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image of The Role of Biofeedback in Improving Vertigo Management in Older Adults. A Controlled Clinical Study in Italy

Abstract

Introduction

Vertigo significantly impacts the psychosocial functioning in older persons, limiting their ability to carry out daily activities. In older adults, the effects of vertigo are even more severe than in younger populations, as it negatively impacts gait and balance, increasing the risk of falls. This, in turn, has a profound effect on their independence and overall quality of life. Despite the importance of providing integrated treatment, only a few psychological interventions have been proposed for older people. The aim of this study is to evaluate the effectiveness of biofeedback in decreasing the emotional, functional, and physical effects of vertigo in a sample of 190 older outpatients over a 3-month follow-up period.

Methods

This is a controlled clinical study involving 190 persons of an outpatients of a Medical Centre, aged over 65 years. All patients received treatment as usual; in addition, the experimental group participated in a brief biofeedback training, using Procomp Infinity by Thought Technology Ltd. No biofeedback booster sessions were provided to the experimental group during the 3- month follow-up. Changes in vertigo severity were assessed using the Dizziness Handicap Inventory (DHI).

Results

Repeated ANOVA measures showed that older patients treated with biofeedback reported a reduction in DHI scores after three months, reflecting a decrease in the subjective perception of the disabling impacts of dizziness on their daily living.

Discussion

These findings support the effectiveness of integrating biofeedback training into the standard care protocol for older patients living with vertigo. Biofeedback treatment has reduced the effects of dizziness and instability on the day-to-day activities in these patients. Through biofeedback training, these patients learned valuable strategies to manage their symptoms, using techniques such as muscle relaxation and breath control to mitigate the arousal and heightened alertness associated with vertigo episodes. Biofeedback empowered these patients, fostering in them a sense of autonomy and self-efficacy in managing their condition.

Conclusion

Despite these promising results, future research should delve deeper into the underlying mechanisms of vertigo in older persons, examining psychological factors and exploring potential correlations with other common comorbidities in this population, such as cardiovascular issues and cognitive decline. Understanding these interconnections will be crucial for developing more comprehensive and effective treatment strategies for older patients with vertigo.

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2025-07-15
2025-09-15
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References

