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A mixed methods randomised feasibility trial investigating the management of benign paroxysmal positional vertigo in acute traumatic brain injury

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Title: A mixed methods randomised feasibility trial investigating the management of benign paroxysmal positional vertigo in acute traumatic brain injury
Authors: Smith, R
Marroney, N
Beattie, J
Newdick, A
Tahtis, V
Burgess, C
Marsden, J
Seemungal, B
Item Type: Journal Article
Abstract: Background Traumatic brain injury (TBI) is the leading cause of long-term disability in working age adults. Recent studies show that most acute TBI patients demonstrate vestibular features of dizziness and imbalance, often from combined peripheral and central vestibular dysfunction. Effective treatment for vestibular impairments post-TBI is important given its significant adverse impact upon quality of life and employment prospects. The most frequent peripheral vestibular disorder in acute TBI is benign paroxysmal positional vertigo (BPPV), affecting approximately half of acute cases. Although there is effective treatment for idiopathic BPPV, there are no high quality clinical data for post-TBI BPPV regarding its prevalence, natural history, which treatment is most effective and when is the best time to treat. In particular, observational studies suggest post-TBI BPPV may be recurrent indicating that hyperacute treatment of BPPV may be futile. Given the potential hurdles and the lack of accurate post-TBI BPPV data, the current study was designed to provide information regarding the feasibility and the optimal design of future large-scale prospective treatment studies that would compare different interventions and their timing for post-TBI BPPV. Method A multi-centre randomised mixed methods feasibility study design was employed. We aim to recruit approximately 75 acute TBI patients across a range of clinical severities, from three major trauma centres in London. Patients will be randomised to one of three treatment arms: (1) therapist-led manoeuvres; (2) patient-led exercises; and (3) advice. Participants will be re-assessed by blinded outcome assessors at 4 and 12 weeks. Acceptability of the intervention will be obtained by patient interviews at the end of their treatment, and therapist interviews at the end of the study. Primary outcomes relate to feasibility parameters including recruitment and retention rates, adverse events, and intervention fidelity. We will also aim to provide a more accurate estimate of the prevalence of BPPV in TBI cases on the trauma ward. Discussion The multi-centre nature of our feasibility study will inform the design of a future prospective treatment trial of BPPV in acute TBI. Important parameters we will obtain from this study, key for designing a future prospective treatment study, include estimating the prevalence of BPPV in TBI patients admitted to UK major trauma wards, and elucidating both patient and care-provider barriers, in delivering BPPV treatment.
Issue Date: 16-Sep-2020
Date of Acceptance: 10-Aug-2020
URI: http://hdl.handle.net/10044/1/82254
DOI: 10.1186/s40814-020-00669-z
ISSN: 2055-5784
Publisher: BioMed Central
Start Page: 1
End Page: 10
Journal / Book Title: Pilot and Feasibility Studies
Volume: 6
Copyright Statement: © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Sponsor/Funder: NIHR
Medical Research Council (MRC)
National Institute for Health Research
National Institute for Health Research
(US) Department of Defense Defense Health Program, Congressionally Directed Medical Research Programs
US Army
Racing Foundation
The Racing Foundation
Imperial Health Charity
National Institute for Health Research
Funder's Grant Number: ICA-CDRF-2017-03-070
IMP-248848/PO #66422916
Keywords: Benign paroxysmal positional vertigo
Feasibility study
Traumatic brain injury
Publication Status: Published
Article Number: 130
Online Publication Date: 2020-09-16
Appears in Collections:Faculty of Medicine
Department of Brain Sciences

This item is licensed under a Creative Commons License Creative Commons