Effectiveness of conventional versus virtual reality based vestibular rehabilitation in the treatment of dizziness, gait and balance impairment in adults with unilateral peripheral vestibular loss: a randomised controlled trial

In a single (assessor) blind, two centre randomised controlled superiority trial, 80 patients with unilateral peripheral vestibular loss will be randomised to either conventional or virtual reality based (NWFP) vestibular rehabilitation for 6 weeks. The primary outcome measure is gait speed (measured with three dimensional gait analysis). Secondary outcomes include computerised posturography, dynamic visual acuity, and validated questionnaires on dizziness, confidence and anxiety/depression. Outcome will be assessed post treatment (8 weeks) and at 6 months.Advances in the gaming industry have allowed mass production of highly sophisticated low cost virtual reality systems that incorporate technology previously not accessible to most therapists and patients. Importantly, they are not confined to rehabilitation departments, can be used at home and provide an accurate record of adherence to exercise. The benefits of providing augmented feedback, increasing intensity of exercise and accurately measuring adherence may improve conventional vestibular rehabilitation but efficacy must first be demonstrated.Clinical trials.gov identifier: NCT01442623Unilateral peripheral vestibular loss (UVL) results in disabling problems including vertigo, dizziness, oscillopsia, and impaired balance and gait [1,2]. In the acute phase most patients are managed at primary care level and recover through a process known as vestibular compensation [3]. Pharmacological treatments are recommended only in the acute phase [4] and the mainstay for treatment thereafter in those who do not recover, is specialised rehabilitation known as vestibular rehabilitation. Vestibular rehabilitation is a safe, effective and non-invasive treatment for the sequelae of UVL [5,6]. Subjectively, balance impairment is rated as more problematic than dizziness or vertigo [7] and while meta-analysis has demonstrated a clear benefit for the reduction in dizziness and vertigo symptoms, a less convincing effect has been sho