  1. Jönsson R. Sixt E. Landahl S. Rosenhall U. Prevalence of dizziness and vertigo in an urban elderly population. J. Vestib. Res. 2004 14 1 47 52 10.3233/VES‑2004‑14105 15156096
    [Google Scholar]
  2. Neuhauser H.K. The epidemiology of dizziness and vertigo. Handb. Clin. Neurol. 2016 137 67 82 10.1016/B978‑0‑444‑63437‑5.00005‑4 27638063
    [Google Scholar]
  3. Bayat A. Hoseinabadi R. Saki N. Sanayi R. Disability and anxiety in vestibular diseases: A cross-sectional study. Cureus 2020 12 11 e11813 10.7759/cureus.11813 33409058
    [Google Scholar]
  4. Neuhauser H.K. Radtke A. von Brevern M. Lezius F. Feldmann M. Lempert T. Burden of dizziness and vertigo in the community. Arch. Intern. Med. 2008 168 19 2118 2124 10.1001/archinte.168.19.2118 18955641
    [Google Scholar]
  5. Ciorba A. Bianchini C. Scanelli G. Pala M. Zurlo A. Aimoni C. The impact of dizziness on quality-of-life in the elderly. Eur. Arch. Otorhinolaryngol. 2017 274 3 1245 1250 10.1007/s00405‑016‑4222‑z 27450383
    [Google Scholar]
  6. Fancello V Hatzopoulos S Santopietro G Fancello G Palma S Skarżyński PH Bianchini C Ciorba A Vertigo in the elderly: A systematic literature review. J Clin Med 2023 12 6 2182 10.3390/jcm12062182
    [Google Scholar]
  7. Lin H.W. Bhattacharyya N. Balance disorders in the elderly: Epidemiology and functional impact. Laryngoscope 2012 122 8 1858 1861 10.1002/lary.23376 22645067
    [Google Scholar]
  8. Walther L.E. Nikolaus T. Schaaf H. Hörmann K. Vertigo and falls in the elderly. HNO 2008 56 9 927 937 10.1007/s00106‑008‑1802‑2 18712512
    [Google Scholar]
  9. Walther L.E. Kleeberg J. Rejmanowski G. Hänsel J. Lundershausen D. Hörmann K. Schnupp T. Löhler J. Falls and fall risk factors. HNO 2012 60 5 446 456, 448-456 10.1007/s00106‑011‑2395‑8 22037969
    [Google Scholar]
  10. Schlick C. Schniepp R. Loidl V. Wuehr M. Hesselbarth K. Jahn K. Falls and fear of falling in vertigo and balance disorders: A controlled cross-sectional study. J. Vestib. Res. 2016 25 5-6 241 251 10.3233/VES‑150564 26890425
    [Google Scholar]
  11. Casani A.P. Navari E. Dizziness and prevention of falls in the elderly. Geriatric Care 2017 3 4 75 77 10.4081/gc.2017.7160
    [Google Scholar]
  12. Agrawal Y. Carey J.P. Della Santina C.C. Schubert M.C. Minor L.B. Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001-2004. Arch. Intern. Med. 2009 169 10 938 944 10.1001/archinternmed.2009.66 19468085
    [Google Scholar]
  13. Hauer K.A. Kempen G.I.J.M. Schwenk M. Yardley L. Beyer N. Todd C. Oster P. Zijlstra G.A.R. Validity and sensitivity to change of the falls efficacy scales international to assess fear of falling in older adults with and without cognitive impairment. Gerontology 2011 57 5 462 472 10.1159/000320054 20975251
    [Google Scholar]
  14. Parham K. Kuchel G.A. A geriatric perspective on benign paroxysmal positional vertigo. J. Am. Geriatr. Soc. 2016 64 2 378 385 10.1111/jgs.13926 26804483
    [Google Scholar]
  15. Gassmann K.G. Rupprecht R. Group I.Z.G.S. Dizziness in an older community dwelling population: A multifactorial syndrome. J. Nutr. Health Aging 2009 13 3 278 282 10.1007/s12603‑009‑0073‑2 19262968
    [Google Scholar]
  16. Sloane P.D. Coeytaux R.R. Beck R.S. Dallara J. Dizziness: State of the science. Ann. Intern. Med. 2001 134 9_Part_2 823 832 10.7326/0003‑4819‑134‑9_Part_2‑200105011‑00005 11346317
    [Google Scholar]
  17. Labuguen R.H. Initial evaluation of vertigo. Am. Fam. Physician 2006 73 2 244 251 16445269
    [Google Scholar]
