Multimodal Physiotherapy for Balance and Vertigo in BPPV Patients

Benign paroxysmal positional vertigo (BPPV) is one of the most common vestibular disorders, characterized by brief episodes of vertigo triggered by changes in head position. It significantly affects balance, mobility, and quality of life, and increases the risk of falls, especially in older adults. Although repositioning maneuvers such as the Epley maneuver are considered the standard treatment, many patients continue to experience residual dizziness, imbalance, and fear of falling.

A multimodal physiotherapy approach that combines patient education, vestibular rehabilitation, and balance training may provide a more comprehensive strategy to address these residual impairments. This approach targets both the vestibular and functional components of recovery, potentially improving overall patient outcomes.

This study is a single-blinded randomized controlled trial designed to evaluate the effects of a multimodal physiotherapy approach compared to standard treatment in patients with BPPV. Participants aged 22 to 79 years diagnosed with BPPV will be recruited using a non-probability convenience sampling technique. Participants will be randomly allocated into two groups: the intervention group receiving patient education, Epley maneuver, and balance training, and the control group receiving only the Epley maneuver. The intervention will be administered three times per week for four weeks.

Outcome measures will include the Dynamic Gait Index for balance, Dizziness Handicap Inventory for vertigo, Falls Efficacy Scale-International for fear of falling, and SF-36 for quality of life. Assessments will be conducted at baseline and after completion of the intervention.

The results of this study will provide evidence on whether a multimodal physiotherapy approach is more effective than standard treatment in improving balance, reducing vertigo symptoms, decreasing fear of falling, and enhancing quality of life in patients with BPPV.

Inclusion criteria

Age group between (22-79). Both the genders Male and Female were included. Diagnosed with posterior canal benign paroxysmal positional vertigo (PC-BPPV) confirmed by a positive Dix-Hall pike maneuver.

Onset of symptoms within the past 3 months. Dynamic Balance impairment by DGI > 21. All patients had history of at least two or more attacks of BPPV over 6 months.

Exclusion criteria

Patients with a history of cervical spine injuries. Patients taking anti-vertigo medication. Patients with a previous diagnosis of Meniere's disease, migraine, or vestibular neuritis Patients with a previous history of neurological diseases. Cases with bilateral involvement. Absence of systemic diseases without medical control and absence of functional limitations that impede independent walking.