Rapid Systematic Review of the Epley Maneuver versus Vestibular Rehabilitation for Benign Paroxysmal Positional Vertigo.

OBJECTIVE To evaluate the effectiveness of the Epley maneuver compared with vestibular rehabilitation on patient-reported symptom relief and conversion of the Dix-Hallpike from positive to negative in patients with posterior benign paroxysmal positional vertigo (p-BPPV). DATA SOURCES PubMed, Embase, and the Cochrane Library. REVIEW METHODS A systematic search was conducted. Studies reporting original study data were included. Relevance and risk of bias (RoB) of the selected articles were assessed. Studies with low relevance, high RoB, or both were excluded. For outcomes of interest, absolute risk differences and their 95% confidence intervals (CIs) were extracted. RESULTS A total of 373 unique studies were retrieved. Five of these satisfied the eligibility criteria. One study with low RoB and 3 studies with moderate RoB showed that the Epley maneuver is more effective than vestibular rehabilitation at 1-week follow-up with regard to patient-reported symptom relief and conversion of the Dix-Hallpike maneuver from positive to negative (risk differences range from 10% [95% CI, 30-47] to 55% [95% CI, 35-71]). There is inconsistent evidence for the effectiveness of the Epley maneuver compared with vestibular rehabilitation at 1-month follow-up. Most studies suggest that the Epley maneuver and vestibular rehabilitation are equally effective at 1-month follow-up. CONCLUSION The Epley maneuver is more effective in treating p-BPPV than vestibular rehabilitation at 1-week follow-up. There is inconsistent evidence for the effectiveness of the Epley maneuver compared with vestibular rehabilitation at 1-month follow-up.