# Effect of Vestibular Rehabilitation Therapy in PPPD: Short-Term Results from a Prospective Observational Study

## TL;DR

A five-week vestibular rehabilitation program significantly reduces dizziness symptoms in patients with PPPD, with benefits lasting up to three months.

## Contribution

This study provides preliminary evidence for the short-term and sustained effectiveness of vestibular rehabilitation therapy in treating PPPD.

## Key findings

- VRT significantly improved physical, emotional, and functional dizziness impacts over five weeks.
- Improvements were largely maintained three months post-treatment without continued therapy.
- Women showed greater emotional improvements compared to men.

## Abstract

Objective: This short-term prospective observational study aimed to evaluate the efficacy of vestibular rehabilitation therapy (VRT) in Patients Diagnosed with Persistent Postural-Perceptual Dizziness (PPPD). Methods: Given the exploratory design, the small sample (n = 25) and absence of a formal power calculation limit precision, findings should be interpreted as preliminary, and confirmatory trials are warranted. Patients were assessed before (T1), immediately after a five-week vestibular rehabilitation program (T2), and again three months later without continued therapy (T3). Clinical symptoms were assessed using the Dizziness Handicap Inventory (DHI). A Generalized Estimating Equations (GEE) model was used to analyze changes in dizziness-related physical, emotional, and functional impacts over time, accounting for sex and its interaction with time. Statistical significance was tested using the Wald test, with results reported as estimated means and standard errors (SEs), and a significance level set at p ≤ 0.05. Results: The mean age of participants was 44.48 ± 14.43 years, and the majority were women (84%). In the functional domain, the mean score difference was 6.69 points between T1 and T2 (p = 0.018), 7.11 points between T1 and T3 (p = 0.013), and 0.42 points between T2 and T3 (p > 0.05). In the emotional domain, the mean difference was 4.12 points between T1 and T2 (p = 0.008), 4.40 points between T1 and T3 (p = 0.005), and 0.29 points between T2 and T3 (p > 0.05). In the physical domain, the mean difference was 3.77 points between T1 and T2 (p = 0.024), 4.32 points between T1 and T3 (p = 0.009), and 0.55 points between T2 and T3 (p > 0.05). For the total score, the mean difference was 14.58 points between T1 and T2 (p = 0.005), 15.83 points between T1 and T3 (p = 0.003), and 1.25 points between T2 and T3 (p > 0.05). The moment variable had a statistically significant effect across all domains. Sex had a significant effect only in the emotional domain, with women consistently reporting higher scores than men. Conclusions: This study demonstrates that a five-week vestibular rehabilitation program significantly improves the physical, emotional, and functional impacts of dizziness in patients with PPPD, with these benefits largely sustained three months after the intervention. Emotional improvements were particularly notable among women, highlighting potential sex-related differences in response to treatment. These findings underscore the importance of addressing emotional health in PPPD management and support the long-term effectiveness of vestibular rehabilitation in improving patient outcomes.