Postmaneuver restrictions in benign paroxysmal positional vertigo: an individual patient data meta-analysis.

Abstract

Treatment of benign paroxysmal positional vertigo (BPPV) with the Epley and Semont maneuvers has been used with and without postmaneuver postural restrictions. Studies examining these restrictions have yielded differing results. This study sought to examine the studies for a more uniform conclusion. Controlled studies with objective identification of unilateral posterior semicircular canal BPPV and symptom resolution were analyzed. A PubMed search identified six studies totaling 523 patients meeting all inclusion criteria. Cohorts treated with and without restrictions were compared. Individual patient pooled analyses in a one-stage comparison were used for the meta-analysis. Pooled results of all restriction types showed no advantage over no restriction. Studies including each individual restriction were examined against the pooled population to look for technique differences. No restriction was found to be statistically significant. The restrictions examined in controlled trials did not differ significantly in clinical outcomes, which suggests that restrictions do not appear to significantly affect the efficacy of BPPV maneuvers.