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Effectiveness of the Epley manoeuvre in posterior canal benign paroxysmal positional vertigo: a randomised clinical trial in primary care

José Luis Ballvé Moreno, Ricard Carrillo Muñoz, Yolanda Rando Matos, Iván Villar Balboa, Oriol Cunillera Puértolas, Jesús Almeda Ortega, Estrella Rodero Perez, Xavier Monteverde Curto, Carles Rubio Ripollès, Noemí Moreno Farres, Olga Lucia Arias Agudelo, Carlos Martin Cantera and Rafael Azagra Ledesma
Br J Gen Pract 2019; 69 (678): e52-e60. DOI: https://doi.org/10.3399/bjgp18X700253
José Luis Ballvé Moreno
Grupo de Estudio del Vértigo en Atención Primaria Florida, Equip d’Atenció Primària Florida Nord, Barcelona.
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Ricard Carrillo Muñoz
Equip d’Atenció Primària Florida Sud, Institut Català de la Salut, Hospitalet de Llobregat, Barcelona.
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Yolanda Rando Matos
Grupo de Estudio del Vértigo en Atención Primaria Florida, Equip d’Atenció Primària Florida Nord, Barcelona.
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Iván Villar Balboa
Equip d’Atenció Primària Florida Sud, Institut Català de la Salut, Hospitalet de Llobregat, Barcelona.
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Oriol Cunillera Puértolas
Unitat de Suport a la Recerca Metropolitana Sud, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Cornellà.
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Jesús Almeda Ortega
Unitat de Suport a la Recerca Metropolitana Sud, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Cornellà.
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Estrella Rodero Perez
Grupo de Estudio del Vértigo en Atención Primaria Florida, Equip d’Atenció Primària Florida Nord, Barcelona.
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Xavier Monteverde Curto
Grupo de Estudio del Vértigo en Atención Primaria Florida, Equip d’Atenció Primària Florida Nord, Barcelona.
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Carles Rubio Ripollès
Grupo de Estudio del Vértigo en Atención Primaria Florida, Equip d’Atenció Primària Florida Nord, Barcelona.
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Noemí Moreno Farres
Grupo de Estudio del Vértigo en Atención Primaria Florida, Equip d’Atenció Primària Florida Nord, Barcelona.
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Olga Lucia Arias Agudelo
Grupo de Estudio del Vértigo en Atención Primaria Florida, Equip d’Atenció Primària Florida Nord, Barcelona.
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Carlos Martin Cantera
Unitat de Suport a la Recerca Barcelona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona.
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Rafael Azagra Ledesma
Unitat de Suport a la Recerca Barcelona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, and Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), and Equip d’Atenció Primària Badia del Valles, Servei d’Atenció Primària Vallés Occidental, Unitat de Suport a la Recerca Barcelona Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain.
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Abstract

Background Evidence on the effectiveness of the Epley manoeuvre in primary care is scarce.

Aim To evaluate effectiveness at 1 week, 1 month, and 1 year of a single Epley manoeuvre versus a sham manoeuvre in primary care.

Design and setting Multicentre, double-blind randomised controlled trial in two primary care practices in Spain from November 2012 to January 2015.

Method Patients were ≥18 years diagnosed with subjective or objective posterior benign paroxysmal positional vertigo (vertigo only, or vertigo and nystagmus after a Dix–Hallpike test [DHT]). The intervention group received the Epley manoeuvre, and the control group received a sham manoeuvre. Betahistine was prescribed following the same regimen in both groups. The main outcome measures were the DHT result classified as negative (neither vertigo nor nystagmus) or positive. Positive results were further divided into a positive result for both vertigo and nystagmus (positive DHT with nystagmus), and a positive result for vertigo only (positive DHT without nystagmus); self-reported resolution of vertigo; and self-reported severity of vertigo evaluated on a 10-point Likert scale (10 = worst imaginable vertigo).

Results In total, 134 patients were randomised to either the intervention group (n = 66) or the sham group (n = 68). The intervention group showed better results in the unadjusted analyses at 1 week, with a lower rate of positive DHT with nystagmus (P = 0.022). A positive baseline DHT with nystagmus was associated with a reduction in vertigo severity (marginal effect for 10-point Likert-like question −1.73, 95% confidence interval [CI] = −2.95 to −0.51) and better positive DHT rates in the intervention group (adjusted odds ratio 0.09, 95% CI = 0.01 to 0.92) in the multivariate analyses.

Conclusion A single Epley manoeuvre performed in primary care is an effective treatment for reversing a positive DHT and reducing vertigo severity in patients with baseline nystagmus in the DHT.

  • benign paroxysmal positional vertigo
  • Epley manoeuvre
  • primary health care
  • randomised controlled trial
  • Received April 3, 2018.
  • Revision requested June 14, 2018.
  • Accepted July 17, 2018.
  • © British Journal of General Practice 2019
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British Journal of General Practice: 69 (678)
Br J Gen Pract
Vol. 69, Issue 678
January 2019
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Effectiveness of the Epley manoeuvre in posterior canal benign paroxysmal positional vertigo: a randomised clinical trial in primary care
José Luis Ballvé Moreno, Ricard Carrillo Muñoz, Yolanda Rando Matos, Iván Villar Balboa, Oriol Cunillera Puértolas, Jesús Almeda Ortega, Estrella Rodero Perez, Xavier Monteverde Curto, Carles Rubio Ripollès, Noemí Moreno Farres, Olga Lucia Arias Agudelo, Carlos Martin Cantera, Rafael Azagra Ledesma
Br J Gen Pract 2019; 69 (678): e52-e60. DOI: 10.3399/bjgp18X700253

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Effectiveness of the Epley manoeuvre in posterior canal benign paroxysmal positional vertigo: a randomised clinical trial in primary care
José Luis Ballvé Moreno, Ricard Carrillo Muñoz, Yolanda Rando Matos, Iván Villar Balboa, Oriol Cunillera Puértolas, Jesús Almeda Ortega, Estrella Rodero Perez, Xavier Monteverde Curto, Carles Rubio Ripollès, Noemí Moreno Farres, Olga Lucia Arias Agudelo, Carlos Martin Cantera, Rafael Azagra Ledesma
Br J Gen Pract 2019; 69 (678): e52-e60. DOI: 10.3399/bjgp18X700253
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Keywords

  • benign paroxysmal positional vertigo
  • Epley manoeuvre
  • primary health care
  • randomised controlled trial

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© 2019 British Journal of General Practice

Print ISSN: 0960-1643
Online ISSN: 1478-5242