Online vestibular rehabilitation for chronic vestibular syndrome: 36-month follow-up of a randomised controlled trial in general practice

Background: Vestibular rehabilitation (VR) is the preferred treatment for chronic vestibular symptoms such as dizziness and vertigo. We developed internet-based VR to increase uptake. Previously, we reported that internet-based VR resulted in a clinically relevant decrease of vestibular symptoms for up to six months, compared to usual care. Aim: To evaluate long-term outcomes of internet-based VR in patients with chronic vestibular syndrome. Design and setting: We conducted a randomised controlled trial in Dutch general practice. 322 participants aged 50 years and older with chronic vestibular syndrome were randomised to stand-alone VR, blended VR (with physiotherapy support), and usual care. Usual care participants were allowed to cross over to stand-alone VR six months after randomisation. Method: We approached participants 36 months after randomisation. Our primary outcome was the presence of vestibular symptoms as measured by the vertigo symptom scale – short form (VSS-SF). Secondary outcomes were dizziness-related impairment, anxiety, depressive symptoms, and health care utilisation. Results: At 36-month follow-up, 65% of participants filled out the VSS-SF. In the usual care group, 38% of participants had crossed over to VR at six months. We found no differences in vestibular symptoms between VR groups and usual care (mean difference -0.8 points, 95%-confidence interval (CI) -2.8 to 1.2, for stand-alone VR; and -0.3, 95%-CI -2.2 to 1.7, for blended VR). In VR groups, clinically relevant improvement compared to baseline maintained over time. Conclusion: Internet-based VR provides a maintained improvement of vestibular symptoms for up to 36 months in patients with chronic vestibular syndrome.