Effectiveness of Vestibular Rehabilitation in Children Post-Concussion: A Systematic Review.

Most of the evidence comes from weak designs: of the twelve studies, five were retrospective cohorts, two were case series and two were single case reports, with only three randomised trials. No meta-analysis could be done, because the studies varied too much in design, sample size and outcome measures. Four of the twelve studies included adults as well as children and did not report results separately by age, so it is unclear how much of the improvement belongs to children. The main outcome measures were built for adults: the Dizziness Handicap Inventory and the ABC balance confidence scale are not validated in children, and there is no agreed clinically meaningful change value for the Balance Error Scoring System. Only English-language, peer-reviewed studies were included, and grey literature was excluded. Most studies delivered vestibular rehabilitation alongside other treatments, so the effect of vestibular rehabilitation on its own is unknown.

The authors report no conflicts of interest. The supplied text does not state who funded the review.

Do not read this as proof that vestibular rehabilitation works on its own in children after concussion. Only three of the twelve included studies were randomised, most children received vestibular rehabilitation alongside other treatments so its contribution cannot be separated, and the studies disagreed with each other on dizziness, balance and vision testing. The review's conclusion is that vestibular rehabilitation shows promise as part of a broader plan, not that it is established treatment.