Department of Physical Therapy, Midwestern University, 555 31st St, Downers Grove, IL 60515, USA.
Phys Ther. 2010 May;90(5):663-78. doi: 10.2522/ptj.20090071. Epub 2010 Mar 25.
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 were obtained from an electronic search of the MEDLINE, EMBASE, and CINAHL databases from 1966 through September 2009.
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 extracted were study descriptors and the information used to code for effect size.
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.
The limitations included the methodological quality of the studies, the lack of quality-of-life measures, and confounding factors in reporting vertigo.
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.
良性阵发性位置性眩晕（BPPV）是眩晕最常见的原因。
本系统评价的目的是确定根据位置测试诊断为后半规管（PC）BPPV 并接受颗粒重定位手法治疗的患者，在治疗后 24 小时或更长时间进行 Dix-Hallpike 测试时，是否会出现良性阵发性位置性眼球震颤（BPPN）的缓解。
数据来自 1966 年至 2009 年 9 月期间 MEDLINE、EMBASE 和 CINAHL 数据库的电子检索。
研究主题是随机对照试验（RCT）、准 RCT、PC BPPV 的诊断、颗粒重定位手法治疗以及治疗后 24 小时或更长时间进行位置测试测量的结果。
提取的数据包括研究描述符和用于编码效应大小的信息。
在 2 项双盲 RCT 中，接受管石复位术（CRP）治疗的患者 BPPN 缓解的优势比为 22 倍（95%置信区间=3.41-141.73）和 37 倍（95%置信区间=8.75-159.22），而接受假治疗的患者优势比为 22 倍（95%置信区间=3.41-141.73）和 37 倍（95%置信区间=8.75-159.22）。这一发现得到了 8 项非盲准 RCT 报告结果的支持。方法学质量有限的研究表明，解脱手法（LM）比对照干预更有效；LM 和 CRP 的有效性没有显著差异；自我管理的 CRP 比自我管理的 LM 更有效；自我管理的 CRP 与自我管理的 CRP 联合应用比单独应用 CRP 更有效。Brandt-Daroff 运动是自我管理治疗中最无效的方法。
这些局限性包括研究的方法学质量、缺乏生活质量措施以及报告眩晕时的混杂因素。
随机对照试验提供了强有力的证据表明 CRP 可解决 PC BPPN，准 RCT 表明 CRP 或由临床医生或患者在家中进行适当指导的 LM 可解决 PC BPPN。没有关于这些手法对与患者相关的结果的影响的数据。
