Internet-Based Vestibular Rehabilitation for Older Adults With Chronic Dizziness: A Randomized Controlled Trial in Primary Care

Adam W A Geraghty, Rosie Essery, Sarah Kirby, Beth Stuart, David Turner, Paul Little, Adolfo Bronstein, Gerhard Andersson, Per Carlbring, Lucy Yardley

Research output: Contribution to journalArticle (Academic Journal)peer-review

38 Citations (Scopus)


PURPOSE: Vestibular rehabilitation is an effective intervention for dizziness due to vestibular dysfunction, but is seldom provided. We aimed to determine the effectiveness of an Internet-based vestibular rehabilitation program for older adults experiencing dizziness in primary care.

METHODS: We undertook a single-center, single-blind randomized controlled trial comparing an Internet-based vestibular rehabilitation intervention (Balance Retraining, freely available from with usual primary care in patients from 54 primary care practices in southern England. Patients aged 50 years and older with current dizziness exacerbated by head movements were enrolled. Those in the intervention group accessed an automated Internet-based program that taught vestibular rehabilitation exercises and suggested cognitive behavioral management strategies. Dizziness was measured by the Vertigo Symptom Scale-Short Form (VSS-SF) at baseline, 3 months, and 6 months. The primary outcome was VSS-SF score at 6 months.

RESULTS: A total of 296 patients were randomized in the trial; 66% were female, and the median age was 67 years. The VSS-SF was completed by 250 patients (84%) at 3 months and 230 patients (78%) at 6 months. Compared with the usual care group, the Internet-based vestibular rehabilitation group had less dizziness on the VSS-SF at 3 months (difference, 2.75 points; 95% CI, 1.39-4.12; P <.001) and at 6 months (difference, 2.26 points; 95% CI, 0.39-4.12; P = .02, respectively). Dizziness-related disability was also lower in the Internet-based vestibular rehabilitation group at 3 months (difference, 6.15 points; 95% CI, 2.81-9.49; P <.001) and 6 months (difference, 5.58 points; 95% CI, 1.19-10.0; P = .01).

CONCLUSIONS: Internet-based vestibular rehabilitation reduces dizziness and dizziness-related disability in older primary care patients without requiring clinical support. This intervention has potential for wide application in community settings.

Original languageEnglish
Pages (from-to)209-216
Number of pages8
JournalAnnals of Family Medicine
Issue number3
Early online date1 May 2017
Publication statusPublished - 1 May 2017

Bibliographical note

© 2017 Annals of Family Medicine, Inc.


  • Aged
  • Dizziness/etiology
  • Female
  • Humans
  • Internet
  • Male
  • Middle Aged
  • Primary Health Care/methods
  • Single-Blind Method
  • Treatment Outcome
  • Vestibular Diseases/complications


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