ORCID
- Jonathan Marsden: 0000-0002-2037-4902
- Rachel Dennett: 0000-0003-0400-0502
- Jennifer Freeman: 0000-0002-4072-9758
Abstract
Background:Vestibular dysfunction occurs in 30% to 70% of cases with multiple sclerosis (MS).Objective:To compare the clinical and cost-effectiveness of a customized vestibular rehabilitation (VR) program with a generic booklet-based VR intervention in people with MS with clinical signs of vestibulopathy.Methods:People with MS and symptoms of vertigo and/or imbalance were screened for vestibulopathy (n = 73). Seventy recruited participants were randomly allocated to a 12-week generic booklet-based home program with telephone support (n = 35) or a 12-week customized VR program (n = 35, 12 face-to-face sessions and a home exercise program). The primary clinical outcome was the Dizziness Handicap Inventory (DHI) at 26 weeks post-randomization. The primary economic endpoint was quality-adjusted life-years (QALYs). Secondary outcomes included vertigo severity, balance, gait, and perceived impact of physical symptoms in MS.Results:There was no significant between-group difference in the DHI: mean reduction −1.76 (95% confidence interval −10.02, 6.50) at week 26 in favor of the customized group (P = .670). There were significant differences in favor of the customized group for vertigo symptom score, balance confidence, walking, and perceived impact of MS. Primary cost-effectiveness analysis showed customized VR to be less costly and more effective. However, removal of 2 cost outliers in sensitivity analysis resulted in a mean cost-per-QALY of £30 147. Customized VR was also cost-effective from a societal perspective.Discussion:Impairment level improvements did not translate into functional improvements as measured by the DHI perhaps reflecting that vestibular dysfunction is one of several impairments in MS. The findings indicate the potential cost-effectiveness of the customized program.
DOI Link
Publication Date
2025-01-01
Publication Title
Neurorehabilitation and Neural Repair
Volume
39
Issue
9
ISSN
1545-9683
Acceptance Date
2025-05-12
Deposit Date
2025-06-18
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study is funded by the Multiple Sclerosis Society, United Kingdom (Ref 71). The article presents independent research. Under the University’s Rights Retention policy, authors grant the University a non-exclusive, irrevocable, worldwide, royalty-free license to make manuscripts of their scholarly articles publicly available under a Creative Commons Attribution (CC BY) license or similar license terms. SC is partially supported by the National Institute for Health Research Applied Research Collaboration South West Peninsula.
Additional Links
Keywords
balance, multiple sclerosis, randomized controlled trial, vertigo, vestibular, vestibular rehabilitation
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
First Page
687
Last Page
700
Recommended Citation
Marsden, J., Dennett, R., & Freeman, J. (2025) 'Vestibular Rehabilitation in Multiple Sclerosis: Randomized Controlled Trial and Cost-Effectiveness Analysis Comparing Customized With Booklet Based Vestibular Rehabilitation for Vestibulopathy', Neurorehabilitation and Neural Repair, 39(9), pp. 687-700. Available at: 10.1177/15459683251345444
