Article

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo.
The purpose of this systematic review was to determine
whether patients diagnosed with posterior canal (PC) BPPV, based on positional
testing, and treated with a particle repositioning maneuver will show the
resolution of benign paroxysmal positional nystagmus (BPPN) on the Dix-Hallpike
Test performed 24 hours or more after treatment. DATA SOURCES: Data were obtained
from an electronic search of the MEDLINE, EMBASE, and CINAHL databases from 1966
through September 2009. STUDY SELECTION: The study topics were randomized
controlled trials (RCTs), quasi-RCTs, the diagnosis of PC BPPV, treatment with
the particle repositioning maneuver, and outcome measured with a positional test
24 hours or more after treatment. DATA EXTRACTION: Data extracted were study
descriptors and the information used to code for effect size. DATA SYNTHESIS: In
2 double-blind RCTs, the odds in favor of the resolution of BPPN were 22 times
(95% confidence interval=3.41-141.73) and 37 times (95% confidence
interval=8.75-159.22) higher in people receiving the canalith repositioning
procedure (CRP) than in people receiving a sham treatment. This finding was
supported by the results reported in 8 nonmasked quasi-RCTs. Studies with limited
methodological quality suggested that a liberatory maneuver (LM) was more
effective than a control intervention; there was no significant difference in the
effectiveness of the LM and the effectiveness of the CRP; the self-administered
CRP was more effective than the self-administered LM; and the CRP administered
together with the self-administered CRP was more effective than the CRP
administered alone. The Brandt-Daroff exercises were the least effective
self-administered treatments. LIMITATIONS: The limitations included the
methodological quality of the studies, the lack of quality-of-life measures, and
confounding factors in reporting vertigo. CONCLUSIONS: Randomized controlled
trials provided strong evidence that the CRP resolves PC BPPN, and quasi-RCTs
suggested that the CRP or the LM performed by a clinician or with proper
instruction at home by the patient resolves PC BPPN. There were no data on the
effects of the maneuvers on outcomes relevant to patients.

Langue : ANGLAIS