Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association.

The guideline excludes studies on benign paroxysmal positional vertigo (BPPV), Meniere's disease, concussion, and central vestibular disorders, so recommendations do not apply to these conditions. Only articles published in English were included, potentially missing relevant international research. Diagnosis of vestibular hypofunction in included studies relied on objective vestibular function testing (caloric, vHIT, etc.), so the guidelines may not apply to individuals with subjective dizziness/imbalance without confirmed hypofunction. Evidence for specific exercise dosages (frequency, intensity, duration) is often weak or based on expert opinion and extrapolation, as few studies directly compared different doses. Many studies combined multiple exercise types (gaze stabilization, balance, habituation), making it difficult to isolate the effect of any single component. The guideline does not address pediatric populations extensively due to a paucity of research, though some emerging evidence is noted. Conflicts of interest: The guideline was supported by a grant from the American Physical Therapy Association (APTA). Authors declared no conflicts of interest related to commercial entities, but the APTA is a professional association that promotes physical therapy practice.

The workgroup received 1-year grant funding from the American Physical Therapy Association (APTA) to support the revision of the guideline. Authors declared no conflicts of interest related to commercial entities selling treatments or devices.

Do not assume that all forms of vestibular rehabilitation are equally effective. Eye movement exercises performed without head movements (saccades or smooth pursuit) are specifically recommended against for treating gaze instability, as they do not improve function. Additionally, while technology like VR is promising, non-immersive VR balance games did not show superiority over traditional low-technology balance exercises in the reviewed studies.