A Systematic Review and Network Meta-Analysis of Efficacy of Postmaneuver Rehabilitation in Benign Paroxysmal Positional Vertigo Treatment
Year: 2025
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Background/Objectives: The high prevalence of benign paroxysmal positional vertigo (BPPV) poses a considerable burden on healthcare systems, with an estimated annual cost of 2 billion dollars per year in the United States. The results of previous network meta-analyses (NMAs) have been inconclusive regarding the efficacy of different treatment strategies for managing BPPV. This study aimed to provide updated evidence of the comparative efficacy and safety of different treatment strategies in patients with BPPV. Methods: The present study was divided into two subgroups. The first part was the posterior canal BPPV, and the second was the horizontal canal BPPV. This frequentist model-based NMA included randomized controlled trials (RCTs) of treatments for BPPV, either in the posterior or horizontal canal. Results: This NMA of 82 RCTs revealed that, regarding posterior canal BPPV, most maneuvers plus postmaneuver rehabilitation/self-treatments were ranked superior to the traditional maneuver with/without medication in terms of the resolution rate. Among them, the modified Epley maneuver + self-treatment at home [odds ratio (OR) = 33.70, 95% confidence intervals (95%CIs) = 6.45–176.13] was ranked to be associated with the highest resolution rate. Regarding horizontal canal BPPV, only the Gufoni maneuver was associated with a significantly better resolution rate (OR = 4.40, 95%CIs = 1.13–17.12) and a higher transition/conversion rate (OR = 3.55, 95%CIs = 1.20–10.57) than that of sham/control groups. Conclusions: This study provides evidence that treatment strategies consisting of maneuvers in combination with postmaneuver rehabilitation/self-treatment may be preferred for managing BPPV affecting the posterior canal. However, no effective treatment strategy for horizontal canal involvement has been identified.
DOI: 10.3390/ohbm6020023
Institutions: I-Shou University, National Sun Yat-sen University, Kaohsiung Medical University, Kaohsiung Veterans General Hospital, Tri-Service General Hospital, Tri-Service General Hospital Beitou Branch, National Defense Medical Center, Landseed Hospital, University of Vienna, King's College London, Anglia Ruskin University, Asia University, China Medical University, An-Nan Hospital, China Medical University Hospital, National Taiwan University, National Taiwan University Hospital, Chang Gung University, Kaohsiung Chang Gung Memorial Hospital
Language: English
Subfield: Neurology
Field: Neuroscience
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $1,207
OpenAlex ID: W4416948103