Abstract:
OBJECTIVE:To determine the clinical and cost effectiveness of booklet based vestibular rehabilitation with and without telephone support for chronic dizziness, compared with routine care. DESIGN:Single blind, parallel group, pragmatic, randomised controlled trial. SETTING:35 general practices across southern England between October 2008 and January 2011. PARTICIPANTS:Patients aged 18 years or over with chronic dizziness (mean duration >five years) not attributable to non-vestibular causes (confirmed by general practitioner) and that could be aggravated by head movement (confirmed by patient). INTERVENTIONS:Participants randomly allocated to receive routine medical care, booklet based vestibular rehabilitation only, or booklet based vestibular rehabilitation with telephone support. For the booklet approach, participants received self management booklets providing comprehensive advice on undertaking vestibular rehabilitation exercises at home daily for up to 12 weeks and using cognitive behavioural techniques to promote positive beliefs and treatment adherence. Participants receiving telephone support were offered up to three brief sessions of structured support from a vestibular therapist. MAIN OUTCOME MEASURES:Vertigo symptom scale-short form and total healthcare costs related to dizziness per quality adjusted life year (QALY). RESULTS:Of 337 randomised participants, 276 (82%) completed all clinical measures at the primary endpoint, 12 weeks, and 263 (78%) at one year follow-up. We analysed clinical effectiveness by intention to treat, using analysis of covariance to compare groups after intervention, controlling for baseline symptom scores. At 12 weeks, scores on the vertigo symptom scale in the telephone support group did not differ significantly from those in the routine care group (adjusted mean difference -1.79 (95% confidence interval -3.69 to 0.11), P=0.064). At one year, both intervention groups improved significantly relative to routine care (telephone support -2.52 (-4.52 to -0.51), P=0.014; booklet only -2.43 (-4.27 to -0.60), P=0.010). Analysis of cost effectiveness acceptability curves showed that both interventions were highly cost effective; at very low QALY values, the booklet only approach was most likely to be cost effective, but the approach with additional telephone support was most likely to be cost effective at QALY values more than £1200 (€1488; $1932). Using the booklet approach with telephone support, five (three to 12) patients would need to be treated for one patient to report subjective improvement at one year. CONCLUSIONS:Booklet based vestibular rehabilitation for chronic dizziness is a simple and cost effective means of improving patient reported outcomes in primary care. TRIAL REGISTRATION:ClinicalTrials.gov NCT00732797.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Yardley L,Barker F,Muller I,Turner D,Kirby S,Mullee M,Morris A,Little Pdoi
10.1136/bmj.e2237subject
Has Abstractpub_date
2012-06-06 00:00:00pages
e2237eissn
0959-8138issn
1756-1833journal_volume
344pub_type
杂志文章,多中心研究,随机对照试验abstract:OBJECTIVE:To evaluate the association between consumption of ultra-processed foods and all cause mortality. DESIGN:Prospective cohort study. SETTING:Seguimiento Universidad de Navarra (SUN) cohort of university graduates, Spain 1999-2018. PARTICIPANTS:19 899 participants (12 113 women and 7786 men) aged 20-91 years ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.l1949
更新日期:2019-05-29 00:00:00
abstract:OBJECTIVES:To determine the strength of evidence for the effectiveness of mental health interventions for patients with three common somatic conditions (chronic fatigue syndrome, irritable bowel syndrome, and chronic back pain). To assess whether results obtained in secondary care can be extrapolated to primary care an...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.325.7372.1082
更新日期:2002-11-09 00:00:00
abstract:OBJECTIVE:To study the comparative importance of environment and genes in the development of islet cell autoimmunity associated with insulin dependent diabetes mellitus. DESIGN:Population based study of diabetic twins. SETTING:Danish population. SUBJECTS:18 monozygotic and 36 dizygotic twin pairs with one or both pa...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.314.7094.1575
更新日期:1997-05-31 00:00:00
abstract::Many clinicians remain unsure of the relevance of measuring quality of life to their clinical practice. In health economics quality of life measures have become the standard means of assessing the results of health care interventions and, more controversially, the means of prioritising funding; but they have many othe...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.305.6861.1074
更新日期:1992-10-31 00:00:00
abstract:OBJECTIVE:To determine whether screening Danish men aged 65 or more for abdominal aortic aneurysms reduces mortality. DESIGN:Single centre randomised controlled trial. SETTING:All five hospitals in Viborg County, Denmark. PARTICIPANTS:All 12,639 men born during 1921-33 and living in Viborg County. In 1994 we include...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.38369.620162.82
更新日期:2005-04-02 00:00:00
abstract:OBJECTIVE:To determine whether genetic factors associated with established rheumatoid arthritis could, in combination with rheumatoid factor, predict the development of radiological erosions in patients with early symmetrical (rheumatoid-like) arthritis. DESIGN:Prospective study. SETTING:Teaching hospital, early arth...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.305.6866.1387
更新日期:1992-12-05 00:00:00
abstract:OBJECTIVE:To assess the role of rhinoviruses in elderly people living in the community. DESIGN:Prospective community based surveillance of elderly people, without intervention. Subjects were telephoned weekly to identify symptomatic upper respiratory tract infections. Symptoms and impact of illnesses were monitored, a...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.313.7065.1119
更新日期:1996-11-02 00:00:00
abstract:OBJECTIVE:To assess whether sleep apnoea syndrome is an independent risk factor for hypertension. DESIGN:Population study. SETTING:Sleep clinic in Toronto. PARTICIPANTS:2,677 adults, aged 20-85 years, referred to the sleep clinic with suspected sleep apnoea syndrome. OUTCOME MEASURES:Medical history, demographic da...
