cqvip:Background: Dizziness is a very common symptom and is usually managed in prima ry care. Vestibular rehabilitation for dizziness is a simple treatment that may be suitable for primary care delivery, but its effectiveness has not yet been de termined. Objective: To evaluate the effectiveness of nurse delivered vestibula r rehabilitation in primary care for patients with chronic dizziness. Design: Si ngle blind randomized, controlled trial. Setting: 20 general practices in south ern England. Patients: 170 adult patients with chronic dizziness who were random ly assigned to vestibular rehabilitation (n = 83) or usual medical care (n = 87) . Intervention: Each patient received one 30 to 40 minute appointment with a p rimary care nurse. The nurse taught the patient exercises to be carried out dail y at home, with the support of a treatment booklet. Measurements: Primary outcom e measures were baseline, 3 month, and 6 month assessment of self reported sp ontaneous and provoked symptoms of dizziness, dizzi ness related quality of li fe, and objective measurement of postural stability with eyes open and eyes clos ed. Results:At 3 months, improvement on all primary outcome measures in the vest ibular rehabilitation group was significantly greater than in the usual medical care group; this improvement was maintained at 6 months. Of 83 treated patients, 56 (67%) reported clinically significant improvement compared with 33 of 87 (3 8%) usual care patients (relative risk, 1.78 [95%CI, 1.31 to 2.42]). Limitat io ns: Psychological elements of the therapy may have contributed to outcomes, and the treatment may be effective only for well motivated patients. Conclusions: V estibular rehabilitation delivered by nurses in general practice improves sympto ms, postural stability, and dizziness related handicap in patients with chronic dizziness.
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