Additional cognitive behavior therapy for persistent postural-perceptual dizziness: a meta-analysis
Objective: To investigate whether additional Cognitive Behavior Therapy (CBT) combined with conventional therapy improves outcomes for patients with Persistent Postural-Perceptual Dizziness (PPPD) compared with conventional therapy alone. Methods: Two reviewers independently searched PubMed, Embase,...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-05-01
|
| Series: | Brazilian Journal of Otorhinolaryngology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1808869424000089 |
| _version_ | 1797315997661659136 |
|---|---|
| author | Jialin Zang Mohan Zheng Hongyuan Chu Xu Yang |
| author_facet | Jialin Zang Mohan Zheng Hongyuan Chu Xu Yang |
| author_sort | Jialin Zang |
| collection | DOAJ |
| description | Objective: To investigate whether additional Cognitive Behavior Therapy (CBT) combined with conventional therapy improves outcomes for patients with Persistent Postural-Perceptual Dizziness (PPPD) compared with conventional therapy alone. Methods: Two reviewers independently searched PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov for relevant Randomized Controlled Trials (RCTs) examining CBT for PPPD which were conducted and published in English from January 2002 to November 2022. RCTs reporting any indicators for assessing corresponding symptoms of PPPD were included, such as Dizziness Handicap Inventory (DHI), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire-9 (PHQ-9). Two independent reviewers conducted extraction of relevant information and evaluation of risk of bias. The Cochrane Collaboration risk of bias tool version 1.0 was used to evaluate risks and assess the quality of the included studies, and Cochrane Review Manager 5.3 software (RevMan 5.3) was used to perform meta-analyses. Results: The results of six RCTs indicated that combining additional CBT with conventional therapy significantly improved outcomes for PPPD patients compared with conventional therapy alone, especially in DHI-Total scores (Mean Difference [MD = −8.17], 95% Confidence Interval [95% CI: −10.26, −6.09], p < 0.00001), HAMA scores (MD = −2.76, 95% CI: [−3.57, −1.94], p < 0.00001), GAD-7 scores (MD = −2.50, 95% CI [−3.29, −1.70], p < 0.00001), and PHQ-9 scores (MD = −2.29, 95% CI [−3.04, −1.55], p < 0.00001). Subgroup analysis revealed a significant benefit of additional CBT compared with conventional therapies alone, including Vestibular Rehabilitation Therapy (VRT) (MD = −8.70, 95% CI: [−12.17, −5.22], p < 0.00001), Selective Serotonin Reuptake Inhibitor (SSRI) (with controlled SSRI: MD = −10.70, 95% CI: [−14.97, −6.43], p < 0.00001), and VRT combined with SSRI (MD = −6.08, 95% CI [−9.49, −2.67], p = 0.0005) in DHI-Total scores. Conclusion: Additional CBT combined with conventional therapy may provide additional improvement for patients with PPPD compared with conventional therapy alone. However, more RCTs are needed to support and guide the application of CBT in treating PPPD. Level of evidence: I; Systematic review of RCTs. |
| first_indexed | 2024-03-08T03:12:54Z |
| format | Article |
| id | doaj.art-9ac18927b8d84db08759f0f4edd39113 |
| institution | Directory Open Access Journal |
| issn | 1808-8694 |
| language | English |
| last_indexed | 2024-03-08T03:12:54Z |
| publishDate | 2024-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Otorhinolaryngology |
| spelling | doaj.art-9ac18927b8d84db08759f0f4edd391132024-02-13T04:06:43ZengElsevierBrazilian Journal of Otorhinolaryngology1808-86942024-05-01903101393Additional cognitive behavior therapy for persistent postural-perceptual dizziness: a meta-analysisJialin Zang0Mohan Zheng1Hongyuan Chu2Xu Yang3Department of Neurology, Peking University Aerospace School of Clinical Medicine (Aerospace Center Hospital), Beijing, ChinaDepartment of Neurology, Peking University Aerospace School of Clinical Medicine (Aerospace Center Hospital), Beijing, ChinaDepartment of Pediatrics, Peking University First Hospital, Beijing, ChinaDepartment of Neurology, Peking