Effectiveness of three vestibular rehabilitation exercises for treating acute unilateral peripheral vestibular dysfunction: a multicenter randomized study

Abstract

Background: Vestibular rehabilitation therapy (VRT) is an established intervention for patients with acute unilateral peripheral vestibular dysfunction (aUPVD). However, the relative effectiveness of different VRT strategies remains uncertain. This multicenter randomized pilot trial aimed to compare the effects of customized vestibular rehabilitation therapy (CVRT), generic Cawthorne-Cooksey exercises (GVRT), and vestibulo-ocular reflex (VOR) adaptation exercises on vestibular symptom recovery and functional improvement. Methods: A total of 34 patients with aUPVD were enrolled across three centers, of whom 23 completed the study and were included in the final analysis (CVRT, n = 11; GVRT, n = 6; VOR, n = 6). All participants underwent an 8-week rehabilitation program, performing prescribed exercises three times daily. Outcomes included the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB), Functional Reach Test (FRT), Visual Analog Scale (VAS), Dizziness Handicap Inventory (DHI), Disability Scale (DS), and Activities-specific Balance Confidence (ABC) scale. Nonparametric tests with post-hoc effect size estimation were applied. Results: Significant within-group improvements were observed in mCTSIB, VAS, DS, DHI, and ABC scores in the CVRT group (p < 0.05). The GVRT group showed significant improvements in mCTSIB (foam EC), VAS, DS, DHI, and ABC (p < 0.05), whereas the VOR adaptation group showed limited improvement in mCTSIB (foam EO) and DS. Although all three intervention groups demonstrated significant improvements after rehabilitation, no statistically significant differences were found among groups. The CVRT group demonstrated the largest numerical gains in VAS and ABC scores, but these differences did not reach statistical significance. Conclusion: All three vestibular physical therapy approaches effectively improved symptoms and functional balance in patients with aUPVD. While between-group differences were not statistically significant, the customized rehabilitation group showed the most consistent pattern of improvement. These findings suggest potential clinical advantages of individualized therapy, warranting confirmation in larger studies.