1. 85% of individuals randomized to undergo treatment with a web-based self-directed regimen were able to successfully navigate the platform and receive the intervention.

2. Compared to the control group, significantly more patients in the intervention group reported a resolution of their vertigo symptoms.

Level of Evidence Rating: 1 (Excellent)

Study Rundown: Benign paroxysmal positional vertigo (BPPV) is a common and bothersome cause of presentations to primary care physicians and ear-nose-throat specialists. BPPV is treated with canalith repositioning maneuvers at the bedside, with a success rate of 80% reported after a single attempt and 92% with repetition. A previous study by Kim et al developed and validated a questionnaire with which patients can diagnose which of the semicircular canals is likely affected during an episode of BPPV with a high rate of accuracy. This randomized controlled trial sought to determine the efficacy of a web-based platform in guiding patients through the self-treatment of BPPV.

585 patients were randomized into this trial, with 292 in the intervention group and 293 controls. 128 patients experienced an episode of BPPV during the trial period with no difference between groups. 72.4% of patients in the intervention group and 42.9% of patients in the control group reported a resolution of their symptoms after a single self-treatment. The highest success rate was amongst patients in the treatment group who had undergone correction of posterior canal BPPV. The web-based program was well received by patients, with more than 80% successfully using it at home without the assistance of study staff or family members.

This randomized controlled trial demonstrated that self-diagnosis and treatment using a web-based platform and questionnaire could prove effective in reducing the recurrence rates of BPPV. The magnitude of the effect size and randomized, double-blinded design of the trial increases the internal validity of the reported results. Limitations of this work include the limited external validity (i.e., results are derived from patients of a single ethnicity and those who have access to a web-based platform) and subjectivity of the primary outcome measure. This trial certainly demonstrates promise for self-treatment of BPPV and potential further applications of web-based patient management in future years.

Click here to read this study in JAMA Neurology

Relevant reading: Questionnaire-based diagnosis of benign paroxysmal positional vertigo

In-Depth [randomized controlled trial]: A multicenter, double-blinded, randomized controlled trial was performed. Patients were recruited from four hospitals in South Korea; eligible patients were older than 20, had single-canal BPPV diagnosed by a physician at an in-person visit, had been successfully treated for BPPV using canalith repositioning maneuvers and had access to a device to participate in the digital education program. 1:1 block randomization was applied.

All patients were instructed to visit the study website – Stop! BPPV – if they experienced a recurrent bout of vertigo. Patients in the intervention group took the validated questionnaire and were instructed via video to perform canalith repositioning specific to the affected semicircular canal. Those in the control group received video instructions for the repositioning maneuver, which was performed at their initial in-person physician visit. The primary outcome was the resolution of BPPV as assessed via telephone interviews conducted with blinded investigators after attempted self-treatment.

21.9% of enrolled patients experienced a recurrent episode of BPPV with no difference between treatment and control groups (19.9% vs 23.9%, 95% confidence interval [CI], –0.11 to 0.03). The mean time to a recurrent episode was 179.8 days. 14.5% of patients were unable to access the web-based system; the proportion was similar between the treatment and control groups. Significantly more patients in the intervention group reported resolution of their symptoms than did patients in the control group after a single attempt of repositioning at home (72.4% vs. 42.9%; χ2 test: 95% CI, 0.13-0.46). In the treatment group, posterior canal BPPV was resolved in 96.4% of cases, and horizontal canal BPPV was resolved in 72.2% of cases. 80.7% of patients who successfully used the web-based system did so without assistance; patients requiring help to navigate the platform were older than those who did not (mean age 68.2 vs. 58.0, p=0.001).

Image: PD

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