Eva Ekvall-Hansson

Dizziness among patients with whiplash-associated disorder: a randomized controlled trial.

OBJECTIVE To investigate whether vestibular rehabilitation for patients with whiplash-associated disorder and dizziness had any effect on balance measures and self-perceived handicap. DESIGN Randomized, controlled trial. SUBJECTS Twenty-nine patients, 20 women and 9 men, age range 22-76 years. METHODS The patients were randomized to an intervention group or a control group. The intervention comprised vestibular rehabilitation. All patients were assessed at baseline, after 6 weeks and after 3 months with 4 different balance measures and the Dizziness Handicap Inventory. RESULTS After 6 weeks, the intervention group showed statistically significant improvements compared with the control group in the following measures: standing on one leg eyes open (p=0.02), blindfolded tandem stance (p=0.045), Dizziness Handicap Inventory total score (p=0.047), Dizziness Handicap Inventory functional score (p=0.005) and in Dizziness Handicap Inventory physical score (p=0.033). After 3 months, the intervention group showed statistically significant improvements compared with the control group in the following measures: standing on one leg eyes open (p=0.000), tandem stance (p=0.033) and Dizziness Handicap Inventory physical score (p=0.04). CONCLUSION Vestibular rehabilitation for patients with whiplash-associated disorder can decrease self-perceived handicap and increase postural control.

What happens with the dizzy patient in primary health care? Does education influence treatment?

Dizziness is a common symptom, and recent research shows that physical activity and specific treatment of vertigo and dizziness are effective. The management of dizzy patients requires assessment and, when appropriate, treatment by a physiotherapist. We have therefore studied how general practitioners (GPs) handle patients with vertigo and dizziness, to find out whether treatment follows current research, emphasizing the importance of physical activity and vestibular rehabilitation. We also wanted to find out whether information and education concerning the importance of physiotherapy and rehabilitation had any influence on the choice of treatment. Searches were performed in medical records at two health care centres on two occasions, in 1998 and 2000. In 1999, an intervention in the form of education was given to the staff. Records from the 311 patients with dizziness/vertigo identified in the searches were read and measures taken by the GPs were registered. The most common procedures – blood tests, control of blood pressure and ECG – were more common in 2000 than in 1998. No patients were left without any measure in 2000, which was the case in 1998. Only a few patients were referred to physiotherapy (8% in 1998 and 12% in 2000). It seems that the intervention did not affect the ratio of patients referred to physiotherapy.

Repeated sets or single set of resistance training – A systematic review

The aim of the study was to review studies concerning single-set and multiple-set resistance training. Twenty-six articles were found, 19 randomized controlled trials and seven studies without randomization process. Out of the 26 articles, 11 showed similar increases in strength when comparing number of sets, mostly one set compared with three sets. Eight of the articles showed a greater increase when training with multiple sets. In four of the articles, the comparison was made between single-set training programmes, multiple-set programmes and periodized multiple-set programmes, showing superior results with periodized training. None of the articles reported superior strength gain in the single-set training group. There was no difference in outcome when comparing articles with trained subjects to articles with untrained subjects. It seems that in order to be physically active and staying fit, the use of single-set training is sufficient. However, to gain the greatest possible strength, the use of multiple-set training seems to be appropriate.

Treatment for benign paroxysmal positional vertigo - a case study

Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo and can be successfully treated with particle-repositioning procedures or habituation exercises. However, some patients do not tolerate this treatment. The aim of the study was to investigate the possibility of treating patients with BPPV, where treatment at first seemed too demanding for the patients, using a descriptive study in a primary health care centre setting. Three patients, aged 79, 81 and 89, with BPPV, who could not tolerate common treatment, were studied. The main outcome measure was the Dix–Hallpike manoeuvre. The patients were successfully treated with versions of manoeuvre treatment and habituation exercises, including rolling from supine to side-lying, performing habituation exercises more slowly than recommended and use of sedation. The results show that, with a few adjustments, it is possible to successfully treat patients for whom the treatment at first seems too demanding. Since BPPV is possible to treat, every opportunity to minimize vertigo among the elderly is valuable, irrespective of factors such as fear, reduced mobility, concomitant or multiple diseases.

Stroke and unsteadiness - A cross-sectional study from primary health care.

BACKGROUND Dizziness is seldom the only symptom among patients who develop stroke but patients, hospitalized for vertigo are at higher risk of stroke than the general population. The proportions of patients who have remaining dizziness after a stroke seem to be unclear. OBJECTIVES To study the frequency of dizziness among stroke patients referred to rehabilitation in primary health care and to study the relation between dizziness and gender, age, activity and self-rated health. METHODS Patients with first-time stroke who were referred to rehabilitation in primary health care after the initial hospital stay were included. Dependence/independence in daily activities and self-rated health was measured. A question about whether the patient had experienced any dizziness or unsteadiness was asked. RESULTS Sixty three patients were included in the study, (39 men, 24 women) aged 36-85 years. The majority of patients were dizzy (70%). Being female increased the risk of being dizzy substantially (OR 9.43). Patients with dizziness had poorer self-rated health than patients without dizziness (p = 0.001). CONCLUSION Dizziness is a common symptom among patients with stroke, especially among female patients, and is associated with lower self-rated health. Therefore, it is important to address dizziness in the rehabilitation of stroke patients.