (MeSH), Semicircular Canals (physiopathology), Treatment Outcome (MeSH), Vertigo (physiopathology), Vertigo (therapy).
- MESH :
- physiology : Head Movements, Posture.
- physiopathology : Otolithic Membrane, Semicircular Canals, Vertigo.
- therapy : Vertigo.
- Adult, Aged, Aged, 80 and over, Female, Humans, Immobilization, Male, Middle Aged, Prognosis, Prospective Studies, Treatment Outcome.
Abstract
OBJECTIVE
Postural restrictions after canalith repositioning maneuvers (CRM) for benign paroxysmal positional vertigo of the posterior semicircular canal (p-BPPV) have no proven value and therefore most physicians regard them as unnecessary. The aim of this study was to assess the short-term efficacy of head and body movement limitations after a single Epley maneuver. A review of the literature was performed to assess the current level of evidence for the efficacy of postural restrictions.
MATERIALS AND METHODS
Sixty-four patients, median age 59 years (range 37-82 years), with p-BPPV, were allocated either to instructions for movement restrictions or free movements for 48 h after a single Epley maneuver. The minimization method was used for allocation to treatment. This procedure 'minimizes' the differences in the distribution of pre-specified prognostic factors (e.g. sex and age) between the two groups of treatment. Minimization was preferred over randomization which is not as effective in balancing baseline characteristics when the number of participants is small. Outcome was assessed by physician and patient reported measures (Dix-Hallpike test, subjective vertigo intensity in a 10-point scale, patient's assessment of improvement) within 1 week after treatment by an independent investigator. The level of statistical significance was 0.05.
RESULTS
More patients with movement restrictions reported a subjective improvement after treatment (p=0.007). Ninety percent of patients with movement restrictions and 74.2% of patients with free movements had a negative follow up Dix-Hallpike test but the difference was not significant (p=0.108). The mean pre-treatment vertigo intensity was reduced from 6.07 and 5.97 to 1.18 and 2.86, respectively but the difference was not significant (p=0.122).
CONCLUSIONS
Postural restrictions do not increase the efficacy of the canal-repositioning maneuver despite the fact that patients report a subjective improvement after post-procedural instructions. In the review of the literature, all studies except one conclude that postural restrictions are unnecessary. However, a number of methodological issues such as inadequate sample size are not addressed and more conclusive evidence is required. Based on current evidence, the use of postural restrictions after the canal-repositioning maneuver is unjustified.
DOI: 10.1016/j.anl.2009.04.004
PubMed: 19410397
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pubmed:19410397Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Are postural restrictions after an Epley maneuver unnecessary? First results of a controlled study and review of the literature.</title><author><name sortKey="Fyrmpas, Georgios" sort="Fyrmpas, Georgios" uniqKey="Fyrmpas G" first="Georgios" last="Fyrmpas">Georgios Fyrmpas</name><affiliation><nlm:affiliation>1st Department of Otolaryngology Head & Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, Kiriakidi 1, 546 36 Thessaloniki, Greece. drfirbas@hotmail.com</nlm:affiliation></affiliation></author><author><name sortKey="Rachovitsas, Demitrios" sort="Rachovitsas, Demitrios" uniqKey="Rachovitsas D" first="Demitrios" last="Rachovitsas">Demitrios Rachovitsas</name></author><author><name sortKey="Haidich, Anna Bettina" sort="Haidich, Anna Bettina" uniqKey="Haidich A" first="Anna Bettina" last="Haidich">Anna Bettina Haidich</name></author><author><name sortKey="Constantinidis, Jiannis" sort="Constantinidis, Jiannis" uniqKey="Constantinidis J" first="Jiannis" last="Constantinidis">Jiannis Constantinidis</name></author><author><name sortKey="Triaridis, Stefanos" sort="Triaridis, Stefanos" uniqKey="Triaridis S" first="Stefanos" last="Triaridis">Stefanos Triaridis</name></author><author><name sortKey="Vital, Victor" sort="Vital, Victor" uniqKey="Vital V" first="Victor" last="Vital">Victor Vital</name></author><author><name sortKey="Tsalighopoulos, Meltiadis" sort="Tsalighopoulos, Meltiadis" uniqKey="Tsalighopoulos M" first="Meltiadis" last="Tsalighopoulos">Meltiadis Tsalighopoulos</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2009">2009</date><idno type="RBID">pubmed:19410397</idno><idno type="pmid">19410397</idno><idno type="doi">10.1016/j.anl.2009.04.004</idno><idno type="wicri:Area/Main/Corpus">000290</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000290</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Are postural restrictions after an Epley maneuver unnecessary? First results of a controlled study and review of the literature.