Effects of nonpharmacological interventions for dizziness in older people: systematic review

Background: 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. Purpose: To determine the effects of conservative non-pharmacological interventions for dizziness in older people. Data Sources: 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. Study Selection: 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. Data Extraction: 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. Data Synthesis: 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. Conclusion: 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.