Effects of Nonpharmacological Interventions for Dizziness in Older People: Systematic Review

Julie C Kendall, Jan Hartvigsen, Michael F Azari, Simon D French

Non-pharmacological interventions have been shown to have some effectiveness in adults with dizziness; however, the effectiveness of these interventions in older people is unknown. To determine the effects of conservative non-pharmacological interventions for dizziness in older people. Cochrane Central Register of Controlled Trials, PubMed, EMBASE, SCOPUS, CINAHL, AMED, Index to Chiropractic Literature, PsychINFO and MANTIS were searched from inception to May 2014. Two investigators independently screened controlled trials with dizzy participants over 60 years of age. Dizziness from a specific diagnosis such as Meniere's disease and benign positional paroxysmal vertigo were excluded. Outcome measures from included studies included self-reported dizziness and postural balance. Two investigators independently extracted data on participants, interventions, comparison group, outcome measures and results. Methodological quality of included studies was assessed with the Cochrane Handbook 12-item risk of bias, and Cochrane Back Group 5-item clinical relevance assessment. Seven articles consisting of seven controlled trials were included. All studies utilized some form of exercise as the main intervention including vestibular rehabilitation exercises, postural balance exercises, and Tai-Chi exercise. Studies had a high risk of bias with a lack of adequate randomization and allocation concealment, reporting on co-interventions, reporting on reasons for drop-outs, and reporting on participant compliance. Heterogeneity between the included studies on interventions and outcome measures prohibited meta-analysis. Only two studies reported a significant difference between the intervention and comparison groups on self-reported dizziness. There is insufficient evidence to determine the effectiveness of non-pharmacological treatments for dizziness in older people. Current evidence suffers from high risk of bias and future well-designed trials are needed with adequate blinding, randomization and compliance.