Effect of vestibular rehabilitation therapy in patients with persistent postural perceptual dizziness: a systematic review and meta-analysis

Yanyan Li; Xiaorui Pei; Rui Ding; Ziqi Liu; Ying Xu; Zhicheng Wang; Yanmei Li; Lianhe Li

doi:10.3389/fneur.2025.1599201

Effect of vestibular rehabilitation therapy in patients with persistent postural perceptual dizziness: a systematic review and meta-analysis

Front Neurol. 2025 Sep 24:16:1599201. doi: 10.3389/fneur.2025.1599201. eCollection 2025.

Authors

Yanyan Li^#¹, Xiaorui Pei^#¹, Rui Ding², Ziqi Liu³, Ying Xu¹, Zhicheng Wang¹, Yanmei Li¹, Lianhe Li⁴

Affiliations

¹ Department of Neurology Ward, Chaoyang Central Hospital of China Medical University, Chaoyang, Liaoning, China.
² Department of Laboratory of Molecular Biology, Chaoyang Central Hospital of China Medical University, Chaoyang, Liaoning, China.
³ Clinical Medicine Major, Xinhua Clinical College, Dalian University, Dalian, Liaoning, China.
⁴ Department of Head and Neck Surgery Ward, Chaoyang Central Hospital of China Medical University, Chaoyang, Liaoning, China.

^# Contributed equally.

Abstract

Background: Persistent Postural-Perceptual Dizziness (PPPD) is an increasingly recognized syndrome defined by enduring experiences of dizziness, unbalance, or non-vertiginous dizziness, generally persisting for a minimum of 3 months. This condition significantly impacts patients' quality of life, highlighting the necessity for prompt and effective management. Vestibular rehabilitation therapy (VRT) has demonstrated efficacy in alleviating dizzy symptoms and enhancing balance. This meta-analysis seeks to assess the effectiveness of VRT in alleviating subjective dizzy symptoms and improving postural control in persons with PPPD.

Methods: Two reviewers independently searched electronic databases (PubMed, EMBASE, SCOPUS, and the Cochrane Library) for pertinent studies investigating VRT for PPPD. Studies employing the Dizziness Handicap Inventory (DHI) as an assessment tool were included, provided they were extracted and presented in English from inception to March 7, 2025. Eight papers were included into this meta-analysis.

Results: The aggregated weighted mean difference (WMD) indicated substantially improved outcomes for PPPD patients who underwent VRT compared to the control group in DHI-total scores (WMD = 21.84, 95% CI: [10.97, 32.71]). In subgroup analysis, DHI-total score improvements were observed in both customized VRT (WMD = 21.06, 95% CI: [5.65, 36.47]) and virtual reality-based VRT groups (WMD = 23.77, 95% CI: [8.09, 39.45]). Detailed data for DHI-Physical (DHI-P), Emotional (DHI-E), and Functional (DHI-F) scores from five trials (442 individuals) indicated a substantial reduction among PPPD patients receiving VRT (DHI-P: WMD = 17.92, 95% CI: [6.47, 29.38]; DHI-E: WMD = 10.51, 95% CI: [0.83, 20.19]; DHI-F: WMD = 15.00, 95% CI: [6.28, 23.72]).

Conclusion: VRT can provide improvement for patients with PPPD, especially in DHI-total scores, DHI-P, DHI-E and DHI-F scores. Customized VRT demonstrated superior therapeutic efficacy compared with virtual reality-based VRT. However, additional randomized controlled trials are necessary to substantiate and inform the utilization of VRT in the treatment of PPPD.

Keywords: dizziness handicap inventory (DHI); persistent postural-perceptual dizziness (PPPD); vestibular rehabilitation; vestibular rehabilitation therapy (VRT); virtual reality therapy.

Publication types

Systematic Review