</title><author><name sortKey="Fyrmpas, Georgios" sort="Fyrmpas, Georgios" uniqKey="Fyrmpas G" first="Georgios" last="Fyrmpas">Georgios Fyrmpas</name><affiliation><nlm:affiliation>1st Department of Otolaryngology Head & Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, Kiriakidi 1, 546 36 Thessaloniki, Greece. drfirbas@hotmail.com</nlm:affiliation></affiliation></author><author><name sortKey="Rachovitsas, Demitrios" sort="Rachovitsas, Demitrios" uniqKey="Rachovitsas D" first="Demitrios" last="Rachovitsas">Demitrios Rachovitsas</name></author><author><name sortKey="Haidich, Anna Bettina" sort="Haidich, Anna Bettina" uniqKey="Haidich A" first="Anna Bettina" last="Haidich">Anna Bettina Haidich</name></author><author><name sortKey="Constantinidis, Jiannis" sort="Constantinidis, Jiannis" uniqKey="Constantinidis J" first="Jiannis" last="Constantinidis">Jiannis Constantinidis</name></author><author><name sortKey="Triaridis, Stefanos" sort="Triaridis, Stefanos" uniqKey="Triaridis S" first="Stefanos" last="Triaridis">Stefanos Triaridis</name></author><author><name sortKey="Vital, Victor" sort="Vital, Victor" uniqKey="Vital V" first="Victor" last="Vital">Victor Vital</name></author><author><name sortKey="Tsalighopoulos, Meltiadis" sort="Tsalighopoulos, Meltiadis" uniqKey="Tsalighopoulos M" first="Meltiadis" last="Tsalighopoulos">Meltiadis Tsalighopoulos</name></author></analytic><series><title level="j">Auris, nasus, larynx</title><idno type="eISSN">1879-1476</idno><imprint><date when="2009" type="published">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Aged (MeSH)</term><term>Aged, 80 and over (MeSH)</term><term>Female (MeSH)</term><term>Head Movements (physiology)</term><term>Humans (MeSH)</term><term>Immobilization (MeSH)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Otolithic Membrane (physiopathology)</term><term>Posture (physiology)</term><term>Prognosis (MeSH)</term><term>Prospective Studies (MeSH)</term><term>Semicircular Canals (physiopathology)</term><term>Treatment Outcome (MeSH)</term><term>Vertigo (physiopathology)</term><term>Vertigo (therapy)</term></keywords><keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Head Movements</term><term>Posture</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Otolithic Membrane</term><term>Semicircular Canals</term><term>Vertigo</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Vertigo</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Female</term><term>Humans</term><term>Immobilization</term><term>Male</term><term>Middle Aged</term><term>Prognosis</term><term>Prospective Studies</term><term>Treatment Outcome</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b></p><p>Postural restrictions after canalith repositioning maneuvers (CRM) for benign paroxysmal positional vertigo of the posterior semicircular canal (p-BPPV) have no proven value and therefore most physicians regard them as unnecessary. The aim of this study was to assess the short-term efficacy of head and body movement limitations after a single Epley maneuver. A review of the literature was performed to assess the current level of evidence for the efficacy of postural restrictions.</p></div><div type="abstract" xml:lang="en"><p><b>MATERIALS AND METHODS</b></p><p>Sixty-four patients, median age 59 years (range 37-82 years), with p-BPPV, were allocated either to instructions for movement restrictions or free movements for 48 h after a single Epley maneuver. The minimization method was used for allocation to treatment. This procedure 'minimizes' the differences in the distribution of pre-specified prognostic factors (e.g. sex and age) between the two groups of treatment. Minimization was preferred over randomization which is not as effective in balancing baseline characteristics when the number of participants is small. Outcome was assessed by physician and patient reported measures (Dix-Hallpike test, subjective vertigo intensity in a 10-point scale, patient's assessment of improvement) within 1 week after treatment by an independent investigator. The level of statistical significance was 0.05.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>More patients with movement restrictions reported a subjective improvement after treatment (p=0.007). Ninety percent of patients with movement restrictions and 74.2% of patients with free movements had a negative follow up Dix-Hallpike test but the difference was not significant (p=0.108). The mean pre-treatment vertigo intensity was reduced from 6.07 and 5.97 to 1.18 and 2.86, respectively but the difference was not significant (p=0.122).</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Postural restrictions do not increase the efficacy of the canal-repositioning maneuver despite the fact that patients report a subjective improvement after post-procedural instructions. In the review of the literature, all studies except one conclude that postural restrictions are unnecessary. However, a number of methodological issues such as inadequate sample size are not addressed and more conclusive evidence is required. Based on current evidence, the use of postural restrictions after the canal-repositioning maneuver is unjustified.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">19410397</PMID><DateCompleted><Year>2009</Year><Month>12</Month><Day>30</Day></DateCompleted><DateRevised><Year>2009</Year><Month>10</Month><Day>19</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1879-1476</ISSN><JournalIssue CitedMedium="Internet"><Volume>36</Volume><Issue>6</Issue><PubDate><Year>2009</Year><Month>Dec</Month></PubDate></JournalIssue><Title>Auris, nasus, larynx</Title><ISOAbbreviation>Auris Nasus Larynx</ISOAbbreviation></Journal><ArticleTitle>Are postural restrictions after an Epley maneuver unnecessary? First results of a controlled study and review of the literature.</ArticleTitle><Pagination><MedlinePgn>637-43</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.anl.2009.04.004</ELocationID><Abstract><AbstractText Label="OBJECTIVE" NlmCategory="OBJECTIVE">Postural restrictions after canalith repositioning maneuvers (CRM) for benign paroxysmal positional vertigo of the posterior semicircular canal (p-BPPV) have no proven value and therefore most physicians regard them as unnecessary. The aim of this study was to assess the short-term efficacy of head and body movement limitations after a single Epley maneuver. A review of the literature was performed to assess the current level of evidence for the efficacy of postural restrictions.