Evaluating the Effectiveness of an Integrated Treatment of Vestibular Rehabilitation and Cognitive Behavior Therapy for Chronic Dizziness in a Community-Based Population: A Randomized Controlled Trial

IMPORTANCE: Chronic dizziness is common in primary care. Cognitive strategies combined with vestibular rehabilitation (VR) may enhance outcomes, but evidence from randomized controlled trials with long-term follow-up is limited. OBJECTIVE: The objective was to evaluate whether a group-based intervention integrating vestibular rehabilitation and cognitive behavioral strategies (VR-CBT) provides added benefit beyond a single-session brief vestibular intervention (BI-VR) in individuals with chronic dizziness. DESIGN: A Single-blinded, randomized controlled trial with assessments at baseline, and after 6 and 12 months was conducted. SETTING: The study was conducted in a primary care setting. PARTICIPANTS: One hundred five adults with chronic dizziness were included in the study. INTERVENTION/EXPOSURE: All participants received BI-VR prior to allocation to either intervention or control group. The intervention comprised of an 8-session group-based program (VR-CBT) and was compared to telephone follow-up (control). MAIN OUTCOME(S) AND MEASURE(S): Primary outcomes were dizziness-related handicap (DHI-N) and preferred gait speed, in addition to several secondary outcomes. Between-group differences were estimated using linear mixed-effects models with Holm-Bonferroni adjustment. RESULTS: DHI-N improved in both groups over time with no statistically significant between-group differences 6 months (6.3 points, 95% CI = -12.7 to 0.2) or 12 months (7.0 points, 95% CI = -13.3 to -0.6). No between-group differences were observed in preferred gait speed at 6 months (MD = 0.05 m/s, 95% CI = -0.03 to 0.13) or 12 months (MD = 0.07 m/s, 95% CI = -0.01 to 0.15). A between-group difference was observed for dizziness intensity after head movement at both follow-ups. No other consistent between-group differences were found. CONCLUSION: Both groups showed sustained improvement in dizziness-related handicap over 12 months, with no statistically significant between-group differences in the primary outcomes. Further research is needed to clarify the usefulness of combined vestibular rehabilitation and cognitive behavioral strategies. RELEVANCE: Both approaches were associated with improvement over time, while the added value of VR-CBT remains uncertain.