Comparative Effectiveness of Canalith Repositioning Alone Versus Combined with Cervical Stabilization Exercises on Residual Dizziness and Postural Stability in Patients with Benign Paroxysmal Positional Vertigo: A Randomized Controlled Trial

Abstract

Background: Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder effectively treated with canalith repositioning procedures (CRP), yet 30–60% of patients experience residual dizziness and postural instability, potentially due to incomplete central compensation and cervical proprioceptive dysfunction. Objective: To compare the effectiveness of CRP alone versus CRP combined with cervical stabilization exercises (CSE) in reducing residual dizziness and improving postural stability in patients with posterior canal BPPV. Methods: An assessor-blinded randomized controlled trial was conducted involving 80 participants allocated equally to CRP alone or CRP+CSE. Interventions were delivered over four weeks, with follow-up at Week 4 and Week 12. Primary outcomes included Dizziness Handicap Inventory (DHI) and Sensory Organization Test (SOT) composite scores, while secondary outcomes included Timed Up and Go (TUG), joint position error (JPE), Vestibular Questionnaire-7 (VQ-7), and fall incidence. Mixed ANOVA and intention-to-treat analysis were applied. Results: The CRP+CSE group demonstrated significantly greater reductions in DHI at Week 4 (mean difference 10.4 points; p<0.001) and Week 12 (8.3 points; p<0.001), along with superior improvements in SOT scores (p=0.012 and p=0.007). Secondary outcomes also favored the combined group, including improvements in TUG (p<0.001), JPE (p<0.001), and VQ-7 (p<0.001), with a lower fall incidence (IRR=0.25; p=0.041). Conclusion: The addition of cervical stabilization exercises to CRP significantly enhances recovery in BPPV by improving dizziness, postural stability, and functional outcomes, supporting a multimodal physiotherapy approach.