  18. Maarsingh O.R. Dros J. Schellevis F.G. van Weert H.C. van der Windt D.A. Riet G. van der Horst H.E. Causes of persistent dizziness in elderly patients in primary care. Ann. Fam. Med. 2010 8 3 196 205 10.1370/afm.1116 20458102
    [Google Scholar]
  19. Tinetti M.E. Williams C.S. Gill T.M. Dizziness among older adults: A possible geriatric syndrome. Ann. Intern. Med. 2000 132 5 337 344 10.7326/0003‑4819‑132‑5‑200003070‑00002 10691583
    [Google Scholar]
  20. Rogers T.S. Noel M.A. Garcia B. Dizziness: Evaluation and management. Am. Fam. Physician 2023 107 5 514 523 37192077
    [Google Scholar]
  21. Frishman W.H. Azer V. Sica D. Drug treatment of orthostatic hypotension and vasovagal syncope. Heart Dis. 2003 5 1 49 64 10.1097/01.HDX.0000050416.53995.43 12549988
    [Google Scholar]
  22. Li Y. Peng B. Pathogenesis, diagnosis, and treatment of cervical vertigo. Pain Physician 2015 18 4 E583 E595 26218949
    [Google Scholar]
  23. Colledge N.R. Barr-Hamilton R.M. Lewis S.J. Sellar R.J. Wilson J.A. Evaluation of investigations to diagnose the cause of dizziness in elderly people: A community based controlled study. BMJ 1996 313 7060 788 792 10.1136/bmj.313.7060.788 8842072
    [Google Scholar]
  24. Bronstein A.M. Vision and vertigo. J. Neurol. 2004 251 4 381 387 10.1007/s00415‑004‑0410‑7 15083281
    [Google Scholar]
  25. Li S. Wang Z. Liu Y. Cao J. Zheng H. Jing Y. Han L. Ma X. Xia R. Yu L. Risk factors for the recurrence of benign paroxysmal positional vertigo: A systematic review and meta-analysis. Ear Nose Throat J. 2022 101 3 NP112 NP134 10.1177/0145561320943362 32776833
    [Google Scholar]
  26. Chen J. Zhang S. Cui K. Liu C. Risk factors for benign paroxysmal positional vertigo recurrence: A systematic review and meta-analysis. J. Neurol. 2021 268 11 4117 4127 10.1007/s00415‑020‑10175‑0 32839838
    [Google Scholar]
  27. Staab J.P. Eckhardt-Henn A. Horii A. Jacob R. Strupp M. Brandt T. Bronstein A. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society. J. Vestib. Res. 2017 27 4 191 208 10.3233/VES‑170622 29036855
    [Google Scholar]
  28. Prell T. Mendorf S. Axer H. Tolerance to dizziness intensity increases with age in people with chronic dizziness. Front. Neurol. 2022 13 934627 10.3389/fneur.2022.934627 35911923
    [Google Scholar]
  29. Regauer V. Seckler E. Grill E. Ippisch R. Jahn K. Bauer P. Müller M. Development of a complex intervention to improve mobility and participation of older people with vertigo, dizziness and balance disorders in primary care: A mixed methods study. BMC Fam. Pract. 2021 22 1 89 10.1186/s12875‑021‑01441‑9 33980155
    [Google Scholar]
  30. Choi H.G. Lee J.K. Kong I.G. Lim H. Kim S.Y. Osteoporosis increases the risk of benign paroxysmal positional vertigo: A nested case–control study using a national sample cohort. Eur. Arch. Otorhinolaryngol. 2019 276 2 335 342 10.1007/s00405‑018‑5230‑y 30511104
    [Google Scholar]
  31. Karataş A. Acar Yüceant G. Yüce T. Haci C. Taylan Cebi I. Salviz M. Association of benign paroxysmal positional vertigo with osteoporosis and vitamin D deficiency: A case-controlled study. J. Int. Adv. Otol. 2017 13 2 259 265 10.5152/iao.2016.2640 28274898
    [Google Scholar]
  32. Lopes A.R. Moreira M.D. Trelha C.S. Marchiori L.L. Association between complaints of dizziness and hypertension in non-institutionalized elders. Int. Arch. Otorhinolaryngol. 2013 17 2 157 162 10.7162/S1809‑97772013000200007 25992007
    [Google Scholar]
  33. Sloane P.D. Hartman M. Mitchell C.M. Psychological factors associated with chronic dizziness in patients aged 60 and older. J. Am. Geriatr. Soc. 1994 42 8 847 852 10.1111/j.1532‑5415.1994.tb06556.x 8046194
    [Google Scholar]
