To assess the efficacy of repositioning manoeuvres for treating benign paroxysmal positional vertigo (BPPV).

The author searched the MEDLINE electronic database (1966 to March 1997) using the textwords: 'benign positional paroxysmal vertigo' combined with the following: 'canalithiasis', 'capulolithiasis', 'treatment', 'physical treatment', 'repositioning maneuver', 'canalith repositioning maneuver', and 'particle positioning maneuver'. The authors also scanned the reference lists of articles for additional relevant studies. The search was restricted to English and French publications.

Study designs of evaluations included in the review

Clinical trials and case reports with a focus on physical treatment of BPPV. Single case reports and basic introductory BPPV papers directed to allied health professionals were excluded. Follow-up ranged from less than 1 month to 39 months.

Specific interventions included in the review

Repositioning manoeuvres (canalith and particle), refused treatment, other treatment (vestibular habituation training, Liberatory manoeuvre or Semont manoeuvre), no treatment or placebo.

Participants included in the review

Patients diagnosed with BPPV.

Outcomes assessed in the review

Response to treatment (improvement) measured as complete, improved, or none.

How were decisions on the relevance of primary studies made?

The author does not state how the papers were selected for the review, or how many of the reviewers performed the selection.

No formal assessment of quality was undertaken.

The author does not state who, or how many of the reviewers, performed the data extraction. Data were extracted for the categories of study identification, number of participants, response to treatment (complete %, improved %, and none %) and length of follow-up (in months).

How were the studies combined?

The findings and the results of relevant studies, and their subsequent conclusions, were compared and compiled into a narrative summary, focusing on the state of the knowledge regarding the efficacy of repositioning manoeuvres.

How were differences between studies investigated?

The author does not state how differences between the studies were investigated.

Twenty-one studies were included in the review with 511 participants: 3 RCTs with 131 participants; 2 randomised clinical trials with 120 participants; and 7 case series with 260 participants.

Response to treatment (complete) ranged from 41% to 61% (treatment group, repositioning manoeuvre or repositioning with vibration) versus 0% to 50% in the control groups (repositioning (without vibration), no treatment or placebo manoeuvre) in the RCTs, 57% to 70% (treatment group, repositioning manoeuvre) versus 25% in the control groups (Liberatory manoeuvre, vestibular habituation treatment or refused treatment) in the randomised clinical trials, and 44% to 90% in the case series.

Response to treatment (improved) ranged from 27% to 60% (treatment group, repositioning manoeuvre or repositioning with vibration) versus 4% to 36% in the control groups (repositioning (without vibration), no treatment or placebo manoeuvre) in the RCTs, 15% to 33% (treatment group, repositioning manoeuvre) versus 0% in the control groups (Liberatory manoeuvre, vestibular habituation treatment or refused treatment) in the randomised clinical trials, and 0% to 24% in the case series.

Response to treatment (none) ranged from 4% to 40% (treatment group, repositioning manoeuvre or repositioning with vibration) versus 14% to 96% in the control groups (repositioning (without vibration), no treatment or placebo manoeuvre) in the RCTs, 5% to 15% (treatment group, repositioning manoeuvre) versus 75% in the control groups (Liberatory manoeuvre, vestibular habituation treatment or refused treatment) in the randomised clinical trials, and 0% to 32% in the case series.

The author states that the efficacy of these repositioning manoeuvres has not been satisfactorily determined.

The author stated the research question and the inclusion and exclusion criteria. The literature search is adequate but the author may have missed additional relevant studies by searching only one electronic database and by restricting the search to English and French language publications.

The quality of the included studies was not formally assessed but the author discussed the limitations of the review. The author has not reported on how the articles were selected, or how many of the reviewers were involved in the process of data extraction.

The data extraction is reported in tables and text and the narrative synthesis was appropriate since there was no basis for a statistical pooling of the data. The author has not performed any tests for homogeneity. The conclusions appear to follow from the results but should be viewed with caution because of the stated methodological limitations of the review.

Practice: The author states that the repositioning manoeuvre can easily be performed in the chiropractic setting, however, the chiropractor should be confident in the diagnosis of BPPV, given that numerous causes of vertigo are serious and life-threatening.

Research: The author did not state any implications for further research.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.