Descriptive data for the four cognitive tasks (nonspatial (NS) easy, NS difficult, visuospatial (VS) easy and VS difficult) in the seated and walking conditions for the 36 participants.

<p>Data are presented as mean (SD), except the percentage of correct answers are presented as median (interquartile range) due to non-normal distributions.</p><p>Descriptive data for the four cognitive tasks (nonspatial (NS) easy, NS difficult, visuospatial (VS) easy and VS difficult) in the seated and walking conditions for the 36 participants.</p

Mean (SD) values for the gait parameters in normal walking (no cognitive task) and the four cognitive dual tasks conditions: nonspatial (NS) easy, NS difficult, visuospatial (VS) easy and VS difficult for the 36 participants.

<p>ANOVA results examining main and interaction effects of task type and difficulty are also presented.</p>a<p>n = 35; erroneously high data for one participant excluded from the analysis of this variable.</p><p>Note: There were also significant effects of added cognitive load (p<0.001) for all gait parameters, with each dual task condition (VS-easy, VS-diff, NS-easy, NS-diff) producing significantly slower gait speeds, shorter step lengths, reduced cadence, increased step time variability and reduced harmonic ratios compared with the no cognitive task walking condition (one-way repeated measures ANOVAs with planned contrasts p≤0.001).</p><p>Mean (SD) values for the gait parameters in normal walking (no cognitive task) and the four cognitive dual tasks conditions: nonspatial (NS) easy, NS difficult, visuospatial (VS) easy and VS difficult for the 36 participants.</p

Force thresholds for stepping, step initiation time, initial step length and stepping strategy for the total sample, fallers and non-fallers, as well as at-home fallers and non at-home faller subgroups.

<p>Data presented as Mean (SD), except multiple steps and stepping strategy which are presented as number (%).</p>*<p>Significantly different to fallers (p<0.05) after controlling for height and weight.</p><p>?Significantly different to non at-home fallers (p<0.05) after controlling for height and weight.</p

Reducing the burden of dizziness in middle-aged and older people: A multifactorial, tailored, single-blind randomized controlled trial

<div><p>Background</p><p>Dizziness is common among older people and is associated with a cascade of debilitating symptoms, such as reduced quality of life, depression, and falls. The multifactorial aetiology of dizziness is a major barrier to establishing a clear diagnosis and offering effective therapeutic interventions. Only a few multidisciplinary interventions of dizziness have been conducted to date, all of a pilot nature and none tailoring the intervention to the specific causes of dizziness. Here, we aimed to test the hypothesis that a multidisciplinary dizziness assessment followed by a tailored multifaceted intervention would reduce dizziness handicap and self-reported dizziness as well as enhance balance and gait in people aged 50 years and over with dizziness symptoms.</p><p>Methods and findings</p><p>We conducted a 6-month, single-blind, parallel-group randomized controlled trial in community-living people aged 50 years and over who reported dizziness in the past year. We excluded individuals currently receiving treatment for their dizziness, those with degenerative neurological conditions including cognitive impairment, those unable to walk 20 meters, and those identified at baseline assessment with conditions that required urgent treatment. Our team of geriatrician, vestibular neuroscientist, psychologist, exercise physiologist, study coordinator, and baseline assessor held case conferences fortnightly to discuss and recommend appropriate therapy (or therapies) for each participant, based on their multidisciplinary baseline assessments. A total of 305 men and women aged 50 to 92 years (mean [SD] age: 67.8 [8.3] years; 62% women) were randomly assigned to either usual care (control; <i>n</i> = 151) or to a tailored, multifaceted intervention (<i>n</i> = 154) comprising one or more of the following: a physiotherapist-led vestibular rehabilitation programme (35% [<i>n</i> = 54]), an 8-week internet-based cognitive-behavioural therapy (CBT) (19% [<i>n</i> = 29]), a 6-month Otago home-based exercise programme (24% [<i>n</i> = 37]), and/or medical management (40% [<i>n</i> = 62]). We were unable to identify a cause of dizziness in 71 participants (23% of total sample). Primary outcome measures comprised dizziness burden measured with the Dizziness Handicap Inventory (DHI) score, frequency of dizziness episodes recorded with monthly calendars over the 6-month follow-up, choice-stepping reaction time (CSRT), and gait variability. Data from 274 participants (90%; 137 per group) were included in the intention-to-treat analysis. At trial completion, the DHI scores in the intervention group (pre and post mean [SD]: 25.9 [19.2] and 20.4 [17.7], respectively) were significantly reduced compared with the control group (pre and post mean [SD]: 23.0 [15.8] and 21.8 [16.4]), when controlling for baseline scores (mean [95% CI] difference between groups [baseline adjusted]: −3.7 [−6.2 to −1.2]; <i>p</i> = 0.003). There were no significant between-group differences in dizziness episodes (relative risk [RR] [95% CI]: 0.87 [0.65 to 1.17]; <i>p</i> = 0.360), CSRT performance (mean [95% CI] difference between groups [baseline adjusted]: −15 [−40 to 10]; <i>p</i> = 0.246), and step-time variability during gait (mean [95% CI] difference between groups [baseline adjusted]: −0.001 [−0.002 to 0.001]; <i>p</i> = 0.497). No serious intervention-related adverse events occurred. Study limitations included the low initial dizziness severity of the participants and the only fair uptake of the falls clinic (medical management) and the CBT interventions.</p><p>Conclusions</p><p>A multifactorial tailored approach for treating dizziness was effective in reducing dizziness handicap in community-living people aged 50 years and older. No difference was seen on the other primary outcomes. Our findings therefore support the implementation of individualized, multifaceted evidence-based therapies to reduce self-perceived disability associated with dizziness in middle-aged and older people.</p><p>Trial registration</p><p>Australian New Zealand Clinical Trials Registry <a href="https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362310" target="_blank">ACTRN12612000379819</a>.</p></div

Primary outcome measures for the intervention and control groups at baseline and follow-up assessments.

<p>Primary outcome measures for the intervention and control groups at baseline and follow-up assessments.</p

Baseline characteristics of the intention-to-treat population.

<p>Baseline characteristics of the intention-to-treat population.</p

CONSORT diagram (CONSORT; GPCOG; DHI).

<p>CONSORT, Consolidated Standards of Reporting Trials; DHI, Dizziness Handicap Inventory; GPCOG, General Practitioner assessment of Cognition.</p

Percentage of intervention group participants (<i>n</i> = 154) assigned to the range of intervention combinations (CBT; VR).

<p>CBT, cognitive-behavioural therapy; VR, vestibular rehabilitation.</p