  34. Eckhardt-Henn A. Breuer P. Thomalske C. Hoffmann S.O. Hopf H.C. Anxiety disorders and other psychiatric subgroups in patients complaining of dizziness. J. Anxiety Disord. 2003 17 4 369 388 10.1016/S0887‑6185(02)00226‑8 12826087
    [Google Scholar]
  35. Furman J.M. Jacob R.G. A clinical taxonomy of dizziness and anxiety in the otoneurological setting. J. Anxiety Disord. 2001 15 1-2 9 26 10.1016/S0887‑6185(00)00040‑2 11388360
    [Google Scholar]
  36. Lahmann C. Henningsen P. Brandt T. Strupp M. Jahn K. Dieterich M. Eckhardt-Henn A. Feuerecker R. Dinkel A. Schmid G. Psychiatric comorbidity and psychosocial impairment among patients with vertigo and dizziness. J. Neurol. Neurosurg. Psychiatry 2015 86 3 302 308 10.1136/jnnp‑2014‑307601 24963122
    [Google Scholar]
  37. Casani A.P. Gufoni M. Capobianco S. Current insights into treating vertigo in older adults. Drugs Aging 2021 38 8 655 670 10.1007/s40266‑021‑00877‑z 34159566
    [Google Scholar]
  38. Wan T. Yu Y.C. Zhao X. Tang P. Gong Y. Efficacy of betahistine plus cognitive behavioral therapy on residual dizziness after successful canalith repositioning procedure for benign paroxysmal positional vertigo. Neuropsychiatr. Dis. Treat. 2018 14 2965 2971 10.2147/NDT.S182809 30464481
    [Google Scholar]
  39. Jalali M.M. Gerami H. Saberi A. Razaghi S. The impact of betahistine versus dimenhydrinate in the resolution of residual dizziness in patients with benign paroxysmal positional vertigo: A randomized clinical trial. Ann. Otol. Rhinol. Laryngol. 2020 129 5 434 440 10.1177/0003489419892285 31810393
    [Google Scholar]
  40. Regauer V. Seckler E. Müller M. Bauer P. Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: A systematic review. BMC Geriatr. 2020 20 1 494 10.1186/s12877‑020‑01899‑9 33228601
    [Google Scholar]
  41. Goessl V.C. Curtiss J.E. Hofmann S.G. The effect of heart rate variability biofeedback training on stress and anxiety: A meta-analysis. Psychol. Med. 2017 47 15 2578 2586 10.1017/S0033291717001003 28478782
    [Google Scholar]
  42. Lehrer P.M. Vaschillo E. Vaschillo B. Lu S.E. Eckberg D.L. Edelberg R. Shih W.J. Lin Y. Kuusela T.A. Tahvanainen K.U.O. Hamer R.M. Heart rate variability biofeedback increases baroreflex gain and peak expiratory flow. Psychosom. Med. 2003 65 5 796 805 10.1097/01.PSY.0000089200.81962.19 14508023
    [Google Scholar]
  43. Ratanasiripong P. Kaewboonchoo O. Ratanasiripong N. Hanklang S. Chumchai P. Biofeedback intervention for stress, anxiety, and depression among graduate students in public health nursing. Nurs. Res. Pract. 2015 2015 1 5 10.1155/2015/160746 25954515
    [Google Scholar]
  44. Schwartz M.S. Andrasik F. Biofeedback: A practitioner’s guide. Guilford Publications New York 2017
    [Google Scholar]
  45. Sherlin L. Gevirtz R. Wyckoff S. Muench F. Effects of respiratory sinus arrhythmia biofeedback versus passive biofeedback control. Int. J. Stress Manag. 2009 16 3 233 248 10.1037/a0016047
    [Google Scholar]
  46. Buizza C. Franco E. Ghilardi A. Is biofeedback for vertigo effective in ordinary medical centers? A controlled trial in Northern Italy. Appl. Psychophysiol. Biofeedback 2023 48 3 345 354 10.1007/s10484‑023‑09588‑0 37231183
    [Google Scholar]
  47. Schwartz N.M. Schwartz M.S. Definitions of biofeedback and applied psychophysiology. Biofeedback: A practitioner's guide The Guilford Press 2003 3rd 27 39
    [Google Scholar]
  48. Schwartz M.S. A new improved universally accepted official definition of biofeedback: Where did it come from? Why? Who did it? Who is it for? What’s next? Biofeedback 2010 38 3 88 90 10.5298/1081‑5937‑38.3.88
