Habituation Exercises versus Proprioceptive Training for Dizziness, Vertigo, Balance, and Quality of Life in Benign Paroxysmal Positional Vertigo: A Randomized Clinical Trial

Abstract

Background: Benign paroxysmal positional vertigo, the most common peripheral vestibular disorder, is caused by displaced otoconia in the semicircular canals, producing brief position-triggered vertigo, nausea, and imbalance that impair postural stability, quality of life, and increase fall risk.

Objective: To compare the habituation exercises and proprioceptive training, each combined with conventional vestibular therapy, against conventional therapy alone, on dizziness, vertigo, balance, and quality of life in chronic benign paroxysmal positional vertigo patients.

Methods: This was a double-blind randomized clinical trial conducted over ten months at the Department of Physical Medicine and Rehabilitation, Ittefaq Hospital, and PSRD, Lahore, Pakistan, following approval from the Research and Ethics Committee of the Riphah International University. Patients with central nervous system involvement, orthopedic conditions limiting proprioceptive tasks (including cervical deficits that could compromise positioning maneuvers), an inability to follow verbal commands, or a history of head injury were excluded. In this trial, 39 patients with Dix-Hallpike-confirmed benign paroxysmal positional vertigo were assigned by coin-toss randomization to three groups of 13: habituation exercises plus conventional therapy (Group A), proprioceptive training plus conventional therapy (Group B), and conventional vestibular therapy alone (Group C). All groups received a weekly Epley repositioning maneuver. The Berg Balance Scale, Dynamic Gait Index, Dizziness Handicap Inventory, Vertigo Visual Analogue Scale, and Activities-specific Balance Confidence Scale were recorded at baseline, three weeks, and six weeks. We assessed within-group change across the three time points with repeated-measures ANOVA and between-group differences at each time point with one-way ANOVA.

Results: All three groups showed statistically significant within-group improvement on every outcome across the three assessment points (p<0.001). In between-group comparison at six weeks, proprioceptive training produced significantly greater gains than the other two groups on the Berg Balance Scale, Dizziness Handicap Inventory, Vertigo Visual Analogue Scale, and Activities-specific Balance Confidence Scale (p<0.05); Dynamic Gait Index improved in all groups but did not differ significantly between groups (p>0.05).

Conclusion: Combining proprioceptive training with the Epley maneuver improves balance, dizziness, vertigo severity, and balance confidence more than habituation exercises or conventional therapy alone in Benign paroxysmal positional vertigo patients, supporting its use as a preferred adjunct in vestibular rehabilitation.