Vestibular Rehabilitation in Multiple Sclerosis: Randomized Controlled Trial and Cost-Effectiveness Analysis Comparing Customized With Booklet Based Vestibular Rehabilitation for Vestibulopathy
Abstract
Background: Vestibular dysfunction occurs in 30% to 70% of cases with multiple sclerosis (MS). Objective: To compare the clinical and cost-effectiveness of a customized vestibular rehabilitation (VR) program with a generic booklet-based VR intervention in people with MS with clinical signs of vestibulopathy. Methods: People with MS and symptoms of vertigo and/or imbalance were screened for vestibulopathy (n = 73). Seventy recruited participants were randomly allocated to a 12-week generic booklet-based home program with telephone support (n = 35) or a 12-week customized VR program (n = 35, 12 face-to-face sessions and a home exercise program). The primary clinical outcome was the Dizziness Handicap Inventory (DHI) at 26 weeks post-randomization. The primary economic endpoint was quality-adjusted life-years (QALYs). Secondary outcomes included vertigo severity, balance, gait, and perceived impact of physical symptoms in MS. Results: There was no significant between-group difference in the DHI: mean reduction −1.76 (95% confidence interval −10.02, 6.50) at week 26 in favor of the customized group (P = .670). There were significant differences in favor of the customized group for vertigo symptom score, balance confidence, walking, and perceived impact of MS. Primary cost-effectiveness analysis showed customized VR to be less costly and more effective. However, removal of 2 cost outliers in sensitivity analysis resulted in a mean cost-per-QALY of £30 147. Customized VR was also…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 73 participants or records.
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