    [Google Scholar]
  49. Hatzitaki V. Voudouris D. Nikodelis T. Amiridis I.G. Visual feedback training improves postural adjustments associated with moving obstacle avoidance in elderly women. Gait Posture 2009 29 2 296 299 10.1016/j.gaitpost.2008.09.011 18996012
    [Google Scholar]
  50. Heiden E. Lajoie Y. Games-based biofeedback training and the attentional demands of balance in older adults. Aging Clin. Exp. Res. 2010 22 5-6 367 373 10.1007/BF03337732 20009499
    [Google Scholar]
  51. Rose D.J. Clark S. Can the control of bodily orientation be significantly improved in a group of older adults with a history of falls? J. Am. Geriatr. Soc. 2000 48 3 275 282 10.1111/j.1532‑5415.2000.tb02646.x 10733053
    [Google Scholar]
  52. Wolf S.L. Barnhart H.X. Kutner N.G. Mcneely E. Coogler C. Xu T. Selected as the best paper in the 1990s: Reducing frailty and falls in older persons: an investigation of tai chi and computerized balance training. J. Am. Geriatr. Soc. 2003 51 12 1794 1803 10.1046/j.1532‑5415.2003.51566.x 14687360
    [Google Scholar]
  53. Jacobson G.P. Newman C.W. The development of the dizziness handicap inventory. Arch. Otolaryngol. Head Neck Surg. 1990 116 4 424 427 10.1001/archotol.1990.01870040046011 2317323
    [Google Scholar]
  54. Jacobson G.P. Newman C.W. Hunter L. Balzer G.K. Balance function test correlates of the dizziness handicap inventory. J. Am. Acad. Audiol. 1991 2 4 253 260 1837740
    [Google Scholar]
  55. Newman C. Jacobson G. Application of self-report scales in balance function handicap assessment and management. Semin. Hear. 1993 14 4 363 375 10.1055/s‑0028‑1085134
    [Google Scholar]
  56. Mutlu B. Serbetcioglu B. Discussion of the dizziness handicap inventory. J. Vestib. Res. 2013 23 6 271 277 10.3233/VES‑130488 24447966
    [Google Scholar]
  57. Nola G. Mostardini C. Salvi C. Ercolani A.P. Ralli G. Validity of Italian adaptation of the Dizziness Handicap Inventory (DHI) and evaluation of the quality of life in patients with acute dizziness. Acta Otorhinol Ital 2010 30 4 190 21253284
    [Google Scholar]
  58. Cram J.R. EMG muscle scanning and diagnostic manual for surface recordings. Clinical EMG for surface recordings. Clinical Resources Atlanta 1990 1 142
    [Google Scholar]
  59. Cacioppo J.T. Tassinary L.G. Berntson G.G. Handbook of psychophysiology. 2nd ed Cambridge University Press 2000
    [Google Scholar]
  60. Renshaw D. Bice M. Cassidy C. Eldridge J. Powell D. A comparison of three computer-based methods used to determine EMG signalamplitude. Int. J. Exerc. Sci. 2010 3 1 43 48 10.70252/AYBG1535 27182326
    [Google Scholar]
  61. Ahsan M.R. Ibrahimy M.I. Khalifa O.O. EMG signal classification for human computer interaction: A review. Eur. J. Sci. Res. 2009 33 3 480 501
    [Google Scholar]
  62. Arabadzhiev T.I. Dimitrov V.G. Dimitrova N.A. Dimitrov G.V. Interpretation of EMG integral or RMS and estimates of “neuromuscular efficiency” can be misleading in fatiguing contraction. J. Electromyogr. Kinesiol. 2010 20 2 223 232 10.1016/j.jelekin.2009.01.008 19233687
    [Google Scholar]
  63. Newman-Toker D.E. Kerber K.A. Hsieh Y.H. Pula J.H. Omron R. Saber Tehrani A.S. Mantokoudis G. Hanley D.F. Zee D.S. Kattah J.C. HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness. Acad. Emerg. Med. 2013 20 10 986 996 10.1111/acem.12223 24127701
    [Google Scholar]
  64. Edlow J.A. Gurley K.L. Newman-Toker D.E. A new diagnostic approach to the adult patient with acute dizziness. J. Emerg. Med. 2018 54 4 469 483 10.1016/j.jemermed.2017.12.024 29395695
    [Google Scholar]
