Positive results from our study will highlight that treatment of benign paroxysmal positional vertigo can be performed by trained general practitioners (GPs) and, therefore, its widespread practice may contribute to improve the quality of life of BPPV patients. Chi-square test or Fisher’s exact test will be conducted to compare categorical measures and Student’s t-test or Mann–Whitney U-test will be used for intergroup comparison variables. Groups will be compared using the intent-to-treat approach and either parametric or nonparametric tests, depending on the nature and distribution of the variables. We will use descriptive statistics of all variables collected. Outcome variables will be: response to the D-H test, patients’ report on presence or absence of vertigo during the previous week (dichotomous variable: yes/no), intensity of vertigo symptoms on a Likert-type scale in the previous week, total score on the Dizziness Handicap Inventory (DHI) and quantity of betahistine taken. All patients attending these two primary care centers, who are newly diagnosed with benign paroxysmal positional vertigo, will be invited to participate in the study and will be randomly assigned either to the treatment group (Epley’s maneuver) or to the control group (a sham maneuver). The study’s scope will include two urban primary care centers which provide care for approximately 49,400 patients. This study is a randomized clinical trial conducted in the primary care setting. The objective of this study is to evaluate the effectiveness of Epley’s maneuver performed by general practitioners (GPs) in the treatment of BPPV. The main cause of vertigo in primary care is benign paroxysmal positional vertigo (BPPV), which should be confirmed by a positive D-H positional test and treated with repositioning maneuvers. Trial Registration ClinicalTrials.Vertigo is a common medical condition with a broad spectrum of diagnoses which requires an integrated approach to patients through a structured clinical interview and physical examination. Nineteen patients (19.6%) in the EM group and 24 (24.5%) in the SM-plus group experienced relevant nausea.Ĭonclusions and Relevance The SM-plus self-maneuver is superior to the EM self-maneuver in terms of the number of days until recovery in pcBPPV. No serious adverse event was detected with both maneuvers. For the secondary end point (effect of a single maneuver), no significant difference was detected (67 of 98 vs 61 of 97 P = .42 α = .05). The mean (SD) time until no positional vertigo attacks could be induced in the SM-plus group was 2.0 (1.6) days (median, 1 day 95% CI, 1.64-2.28 days) in the EM group, 3.3 (3.6) days (median, 2 days 95% CI, 2.62-4.06 days) ( P = .01 α = .05, 2-tailed Mann-Whitney test). Results Of the 195 participants included in the analysis, the mean (SD) age was 62.6 (13.9) years, and 125 (64.1%) were women. The secondary end point was the effect of the single maneuver performed by the physician. The primary end point was the number of days until no positional vertigo could be induced on 3 consecutive mornings. Main Outcome and Measures Patients had to document whether they could provoke positional vertigo every morning. Interventions After being randomized to the SM-plus or the EM group, patients received 1 initial maneuver from a physician, then subsequently performed self-maneuvers at home 3 times in the morning, 3 times at noon, and 3 times in the evening. The analysis was prespecified and per-protocol. After consideration of the exclusion criteria as well as informed consent, 56 patients were excluded and 2 declined to participate, with 195 participants included in the final analysis. Two hundred fifty-three patients were assessed for eligibility. Patients were selected randomly during routine outpatient care after being referred to 1 of the 3 centers. Recruitment took place from June 1, 2020, until March 10, 2022. Objective To compare the effectiveness of the Semont-plus maneuver (SM-plus) and the Epley maneuver (EM) for treatment of posterior canal benign paroxysmal positional vertigo (pcBPPV) canalolithiasis.ĭesign, Setting, and Participants This prospective randomized clinical trial was performed at 3 national referral centers (in Munich, Germany Siena, Italy and Bruges, Belgium) over 2 years, with a follow-up to 4 weeks after the initial examination. Importance Questions remain concerning treatment efficacy for the common condition of benign paroxysmal positional vertigo (BPPV).
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