<LEAP> highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness and appropriateness of interventions—medications, surgery, education, nutrition, exercise—and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature.1 Each article in this PTJ series summarizes a Cochrane review or other scientific evidence on a single topic and presents clinical scenarios based on real patients or programs to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on an adult patient with unilateral peripheral vestibular hypofunction. Could a physical therapist–guided vestibular rehabilitation program decrease his symptoms and improve his function?
Dizziness is a common patient complaint in primary care practice and results in more than 6 million physician visits per year in the United States alone.2 From 2001 through 2004, 35.4% of US adults aged 40 years and older had vestibular dysfunction, the majority being diagnosed with unilateral peripheral vestibular dysfunction (UPVD).3,4 Symptoms of UPVD include dizziness, visual disturbance, imbalance, and functional deficits. The diagnosis of UPVD is made by a detailed history; a thorough clinical examination, including oculomotor and vestibular ocular reflex (VOR) testing; and laboratory testing, such as electronystagmography and caloric testing.
Potential causes of UPVD include vestibular neuritis, vestibular labyrinthitis, Ménière disease, perilymphatic fistula, acoustic neuroma, and benign paroxysmal positional vertigo (BPPV).5 With the exception of BPPV, those diagnoses result in vestibular hypofunction (decreased …
