Guided and unguided internet-based vestibular rehabilitation versus usual care for dizzy adults of 50 years and older: a protocol for a three-armed randomised trial

Vincent A van Vugt, Johannes C van der Wouden, Judith E Bosmans, Martin Smalbrugge, Willianne van Diest, Rosie Essery, Lucy Yardley, Henriëtte E van der Horst, Otto R Maarsingh

Research output: Contribution to JournalArticleAcademicpeer-review


INTRODUCTION: Dizziness is a common symptom in general practice with a high prevalence among older adults. The most common cause of dizziness in general practice is peripheral vestibular disease. Vestibular rehabilitation (VR) is a safe and effective treatment for peripheral vestibular disease that entails specific exercises to maximise the central nervous system compensation for the effects of vestibular pathology. An internet-based VR intervention has recently been shown to be safe and effective. Online interventions are low cost and easily accessible, but prone to attrition and non-adherence. A combination of online and face-to-face therapy, known as blended care, may balance these advantages and disadvantages.

METHODS AND ANALYSIS: A single-blind, three-arm, randomised controlled trial among patients aged 50 years and over presenting with dizziness of vestibular origin in general practice will be performed. In this study, we will compare the clinical and cost-effectiveness of stand-alone internet-based VR and internet-based VR with physiotherapeutic support ('blended care') with usual care during 6 months of follow-up. We will use a translated Dutch version of a British online VR intervention. Randomisation will be stratified by dizziness severity. The primary outcome measure is the Vertigo Symptoms Scale-Short Form. Intention-to-treat analysis will be performed, adjusting for confounders. The economic evaluation will be conducted from a societal perspective. We will perform an additional analysis on the data to identify predictors of successful treatment in the same population to develop a clinical decision rule for general practitioners.

ETHICS AND DISSEMINATION: The ethical committee of the VU University Medical Center approved ethics and dissemination of the study protocol. The insights and results of this study will be widely disseminated through international peer-reviewed journals and conference presentations.


Original languageEnglish
Article numbere015479
Pages (from-to)e015479
JournalBMJ Open
Issue number1
Publication statusPublished - 20 Jan 2017


This study was funded by ZonMw (programma Kwaliteit van Zorg: Versnellen, verbreden, vernieuwen; grant number 839110015). The results of the study will be submitted for publication to peer-reviewed scientific journals. There are no restrictions placed on publication by ZonMw.

FundersFunder number
Economic and Social Research CouncilES/F029624/1


    • Aged
    • Aged, 80 and over
    • Clinical Protocols
    • Dizziness
    • Exercise Therapy
    • Female
    • Humans
    • Internet
    • Journal Article
    • Male
    • Middle Aged
    • Physical Therapy Modalities
    • Postural Balance
    • Randomized Controlled Trial
    • Research Design
    • Research Support, Non-U.S. Gov't
    • Treatment Outcome
    • Vertigo
    • Vestibular Diseases
    • Vestibule, Labyrinth


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