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Vestibular Rehabilitation in Multiple Sclerosis: improving vertigo, mobility and quality of life of people with MS. (VeRMiS)
Vestibular dysfunction results in vertigo, dizziness, oculomotor and balance deficits and decreased quality of life and is seen in 20% of people with Multiple Sclerosis (pwMS). Vertigo can be treated with vestibular rehabilitation (VR); this may be customised or delivered via a booklet. VR of isolated peripheral vestibular disorders is effective but it is unknown how additional symptoms affect outcome. There is limited evidence about the effectiveness of VR for central vestibular disorders, a common cause of vertigo in pwMS.We will recruit 72 ambulant pwMS reporting vertigo and diagnosed with peripheral and/or central vestibular disorders. They will be entered into a randomised, blinded controlled trial and cost-effectiveness analysis comparing customised VR with VR delivered via a booklet. The primary outcome will assess the impact of dizziness with secondary outcomes exploring balance, participation and quality of life. The influence of diagnosis and additional symptoms on recovery and the sensitivity and specificity of bedside tests in diagnosing peripheral and central disorders compared to oculomotor testing will be explored. In 50% of pwMS symptoms are caused by Benign Paroxysmal Positional Vertigo (BPPV). We will determine success rate following repositioning manoeuvres for BPPV in approximately 70 people and symptom re-occurrence over 12 months.
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