University Aerospace School of Clinical Medicine (Aerospace Center Hospital), Beijing, China; Corresponding author.Objective: To investigate whether additional Cognitive Behavior Therapy (CBT) combined with conventional therapy improves outcomes for patients with Persistent Postural-Perceptual Dizziness (PPPD) compared with conventional therapy alone. Methods: Two reviewers independently searched PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov for relevant Randomized Controlled Trials (RCTs) examining CBT for PPPD which were conducted and published in English from January 2002 to November 2022. RCTs reporting any indicators for assessing corresponding symptoms of PPPD were included, such as Dizziness Handicap Inventory (DHI), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire-9 (PHQ-9). Two independent reviewers conducted extraction of relevant information and evaluation of risk of bias. The Cochrane Collaboration risk of bias tool version 1.0 was used to evaluate risks and assess the quality of the included studies, and Cochrane Review Manager 5.3 software (RevMan 5.3) was used to perform meta-analyses. Results: The results of six RCTs indicated that combining additional CBT with conventional therapy significantly improved outcomes for PPPD patients compared with conventional therapy alone, especially in DHI-Total scores (Mean Difference [MD = −8.17], 95% Confidence Interval [95% CI: −10.26, −6.09], p < 0.00001), HAMA scores (MD = −2.76, 95% CI: [−3.57, −1.94], p < 0.00001), GAD-7 scores (MD = −2.50, 95% CI [−3.29, −1.70], p < 0.00001), and PHQ-9 scores (MD = −2.29, 95% CI [−3.04, −1.55], p < 0.00001). Subgroup analysis revealed a significant benefit of additional CBT compared with conventional therapies alone, including Vestibular Rehabilitation Therapy (VRT) (MD = −8.70, 95% CI: [−12.17, −5.22], p < 0.00001), Selective Serotonin Reuptake Inhibitor (SSRI) (with controlled SSRI: MD = −10.70, 95% CI: [−14.97, −6.43], p < 0.00001), and VRT combined with SSRI (MD = −6.08, 95% CI [−9.49, −2.67], p = 0.0005) in DHI-Total scores. Conclusion: Additional CBT combined with conventional therapy may provide additional improvement for patients with PPPD compared with conventional therapy alone. However, more RCTs are needed to support and guide the application of CBT in treating PPPD. Level of evidence: I; Systematic review of RCTs.http://www.sciencedirect.com/science/article/pii/S1808869424000089DizzinessCognitive behavioral therapyDizziness handicap inventory |
| spellingShingle | Jialin Zang Mohan Zheng Hongyuan Chu Xu Yang Additional cognitive behavior therapy for persistent postural-perceptual dizziness: a meta-analysis Brazilian Journal of Otorhinolaryngology Dizziness Cognitive behavioral therapy Dizziness handicap inventory |
| title | Additional cognitive behavior therapy for persistent postural-perceptual dizziness: a meta-analysis |
| title_full | Additional cognitive behavior therapy for persistent postural-perceptual dizziness: a meta-analysis |
| title_fullStr | Additional cognitive behavior therapy for persistent postural-perceptual dizziness: a meta-analysis |
| title_full_unstemmed | Additional cognitive behavior therapy for persistent postural-perceptual dizziness: a meta-analysis |
| title_short | Additional cognitive behavior therapy for persistent postural-perceptual dizziness: a meta-analysis |
| title_sort | additional cognitive behavior therapy for persistent postural perceptual dizziness a meta analysis |
| topic | Dizziness Cognitive behavioral therapy Dizziness handicap inventory |
| url | http://www.sciencedirect.com/science/article/pii/S1808869424000089 |
| work_keys_str_mv | AT jialinzang additionalcognitivebehaviortherapyforpersistentposturalperceptualdizzinessametaanalysis AT mohanzheng additionalcognitivebehaviortherapyforpersistentposturalperceptualdizzinessametaanalysis AT hongyuanchu additionalcognitivebehaviortherapyforpersistentposturalperceptualdizzinessametaanalysis AT xuyang additionalcognitivebehaviortherapyforpersistentposturalperceptualdizzinessametaanalysis |