Several components of postural control are affected by benign paroxysmal positional vertigo but improve after particle-repositioning maneuvers: A systematic review and meta-analysis.

Sara Pauwels, Laura Casters, Nele Lemkens, Winde Lemmens, Pieter Meyns, Joke Spildooren, Kenneth Meijer, Raymond van de Berg

Journal: Clinical rehabilitation 2025;39(1):3-22

PMID: 39501612

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Abstract

OBJECTIVE

Benign Paroxysmal Positional Vertigo is a vestibular disorder causing vertigo and imbalance. This systematic review and meta-analysis aims to explore the impact of benign paroxysmal positioning vertigo and repositioning maneuvers on postural control.

DATA SOURCES

In September 2024, PubMed, Web of Science, Scopus and reference lists of included studies were systematically searched. Articles comparing measures of postural control between patients and controls, and/or pre- and posttreatment were considered relevant.

METHODS

Study selection, data extraction and identification of risk of bias were done by two researchers. If possible, meta-analysis was performed with Review Manager version 5.4.1 and standardized mean differences were calculated with a random-effects model.

RESULTS

Twenty-one of the 37 included studies were useful for meta-analyses. Meta-analyses revealed that benign paroxysmal positional vertigo negatively affects perception of verticality (p < .001; SMD = 0.73; 95% CI = [0.39;1.08]) and sensory orientation (p < .001; SMD = -1.66; 95% CI = [-2.08, -1.23]). The perception of verticality (p < .001; SMD = 0.99; 95% CI = [0.76;1.21]) and sensory orientation (p < .001; SMD = -0.77; 95% CI = [-1.11, -0.44]) improved after treatment with repositioning maneuvers. Results of systematic review indicate stability in gait was impaired, vertigo but improve after repositioning maneuvers. Limits of stability were impaired in older patients, but did not improved after repositioning maneuvers.

CONCLUSION

Benign paroxysmal positioning vertigo affects several underlying components of postural control. Repositioning maneuvers can significantly improve the related postural control impairments. This may partly explain the increased odds of falling in these patients, and the positive treatment effect of repositioning maneuvers on falls and fear of falling.

Address: Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium.; Department of Otorhinolaryngology and Head & Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre+, Maastricht, The Netherlands.; Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium.; Department of Otorhinolaryngology, Head and Neck Surgery ZOL Hospital, Genk, Belgium.; Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.; Department of Otorhinolaryngology and Head & Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre+, Maastricht, The Netherlands.

DOI: 10.1177/02692155241292662

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MeSH Terms: Humans, Benign Paroxysmal Positional Vertigo, Postural Balance, Patient Positioning