journal_title:BMJ (Clinical research ed.)
pub_type: 评论,杂志文章
doi:10.1136/bmj.320.7233.479
更新日期:2000-02-19 00:00:00
abstract:OBJECTIVES:To assess heat related mortalities in relation to climate within Europe. DESIGN:Observational population study. SETTING:North Finland, south Finland, Baden-Württemberg, Netherlands, London, north Italy, and Athens. SUBJECTS:People aged 65-74. MAIN OUTCOME MEASURES:Mortalities at temperatures above, below...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.321.7262.670
更新日期:2000-09-16 00:00:00
abstract:OBJECTIVES:To relate cancer since entry into the Framingham Heart Study with the risk of incident Alzheimer's disease and to estimate the risk of incident cancer among participants with and without Alzheimer's disease. DESIGN:Community based prospective cohort study; nested age and sex matched case-control study. SET...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.e1442
更新日期:2012-03-12 00:00:00
abstract:OBJECTIVE:To investigate any long term effects of traumatic birth and obstetric procedures in relation to suicide by violent means in offspring as adults. DESIGN:Prospective case-control study. SETTING:Stockholm, Sweden. SUBJECTS:242 adults who committed suicide by violent means from 1978 to 1995, and who were born ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.317.7169.1346
更新日期:1998-11-14 00:00:00
abstract:OBJECTIVE:To assess the effect on time to diagnosis of recurrence and on quality of life of transferring primary responsibility for follow up of women with breast cancer in remission from hospital to general practice. DESIGN:Randomised controlled trial with 18 month follow up in which women received routine follow up ...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.313.7058.665
更新日期:1996-09-14 00:00:00
abstract:OBJECTIVE:To analyse the relation between treated blood pressure and concomitant risk factor and morbidity from acute myocardial infarction. DESIGN:Prospective longitudinal study. Treated blood pressures and other variables were used to predict acute myocardial infarction. SETTING:Primary health care in Skaraborg, Sw...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.308.6930.681
更新日期:1994-03-12 00:00:00
abstract:OBJECTIVE:To compare the effects of treatments for coronavirus disease 2019 (covid-19). DESIGN:Living systematic review and network meta-analysis. DATA SOURCES:WHO covid-19 database, a comprehensive multilingual source of global covid-19 literature, up to 3 December 2020 and six additional Chinese databases up to 12 ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.m2980
更新日期:2020-07-30 00:00:00
abstract:OBJECTIVE:To evaluate the immunogenicity and reactogenicity of a new triple S recombinant hepatitis B vaccine in a cohort of healthy people in whom currently licensed hepatitis B vaccines had persistently not induced an immune response. DESIGN:Single centre, randomised, double blind, dose-response study. SETTING:Rese...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.314.7077.329
更新日期:1997-02-01 00:00:00
abstract:OBJECTIVE:To assess the efficacy of a newly developed system for applying continuous or intermittent negative (subatmospheric) extrathoracic pressure in respiratory failure. DESIGN:Uncontrolled clinical trials in infants deteriorating or failing to improve despite standard medical treatment. SETTING:Paediatric and ne...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章
doi:10.1136/bmj.299.6710.1253
更新日期:1989-11-18 00:00:00
abstract:OBJECTIVE:To determine whether use of tinzaparin, a low molecular weight heparin introduced for prophylactic management of deep vein thrombosis, increases the risk of serious postoperative bleeding leading to a higher than expected 28 day readmission rate after discharge for hysterectomy. DESIGN:Retrospective case-con...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.38783.624444.55
更新日期:2006-04-08 00:00:00
abstract:OBJECTIVES:To determine whether an aid to the diagnosis of pigmented skin lesions reduces the ratio of benign lesions to melanomas excised in general practice. DESIGN:Controlled trial randomised by practice. SETTING:General practices in Perth, Western Australia. PARTICIPANTS:468 general practitioners in 223 practice...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.327.7411.375
更新日期:2003-08-16 00:00:00
abstract:OBJECTIVES: To provide contemporary estimates of the prevalence of microcephaly in Europe, determine if the diagnosis of microcephaly is consistent across Europe, and evaluate whether changes in prevalence would be detected using the current European surveillance performed by EUROCAT (the European Surveillance of Conge...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.i4721