</AbstractText><AbstractText Label="MATERIALS AND METHODS" NlmCategory="METHODS">Sixty-four patients, median age 59 years (range 37-82 years), with p-BPPV, were allocated either to instructions for movement restrictions or free movements for 48 h after a single Epley maneuver. The minimization method was used for allocation to treatment. This procedure 'minimizes' the differences in the distribution of pre-specified prognostic factors (e.g. sex and age) between the two groups of treatment. Minimization was preferred over randomization which is not as effective in balancing baseline characteristics when the number of participants is small. Outcome was assessed by physician and patient reported measures (Dix-Hallpike test, subjective vertigo intensity in a 10-point scale, patient's assessment of improvement) within 1 week after treatment by an independent investigator. The level of statistical significance was 0.05.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">More patients with movement restrictions reported a subjective improvement after treatment (p=0.007). Ninety percent of patients with movement restrictions and 74.2% of patients with free movements had a negative follow up Dix-Hallpike test but the difference was not significant (p=0.108). The mean pre-treatment vertigo intensity was reduced from 6.07 and 5.97 to 1.18 and 2.86, respectively but the difference was not significant (p=0.122).</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Postural restrictions do not increase the efficacy of the canal-repositioning maneuver despite the fact that patients report a subjective improvement after post-procedural instructions. In the review of the literature, all studies except one conclude that postural restrictions are unnecessary. However, a number of methodological issues such as inadequate sample size are not addressed and more conclusive evidence is required. Based on current evidence, the use of postural restrictions after the canal-repositioning maneuver is unjustified.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Fyrmpas</LastName><ForeName>Georgios</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>1st Department of Otolaryngology Head & Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, Kiriakidi 1, 546 36 Thessaloniki, Greece. drfirbas@hotmail.com</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Rachovitsas</LastName><ForeName>Demitrios</ForeName><Initials>D</Initials></Author><Author ValidYN="Y"><LastName>Haidich</LastName><ForeName>Anna Bettina</ForeName><Initials>AB</Initials></Author><Author ValidYN="Y"><LastName>Constantinidis</LastName><ForeName>Jiannis</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Triaridis</LastName><ForeName>Stefanos</ForeName><Initials>S</Initials></Author><Author ValidYN="Y"><LastName>Vital</LastName><ForeName>Victor</ForeName><Initials>V</Initials></Author><Author ValidYN="Y"><LastName>Tsalighopoulos</LastName><ForeName>Meltiadis</ForeName><Initials>M</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D003160">Comparative Study</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016449">Randomized Controlled Trial</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2009</Year><Month>05</Month><Day>01</Day></ArticleDate></Article><MedlineJournalInfo><Country>Netherlands</Country><MedlineTA>Auris Nasus Larynx</MedlineTA><NlmUniqueID>7708170</NlmUniqueID><ISSNLinking>0385-8146</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D019416" MajorTopicYN="N">Head Movements</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="N">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007103" MajorTopicYN="Y">Immobilization</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D010037" MajorTopicYN="N">Otolithic Membrane</DescriptorName><QualifierName UI="Q000503" MajorTopicYN="Y">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011187" MajorTopicYN="N">Posture</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="Y">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011379" MajorTopicYN="N">Prognosis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011446" MajorTopicYN="N">Prospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012665" MajorTopicYN="N">Semicircular Canals</DescriptorName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014717" MajorTopicYN="N">Vertigo</DescriptorName><QualifierName UI="Q000503" MajorTopicYN="Y">physiopathology</QualifierName><QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName></MeshHeading></MeshHeadingList><NumberOfReferences>26</NumberOfReferences></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2008</Year><Month>06</Month><Day>13</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2009</Year><Month>04</Month><Day>02</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2009</Year><Month>04</Month><Day>03</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2009</Year><Month>5</Month><Day>5</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2009</Year><Month>5</Month><Day>5</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2009</Year><Month>12</Month><Day>31</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">19410397</ArticleId><ArticleId IdType="pii">S0385-8146(09)00088-1</ArticleId><ArticleId IdType="doi">10.1016/j.anl.2009.04.004</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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