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dc.contributor.authorMarsden, Jen
dc.contributor.authorPavlou, Men
dc.contributor.authorDennett, Ren
dc.contributor.authorGibbon, Aen
dc.contributor.authorKnight-Lozano, Ren
dc.contributor.authorJeu, Len
dc.contributor.authorFlavell, Cen
dc.contributor.authorFreeman, Jen
dc.contributor.authorBamiou, DEen
dc.contributor.authorHarris, Cen
dc.contributor.authorHawton, Aen
dc.contributor.authorGoodwin, Een
dc.contributor.authorJones, Ben
dc.contributor.authorCreanor, Sen

<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Symptoms arising from vestibular system dysfunction are observed in 49–59% of people with Multiple Sclerosis (MS). Symptoms may include vertigo, dizziness and/or imbalance. These impact on functional ability, contribute to falls and significant health and social care costs. In people with MS, vestibular dysfunction can be due to peripheral pathology that may include Benign Paroxysmal Positional Vertigo (BPPV), as well as central or combined pathology. Vestibular symptoms may be treated with vestibular rehabilitation (VR), and with repositioning manoeuvres in the case of BPPV. However, there is a paucity of evidence about the rate and degree of symptom recovery with VR for people with MS and vestibulopathy. In addition, given the multiplicity of symptoms and underpinning vestibular pathologies often seen in people with MS, a customised VR approach may be more clinically appropriate and cost effective than generic booklet-based approaches. Likewise, BPPV should be identified and treated appropriately.</jats:p> </jats:sec><jats:sec> <jats:title>Methods/ design</jats:title> <jats:p>People with MS and symptoms of vertigo, dizziness and/or imbalance will be screened for central and/or peripheral vestibulopathy and/or BPPV. Following consent, people with BPPV will be treated with re-positioning manoeuvres over 1–3 sessions and followed up at 6 and 12 months to assess for any re-occurrence of BPPV. People with central and/or peripheral vestibulopathy will be entered into a randomised controlled trial (RCT). Trial participants will be randomly allocated (1:1) to either a 12-week generic booklet-based home programme with telephone support or a 12-week VR programme consisting of customised treatment including 12 face-to-face sessions and a home exercise programme. Customised or booklet-based interventions will start 2 weeks after randomisation and all trial participants will be followed up 14 and 26 weeks from randomisation. The primary clinical outcome is the Dizziness Handicap Inventory at 26 weeks and the primary economic endpoint is quality-adjusted life-years. A range of secondary outcomes associated with vestibular function will be used.</jats:p> </jats:sec><jats:sec> <jats:title>Discussion</jats:title> <jats:p>If customised VR is demonstrated to be clinically and cost-effective compared to generic booklet-based VR this will inform practice guidelines and the development of training packages for therapists in the diagnosis and treatment of vestibulopathy in people with MS.</jats:p> </jats:sec><jats:sec> <jats:title>Trial registration</jats:title> <jats:p>ISRCTN Number: <jats:ext-link xmlns:xlink="" ext-link-type="uri" xlink:href="">27374299</jats:ext-link></jats:p> <jats:p>Date of Registration 24/09/2018</jats:p> <jats:p>Protocol Version 15 25/09/2019</jats:p> </jats:sec>

dc.publisherSpringer Science and Business Media LLCen
dc.titleVestibular rehabilitation in multiple sclerosis: study protocol for a randomised controlled trial and cost-effectiveness analysis comparing customised with booklet based vestibular rehabilitation for vestibulopathy and a 12 month observational cohort study of the symptom reduction and recurrence rate following treatment for benign paroxysmal positional vertigoen
dc.typeJournal Article
plymouth.journalBMC Neurologyen
plymouth.organisational-group/Plymouth/Faculty of Health
plymouth.organisational-group/Plymouth/Faculty of Health/School of Health Professions
plymouth.organisational-group/Plymouth/Faculty of Health/School of Psychology
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA03 Allied Health Professions, Dentistry, Nursing and Pharmacy
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plymouth.organisational-group/Plymouth/Research Groups/Centre for Brain, Cognition and Behaviour (CBCB)
plymouth.organisational-group/Plymouth/Research Groups/Centre for Brain, Cognition and Behaviour (CBCB)/Brain
plymouth.organisational-group/Plymouth/Research Groups/Institute of Health and Community
plymouth.organisational-group/Plymouth/Users by role
plymouth.organisational-group/Plymouth/Users by role/Academics
plymouth.organisational-group/Plymouth/Users by role/Professional Services staff
dc.rights.embargoperiodNot knownen
rioxxterms.typeJournal Article/Reviewen

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