更新日期:2016-09-13 00:00:00
abstract:OBJECTIVE:To systematically review the accuracy of physicians' clinical predictions of survival in terminally ill cancer patients. DATA SOURCES:Cochrane Library, Medline (1996-2000), Embase, Current Contents, and Cancerlit databases as well as hand searching. STUDY SELECTION:Studies were included if a physician's tem...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.327.7408.195
更新日期:2003-07-26 00:00:00
abstract:OBJECTIVE:To investigate whether an important football match increases stress to such an extent that it triggers acute myocardial infarction and stroke. DESIGN:Longitudinal study of mortality around 22 June 1996 (the day the Dutch football team was eliminated from the European football championship). Mortality on 22 J...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.321.7276.1552
更新日期:2000-12-23 00:00:00
abstract:OBJECTIVE:To quantify the association of indices of central obesity, including waist circumference, hip circumference, thigh circumference, waist-to-hip ratio, waist-to-height ratio, waist-to-thigh ratio, body adiposity index, and A body shape index, with the risk of all cause mortality in the general population, and t...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.m3324
更新日期:2020-09-23 00:00:00
abstract:OBJECTIVE:To examine the association between accidental dural puncture and long term headache and related symptoms. DESIGN:Postal questionnaire survey to elucidate new symptoms occurring after childbirth, and linking of these to data in obstetric and anaesthetic case notes. Women were surveyed between 13 months and ni...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6882.883
更新日期:1993-04-03 00:00:00
abstract:OBJECTIVE:To examine association of different measures of serum lipid concentration and obesity with mortality in women. DESIGN:Prospective observational study initiated in 1968-9, follow up examination after 12 years, and follow up study based on death certificates after 20 years. SETTING:Gothenburg, Sweden. SUBJEC...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.307.6916.1385
更新日期:1993-11-27 00:00:00
abstract:OBJECTIVES:To evaluate the long term effects of perioperative beta blockade on mortality and cardiac morbidity in patients with diabetes undergoing major non-cardiac surgery. DESIGN:Randomised placebo controlled and blinded multicentre trial. Analyses were by intention to treat. SETTING:University anaesthesia and sur...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.332.7556.1482
更新日期:2006-06-24 00:00:00
abstract::Eleven euthyroid patients with severe Graves' eye disease were treated with intravenous methylprednisolone and followed up for six months or more by ophthalmological assessment, orbital computed tomography (CT), photographs, and antibody measurements. Papilloedema resolved in the single patient in whom it was present;...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.297.6663.1574
更新日期:1988-12-17 00:00:00
abstract:OBJECTIVE:To compare the effectiveness of classroom based cognitive behavioural therapy with attention control and usual school provision for adolescents at high risk of depression. DESIGN:Three arm parallel cluster randomised controlled trial. SETTING:Eight UK secondary schools. PARTICIPANTS:Adolescents (n=5030) ag...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.e6058
更新日期:2012-10-05 00:00:00
abstract:OBJECTIVE:To assess whether occupational exposure among commercial airline cabin attendants are associated with risk of cancer. DESIGN:Record linkage study. SETTING:Finland. SUBJECTS-1577 female and 187 male cabin attendants who had worked for the Finnish airline companies. MAIN OUTCOME MEASURE:Standardised incidenc...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.311.7006.649
更新日期:1995-09-09 00:00:00
abstract:OBJECTIVE:To assess the association between mind wandering (thinking unrelated to the task at hand) and the risk of being responsible for a motor vehicle crash. DESIGN:Responsibility case-control study. SETTING:Adult emergency department of a university hospital in France, April 2010 to August 2011. PARTICIPANTS:955...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.e8105
更新日期:2012-12-13 00:00:00
abstract:OBJECTIVE:To assess the extent to which the prevailing model of smoking cessation (that smokers typically prepare their attempts to stop smoking in advance and that doing so increases their chances of success) is correct. DESIGN:Cross sectional household survey. SETTING:England. PARTICIPANTS:918 smokers who reported...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.38723.573866.AE
更新日期:2006-02-25 00:00:00