THE BACK PAGE RESEARCH REVIEW Review of non-drug options to treat dizziness in seniors BY SHAWN THISTLE STUDY TITLE: Effects of nonpharmacological interventions for dizziness in older people: A systematic review AUTHORS: Kendall JC, Hartvigsen J, Azari MF & French SD PUBLICATION INFORMATION: Physical Therapy 2016; 96: 641-649. izziness has been re-ported in up to 58 per cent of women and 30 per cent of men over 65, with prevalence increas-ing with age. Dizziness is associated with an increased risk of falls, leading to an increase in disability, morbidity and mortality, and a decrease in independ-ence. Typically, older people are un-der-referred and under-treated for diz-ziness. Dizziness can often be multifactorial in nature, but it has been categorized as being caused by: frailty, psychological disorders, cardiovascular disorders, pr-esyncope (lightheadedness, weakness, blurred vision and feeling faint) and nonspecific disorders or disorders of the ear, nose and throat. It can also be as-sociated with anxiety, spinal pain and increased medication use, including inappropriate prescriptions and polyp-harmacy. Given the increased risk of falls asso-ciated with polypharmacy, it is impor-tant to examine the effectiveness of nonpharmacological therapies for dizzi-ness in older people. This was a systematic review that searched nine databases from inception to May 2014, using appropriate search terms for each database. Reference lists of included articles and relevant system-atic reviews were screened for additional resources. Two authors independently screened titles and abstracts for inclu-sion. Two authors then independently D the heterogeneity of the included stud-ies, meta-analysis of the data could not be performed and thus a narrative syn-thesis was completed. A total of 1,966 records were identified, 1,435 titles and abstracts were screened and 51 records were identified for full-text analysis. Forty were eventually re-viewed (11 could not be translated). Seven studies met the inclusion criteria. All included studies contained some form of exercise (vestibular rehabilita-tion, balance exercise or tai chi) as the main intervention. Self-reported dizziness and balance were the most commonly used outcome measures. With respect to studies showing sig-nificant differences, two studies fa-voured the interventions for self-re-ported dizziness and four studies favoured the intervention with respect to balance. This review highlights the significant methodological flaws in the body of evidence studying nonpharmacological therapies for dizziness in those over 65 and the critical need for more clinically relevant studies. The studies included in this review suggest the following may be beneficial: • individual or group vestibular reha-bilitation • individualized or group strength and balance training • Tai chi • head-neck balance exercises based on the Cawthorne-Cooksey protocol Importantly, the limited findings of this study will hopefully highlight the need for high quality research regarding the effectiveness of individual and com-bined therapies, and the optimal dose for prescribing them. www.canadianchiropractor.ca applied the inclusion criteria to the full texts of the articles that remained fol-lowing screening to determine which studies to include in the review. Results Inclusion criteria The study included ontrolled trials published in English. Study participants had to be over 60 years of age and have dizziness related to presbyastasis (age-related vestibular dysfunction), cervicogenic dizziness associated with osteoarthritis, nonspecific dizziness or dizziness with unspecified origin (other specific causes were excluded). Interventions consisting of exercise, manual therapy, CBT and/or acupunc-ture were included in the review. Com-parisons could include placebo, sham therapy, no treatment or another active intervention. Primary outcome measures could be any self-reported measures of dizziness. Objective measures (such as balance, number of falls, or quality of life) could also be included. Two authors independently extracted data from the included studies related to participant characteristics, interven-tions and outcomes. Two authors then independently assessed each included article for risk of bias according to the Cochrane 12-item criteria. In addition to evaluating the methodology, two authors assessed the clinical relevance of each included study using the five-item clinical relevance assessment of the Cochrane Back Review Group. Due to Application, conclusions DR. SHAWN THISTLE is the founder and CEO of RRS Education (rrseducation.com), which helps busy clinicians integrate current research evidence rationally into practice. He also maintains a practice in Toronto, lectures at CMCC and provides chiropractic medicolegal consulting services. Reach him at: [email protected] 46 Canadian Chiropractor December 2016
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