abstract: 'BackgroundTraumatic brain injury (TBI) is the leading cause of long-term

  disability in working age adults. Recent studies show that most acute

  TBI patients demonstrate vestibular features of dizziness and imbalance,

  often from combined peripheral and central vestibular dysfunction.

  Effective treatment for vestibular impairments post-TBI is important

  given its significant adverse impact upon quality of life and employment

  prospects. The most frequent peripheral vestibular disorder in acute TBI

  is benign paroxysmal positional vertigo (BPPV), affecting approximately

  half of acute cases. Although there is effective treatment for

  idiopathic BPPV, there are no high-quality clinical data for post-TBI

  BPPV regarding its prevalence, natural history, which treatment is most

  effective and when is the best time to treat. In particular,

  observational studies suggest post-TBI BPPV may be recurrent, indicating

  that hyperacute treatment of BPPV may be futile. Given the potential

  hurdles and the lack of accurate post-TBI BPPV data, the current study

  was designed to provide information regarding the feasibility and

  optimal design of future large-scale prospective treatment studies that

  would compare different interventions and their timing for post-TBI

  BPPV.MethodA multi-centre randomised mixed methods feasibility study

  design was employed. We aim to recruit approximately 75 acute TBI

  patients across a range of clinical severities, from three major trauma

  centres in London. Patients will be randomised to one of three treatment

  arms: (1) therapist-led manoeuvres, (2) patient-led exercises and (3)

  advice. Participants will be re-assessed by blinded outcome assessors at

  4 and 12weeks. Acceptability of the intervention will be obtained by

  patient interviews at the end of their treatment and therapist

  interviews at the end of the study. Primary outcomes relate to

  feasibility parameters including recruitment and retention rates,

  adverse events and intervention fidelity. We will also aim to provide a

  more accurate estimate of the prevalence of BPPV in TBI cases on the

  trauma ward.DiscussionThe multi-centre nature of our feasibility study

  will inform the design of a future prospective treatment trial of BPPV

  in acute TBI. Important parameters we will obtain from this study, key

  for designing a future prospective treatment study, include estimating

  the prevalence of BPPV in TBI patients admitted to UK major trauma

  wards, and elucidating both patient and care-provider barriers in

  delivering BPPV treatment.Trial registrationISRCTN, ISRCTN91943864.

  Registered on 10 February 2020.'
affiliation: 'Smith, RM; Seemungal, BM (Corresponding Author), Imperial Coll London,
  Dept Brain Sci, Neurootol Unit, Brain \& Vestibular Grp BAVG, London, England.

  Smith, Rebecca M.; Tahtis, Vassilios; Seemungal, Barry M., Imperial Coll London,
  Dept Brain Sci, Neurootol Unit, Brain \& Vestibular Grp BAVG, London, England.

  Marroney, Natalie; Beattie, Jenna; Seemungal, Barry M., Imperial Coll Healthcare
  NHS Trust, London, England.

  Newdick, Abby, St Georges Univ Hosp NHS Fdn Trust, London, England.

  Tahtis, Vassilios, Kings Coll Hosp NHS Fdn Trust, London, England.

  Burgess, Caroline, Kings Coll London, Populat Hlth Sci, London, England.

  Marsden, Jonathan, Univ Plymouth, Sch Hlth Profess, Plymouth, Devon, England.'
article-number: '130'
author: Smith, Rebecca M. and Marroney, Natalie and Beattie, Jenna and Newdick, Abby
  and Tahtis, Vassilios and Burgess, Caroline and Marsden, Jonathan and Seemungal,
  Barry M.
author-email: 'rmsmi15@ic.ac.uk

  bmseem@ic.ac.uk'
author_list:
- family: Smith
  given: Rebecca M.
- family: Marroney
  given: Natalie
- family: Beattie
  given: Jenna
- family: Newdick
  given: Abby
- family: Tahtis
  given: Vassilios
- family: Burgess
  given: Caroline
- family: Marsden
  given: Jonathan
- family: Seemungal
  given: Barry M.
da: '2023-09-28'
doi: 10.1186/s40814-020-00669-z
eissn: 2055-5784
files: []
journal: PILOT AND FEASIBILITY STUDIES
keywords: 'Feasibility study; Traumatic brain injury; Benign paroxysmal positional

  vertigo; Rehabilitation'
keywords-plus: 'QUALITY-OF-LIFE; CLINICAL-TRIAL; RISK-FACTORS; DIZZINESS; FALLS; SCALE;

  DISABILITY; COMMUNITY; VALIDITY; OUTCOMES'
language: English
number: '1'
number-of-cited-references: '58'
orcid-numbers: 'Smith, Rebecca/0000-0003-2628-9861

  Seemungal, Barry/0000-0002-6578-0904'
papis_id: 967a445ccd2525f24d245b7777c146ba
ref: Smith2020mixedmethods
times-cited: '1'
title: A mixed methods randomised feasibility trial investigating the management of
  benign paroxysmal positional vertigo in acute traumatic brain injury
type: Article
unique-id: WOS:000729238200130
usage-count-last-180-days: '0'
usage-count-since-2013: '0'
volume: '6'
web-of-science-categories: Medicine, Research \& Experimental
year: '2020'