Summary of the Clinical Practice Guideline
Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline
Hall, C. D., Hermand, S. J., et al. (2016).
Journal of Neurologic Physical Therapy, 40(2), 124-155.
Go to Article
American Physical Therapy Association
This is a guideline from the American Physical Therapy Association - Neurology Section providing recommendations for physical therapists and other clinicians performing vestibular rehabilitation to recover function in patients with peripheral vestibular hypofunction. Recommendations for vestibular rehabilitation activities within the scope of Audiology practice are provided in this summary.
Evidence Ratings for This Document
Recommendations are classified into one of four grades based the strength and the quality of the supporting evidence using the following criteria:
- Grade A Recommendations: are supported by strong evidence from a preponderance of class II studies or at least one class I study
- Grade B Recommendations: are supported by moderate evidence from a preponderance of class II studies or a single high-quality randomized control trial
- Grade C Recommendations: are supported by weak evidence from a preponderance of class III and/or IV studies or a single class II study
- Grade D Recommendations: are based on expert opinion from the clinical experience of the guideline development team
Classes of evidence that support the recommendations are based on CEBM Levels of Evidence Scheme and are defined as follows:
- Class I Evidence: is from diagnostic studies, prospective studies, or randomized control trials with 50% or better critical appraisal scores
- Class II Evidence: is from diagnostic studies, prospective studies, or randomized control trials with less than 50% critical appraisal scores
- Class III Evidence: is from case-controlled or retrospective studies
- Class IV Evidence: is from a case study or a case series
- Class V Evidence: is from expert opinion
Recommendations from This Guideline
What are Recommendations?
Go to Map
Achievement of treatment goals, resolution of symptoms, or plateau in progress should be considered as reasons for stopping vestibular rehabilitation in patients with unilateral and bilateral peripheral vestibular hypofunction (Grade D Recommendation).
"Clinicians may prescribe a home exercise program of gaze stability exercises consisting of a minimum of 3 times per day for a total of at least 12 minutes per day for patients with acute/subacute vestibular hypofunction and at least 20 minutes per day for patients with chronic vestibular hypofunction" (Grade D Recommendation; p. 128).
Recommendations for prescribed vestibular exercises for patients with unilateral or bilateral vestibular hypofunction include:
- Clinicians should provide targeted exercises to address impairments and functional limitations in patients with unilateral and bilateral peripheral vestibular hypofunction (Grade B Recommendation).
- "Clinicians should not offer saccadic or smooth-pursuit exercises in isolation (i.e., without head movement) as specific exercises for gaze stability to patients with unilateral or bilateral vestibular hypofunction" (Grade A Recommendation; p. 128).
General recommendations for vestibular rehabilitation for patients with unilateral or bilateral peripheral vestibular hypofunction include:
- Individuals with peripheral vestibular hypofunction should be offered vestibular rehabilitation (Grade A Recommendation).
- "Clinicians may offer supervised vestibular rehabilitation" (Grade B Recommendation; p. 128) and complete ongoing evaluation of "factors that could modify rehabilitation outcomes" (Grade C Recommendation; p. 128).