  65. Weber K.P. MacDougall H.G. Halmagyi G.M. Curthoys I.S. Impulsive testing of semicircular-canal function using video-oculography. Ann. N. Y. Acad. Sci. 2009 1164 1 486 491 10.1111/j.1749‑6632.2008.03730.x 19645955
    [Google Scholar]
  66. Johkura K. Nystagmus the diagnosis of vertigo and dizziness. Brain Nerve 2013 65 9 1057 1069 24018742
    [Google Scholar]
  67. Post R.E. Dickerson L.M. Dizziness: A diagnostic approach. Am. Fam. Physician 2010 82 4 361 368, 369 20704166
    [Google Scholar]
  68. Park H.J. Shin J.E. Lee Y.J. Park M.S. Kim J.M. Na B.R. Hyperventilation-induced nystagmus in patients with vestibular neuritis in the acute and follow-up stages. Audiol. Neurotol. 2011 16 4 248 253 10.1159/000320841 20980745
    [Google Scholar]
  69. Gopinath B. McMahon C.M. Rochtchina E. Mitchell P. Dizziness and vertigo in an older population: The Blue Mountains prospective cross-sectional study. Clin. Otolaryngol. 2009 34 6 552 556 10.1111/j.1749‑4486.2009.02025.x 20070765
    [Google Scholar]
  70. Mueller M. Strobl R. Jahn K. Linkohr B. Peters A. Grill E. Burden of disability attributable to vertigo and dizziness in the aged: Results from the KORA-Age study. Eur. J. Public Health 2014 24 5 802 807 10.1093/eurpub/ckt171 24213583
    [Google Scholar]
  71. Bellelli G. Bruni A. Malerba M. Mazzone A. Aliberti S. Pesci A. Annoni G. Geriatric multidimensional assessment for elderly patients with acute respiratory diseases. Eur. J. Intern. Med. 2014 25 4 304 311 10.1016/j.ejim.2014.03.002 24698475
    [Google Scholar]
  72. Delgado Silveira E. Fernández-Villalba E.M. García-Mina Freire M. Albiñana Pérez M.S. Casajús Lagranja M.P. Peris Martí J.F. The impact of pharmacy intervention on the treatment of elderly multi-pathological patients. Farm. Hosp. 2015 39 4 192 202 10.7399/fh.2015.39.4.8329 26276737
    [Google Scholar]
  73. Fernández L. Breinbauer H.A. Delano P.H. Vertigo and dizziness in the elderly. Front. Neurol. 2015 6 144 10.3389/fneur.2015.00144 26167157
    [Google Scholar]
  74. Wipperman J. Dizziness and vertigo. Prim. Care 2014 41 1 115 131 10.1016/j.pop.2013.10.004 24439886
    [Google Scholar]
  75. Gurr B. Moffat N. Psychological consequences of vertigo and the effectiveness of vestibular rehabilitation for brain injury patients. Brain Inj. 2001 15 5 387 400 10.1080/02699050010005904 11350653
    [Google Scholar]
  76. Jacobson E. Progressive relaxation. Am. J. Psychol. 1987 100 3/4 522 537 10.2307/1422693
    [Google Scholar]
  77. Hanlon J.T. Lindblad C.I. Hajjar E.R. McCarthy T.C. Update on drug-related problems in the elderly. Am. J. Geriatr. Pharmacother. 2003 1 1 38 43 10.1016/S1543‑5946(03)80014‑4 15555464
    [Google Scholar]
  78. Morowatisharifabad M.A. Sharifabad M.H. Aboutorabi-zarchi M. Prevalence and related factors of dizziness among older adults: A cross-sectional study in Ardakan City, Iran. Curr. Aging Sci. 2024 17 3 237 246 10.2174/0118746098277513240207070946 38415494
    [Google Scholar]
  79. Ciorba A. Dizziness and the risk of falling in the elderly: A literature review. J. Hear. Sci. 2015 5 1 9 13 10.17430/893746
    [Google Scholar]
  80. Karlsson M.K. Vonschewelov T. Karlsson C. Cöster M. Rosengen B.E. Prevention of falls in the elderly: A review. Scand. J. Public Health 2013 41 5 442 454 10.1177/1403494813483215 23554390
    [Google Scholar]
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  • Article Type:
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Keywords: Older people ; biofeedback ; disability ; integrated treatment ; quality of life ; vertigo
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