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Br J Gen Pract. 2019 Jan;69(678):e52-e60. doi: 10.3399/bjgp18X700253. Epub 2018 Dec 3.

Effectiveness of the Epley manoeuvre in posterior canal benign paroxysmal positional vertigo: a randomised clinical trial in primary care.

Author information

1
Grupo de Estudio del Vértigo en Atención Primaria Florida, Equip d'Atenció Primària Florida Nord, Barcelona.
2
Equip d'Atenció Primària Florida Sud, Institut Català de la Salut, Hospitalet de Llobregat, Barcelona.
3
Unitat de Suport a la Recerca Metropolitana Sud, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Cornellà.
4
Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona.
5
Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, and Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), and Equip d'Atenció Primària Badia del Valles, Servei d'Atenció Primària Vallés Occidental, Unitat de Suport a la Recerca Barcelona Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain.

Abstract

BACKGROUND:

Evidence on the effectiveness of the Epley manoeuvre in primary care is scarce.

AIM:

To evaluate effectiveness at 1 week, 1 month, and 1 year of a single Epley manoeuvre versus a sham manoeuvre in primary care.

DESIGN AND SETTING:

Multicentre, double-blind randomised controlled trial in two primary care practices in Spain from November 2012 to January 2015.

METHOD:

Patients were ≥18 years diagnosed with subjective or objective posterior benign paroxysmal positional vertigo (vertigo only, or vertigo and nystagmus after a Dix-Hallpike test [DHT]). The intervention group received the Epley manoeuvre, and the control group received a sham manoeuvre. Betahistine was prescribed following the same regimen in both groups. The main outcome measures were the DHT result classified as negative (neither vertigo nor nystagmus) or positive. Positive results were further divided into a positive result for both vertigo and nystagmus (positive DHT with nystagmus), and a positive result for vertigo only (positive DHT without nystagmus); self-reported resolution of vertigo; and self-reported severity of vertigo evaluated on a 10-point Likert scale (10 = worst imaginable vertigo).

RESULTS:

In total, 134 patients were randomised to either the intervention group (n = 66) or the sham group (n = 68). The intervention group showed better results in the unadjusted analyses at 1 week, with a lower rate of positive DHT with nystagmus (P = 0.022). A positive baseline DHT with nystagmus was associated with a reduction in vertigo severity (marginal effect for 10-point Likert-like question -1.73, 95% confidence interval [CI] = -2.95 to -0.51) and better positive DHT rates in the intervention group (adjusted odds ratio 0.09, 95% CI = 0.01 to 0.92) in the multivariate analyses.

CONCLUSION:

A single Epley manoeuvre performed in primary care is an effective treatment for reversing a positive DHT and reducing vertigo severity in patients with baseline nystagmus in the DHT.

KEYWORDS:

Epley manoeuvre; benign paroxysmal positional vertigo; primary health care; randomised controlled trial

PMID:
30510098
PMCID:
PMC6301349
[Available on 2020-01-01]
DOI:
10.3399/bjgp18X700253

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