Vestibular Rehabilitation in Multiple Sclerosis: Randomized Controlled Trial and Cost-Effectiveness Analysis Comparing Customized With Booklet Based Vestibular Rehabilitation for Vestibulopathy.
Jonathan Marsden, Rachel Dennett, Angela Gibbon and 10 others
PMID 40528281WHAT IT FOUND
For people with MS and vestibular issues, customized physiotherapy showed no significant advantage over a generic booklet-based home program on the primary measure of dizziness impact.
However, the customized group improved more on secondary measures of walking, balance confidence, and vertigo severity.
Key findings
01There was no evidence of a statistically significant difference between groups in the primary outcome, the Dizziness Handicap Inventory, at 26 weeks.
02The customized intervention group showed significant improvements compared to the control group in secondary outcomes including the Dynamic Gait Index, Activities-Specific Balance Confidence Scale, and Vertigo Symptom Scale.
03The customized program cost more to deliver but was found to be less costly overall and more effective when societal costs were included, though this was sensitive to two high-cost outliers in the control group.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was powered to detect differences in the primary outcome (DHI) but not in the health economic measures or secondary outcomes. Most participants had central or combined vestibulopathy, limiting the generalizability to those with purely peripheral issues. The cost-effectiveness analysis was highly sensitive to two outliers in the control group; removing them reversed the finding that the customized intervention was less costly. Recruitment was affected by the COVID-19 pandemic, leading to remote assessments for some participants and potential protocol deviations. Participants and therapists were not blinded to the allocation, which could influence self-reported secondary outcomes.
Declared interests
The authors declared no potential conflicts of interest. The study was funded by the Multiple Sclerosis Society, United Kingdom.
The easy way to misread this
Do not conclude that customized vestibular rehabilitation is cost-effective. While the primary analysis suggested it was, this result depended entirely on two high-cost outliers in the control group. When these were excluded, the customized intervention was more expensive, and the probability of it being cost-effective at standard thresholds was low.
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