Objectives
This was a systematic review investigating the efficacy of gaze stabilisation exercises as a stand-alone treatment or as part of multimodal treatment strategies for patients with confirmed vestibular dysfunction (central, peripheral, mixed central/peripheral). The comparator groups comprised of sham/placebo, usual care or vestibular rehabilitation excluding gaze stabilisation exercises. The primary outcomes of interest related to dynamic visual acuity (DVA) with laboratory measures of vestibular function and self-reported dizziness.
Methods
Data sources
Electronic databases PubMed, CINAHL, Web of Science, SPORT Discus, Pedro and Embase were searched from inception up to the 31st of December 2016. No language, publication year or publication status limits were applied to the searches.
Study selection
Randomised controlled trials of adults with confirmed peripheral (unilateral or bilateral), central or mixed vestibular dysfunction or disease where vestibular rehabilitation (including or comprising solely of adaptation exercises) in comparison to sham/placebo, usual care or vestibular rehabilitation excluding gaze stabilisation exercises was prescribed. Each record was independently reviewed by two reviewers to assess for eligibility with less than 1% of initially identified papers included in the final review.
Data extraction
Two authors independently extracted data and assessed each study for risk of bias standardised form.
Results
Data synthesis
22 studies, with a total of 765 adults, were included but only nine studies provided sufficient data for meta-analysis. When vestibular rehabilitation (including adaptation) was compared with sham/no treatment, no DVA outcomes could be evaluated, however a promising effect on Dizziness Handicap Inventory Score (DHI) was noted from two studies comprising 65 subjects (MD: -13.85; CI -20.67, -7.02; I2 68%). When vestibular rehabilitation (including adaptation exercises) was compared with vestibular rehabilitation (excluding adaptation exercises), no significant difference was noted from two studies comprising 19 subjects on DVA with high heterogeneity noted (SMD: 0.84; CI -1.96, 0.28; p=0.14; I2 82%). Similarly, from five studies comprising 114 subjects no effect on DHI total was observed (SMD: -0.13; CI: -0.51, 0.25; p=0.50 I2 47%).
Conclusion
When considered as a stand-alone intervention or in addition to vestibular rehabilitation, insufficient data was provided to conclusively conduct a meta-analysis of the efficacy of gaze stabilisation exercises on dynamic visual acuity in patients with confirmed vestibular dysfunction. Moreover, we identified individual small RCTs that demonstrated efficacy of GS exercises but could not be included in the MA due to heterogeneity of outcomes. Larger pragmatic randomised control trials with defined outcome measures of visual acuity are required in this area.
References
Not applicable
Ethical Approval
Not applicable
