PDF(Pubmed)
Abstract：
UNASSIGNED: Benign paroxysmal positional vertigo (BPPV) affects approximately half of acute, moderate-severe traumatic brain injury (TBI) patients. To date, there have been no rigorous studies of BPPV assessment or treatment in this cohort. We aimed to determine the safety, practicability, and efficacy of therapist-led BPPV management in acute TBI and the feasibility of a larger effectiveness trial.
UNASSIGNED: This was a multi-centre, three-arm, parallel-groups, randomised, feasibility trial. Recruitment was via convenience sampling. The main inclusion criteria were age over 18 years and a confirmed, non-penetrating, acute TBI. BPPV-positive patients were randomly allocated to one of three interventions (repositioning manoeuvres, Brandt-Daroff exercises or advice) using minimisation criteria. Outcome assessors were blinded to the intervention.
UNASSIGNED: Of 2014 patients screened for inclusion, 180 were assessed for BPPV. Of those assessed, 34% (62/180) had BPPV, and 58 patients received an intervention. Therapist-led interventions were delivered safely and accurately according to intervention monitoring criteria. Resolution of BPPV was observed in 35/58 (60%) patients. The resolution rate was highest following repositioning manoeuvres (78%), followed by the advice (53%) and Brandt-Daroff interventions (42%). 10 patients experienced recurrence. This was observed more frequently in those with skull fractures and bilateral or mixed BPPV.
UNASSIGNED: Overall, the results provide strong evidence for the feasibility of a future trial. Therapist-led management of BPPV in acute TBI was safe and practicable. Repositioning manoeuvres seemingly yielded a superior treatment effect. However, given the high recurrence rate of post-traumatic BPPV, the optimal time to treat according to patients\' specific recurrence risk requires further investigation.
UNASSIGNED: ISRCTN91943864, https://doi.org/10.1186/ISRCTN91943864.
UNASSIGNED: This was a multi-centre, three-arm, parallel-groups, randomised, feasibility trial. Recruitment was via convenience sampling. The main inclusion criteria were age over 18 years and a confirmed, non-penetrating, acute TBI. BPPV-positive patients were randomly allocated to one of three interventions (repositioning manoeuvres, Brandt-Daroff exercises or advice) using minimisation criteria. Outcome assessors were blinded to the intervention.
UNASSIGNED: Of 2014 patients screened for inclusion, 180 were assessed for BPPV. Of those assessed, 34% (62/180) had BPPV, and 58 patients received an intervention. Therapist-led interventions were delivered safely and accurately according to intervention monitoring criteria. Resolution of BPPV was observed in 35/58 (60%) patients. The resolution rate was highest following repositioning manoeuvres (78%), followed by the advice (53%) and Brandt-Daroff interventions (42%). 10 patients experienced recurrence. This was observed more frequently in those with skull fractures and bilateral or mixed BPPV.
UNASSIGNED: Overall, the results provide strong evidence for the feasibility of a future trial. Therapist-led management of BPPV in acute TBI was safe and practicable. Repositioning manoeuvres seemingly yielded a superior treatment effect. However, given the high recurrence rate of post-traumatic BPPV, the optimal time to treat according to patients\' specific recurrence risk requires further investigation.
UNASSIGNED: ISRCTN91943864, https://doi.org/10.1186/ISRCTN91943864.
摘要：
■良性阵发性位置性眩晕（BPPV）影响大约一半的急性，中重度创伤性脑损伤（TBI）患者。迄今为止,在该队列中,尚无关于BPPV评估或治疗的严格研究.我们的目标是确定安全性，实用性,治疗师主导的BPPV管理在急性TBI中的疗效以及更大有效性试验的可行性。
■这是一个多中心，三臂,平行组，随机化，可行性试验。招聘是通过便利抽样进行的。主要纳入标准是年龄在18岁以上，非穿透性，急性TBI。BPPV阳性患者被随机分配到三种干预措施之一(重新定位操作，Brandt-Daroff练习或建议）使用最小化标准。结果评估人员对干预措施视而不见。
■在接受纳入筛查的2014年患者中，180例进行了BPPV评估。在那些被评估的人中，34%(62/180)有BPPV，58名患者接受了干预。根据干预监测标准，治疗师主导的干预措施安全准确地交付。在35/58（60％）患者中观察到BPPV的消退。重新定位操作后的分辨率最高（78％），其次是建议(53%)和勃兰特-达洛夫干预(42%)。10例患者复发。在颅骨骨折和双侧或混合性BPPV的患者中更常见。
■总的来说，研究结果为未来试验的可行性提供了有力证据.在急性TBI中，治疗师主导的BPPV管理是安全可行的。重新定位动作似乎产生了优越的治疗效果。然而,鉴于创伤后BPPV的高复发率，根据患者特定复发风险的最佳治疗时间需要进一步调查.
■ISRCTN91943864,https://doi.org/10.1186/ISRCTN91943864.
■这是一个多中心，三臂,平行组，随机化，可行性试验。招聘是通过便利抽样进行的。主要纳入标准是年龄在18岁以上，非穿透性，急性TBI。BPPV阳性患者被随机分配到三种干预措施之一(重新定位操作，Brandt-Daroff练习或建议）使用最小化标准。结果评估人员对干预措施视而不见。
■在接受纳入筛查的2014年患者中，180例进行了BPPV评估。在那些被评估的人中，34%(62/180)有BPPV，58名患者接受了干预。根据干预监测标准，治疗师主导的干预措施安全准确地交付。在35/58（60％）患者中观察到BPPV的消退。重新定位操作后的分辨率最高（78％），其次是建议(53%)和勃兰特-达洛夫干预(42%)。10例患者复发。在颅骨骨折和双侧或混合性BPPV的患者中更常见。
■总的来说，研究结果为未来试验的可行性提供了有力证据.在急性TBI中，治疗师主导的BPPV管理是安全可行的。重新定位动作似乎产生了优越的治疗效果。然而,鉴于创伤后BPPV的高复发率，根据患者特定复发风险的最佳治疗时间需要进一步调查.
■ISRCTN91943864,https://doi.org/10.1186/ISRCTN91943864.
