The merits of vestibular rehabilitation: Exploring vertigo and dizziness in general practice

Research output: ThesisPhd-Thesis - Research and graduation internal


This dissertation is about dizziness in general practice. Each year millions of Dutch people develop dizziness symptoms. Dizziness reduces quality of life and causes high healthcare costs. One of the most important treatments for dizziness is vestibular rehabilitation (VR). VR is a personalised treatment with simple daily exercises, designed to activate the balance system. The main goal of this doctoral research project was the development and evaluation of an online VR version for general practice.

A questionnaire study that we conducted among 426 general practitioners showed that only 6.8% ever used VR. In collaboration with the University of Southampton, we developed an online VR treatment for chronic dizziness. In a three-armed randomized controlled trial, we compared online VR, with and without physical therapy support, with usual care. The standalone online VR intervention consisted of a website with information about dizziness and instructions to perform daily exercises. In the VR group with physical therapy support, the same online intervention was supplemented by home visits by the physical therapist. In the third and final group, participants received usual care from their general practitioner without restrictions. After six months, both online VR participants with and without physiotherapy support experienced less dizziness symptoms than usual care participants. A cost-effectiveness study that we subsequently conducted showed that online VR without support has the greatest chance to become cost-effective in the future. To conclude, this dissertation shows that online VR is an accessible, safe and effective treatment for chronic dizziness in Dutch general practice.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • Vrije Universiteit Amsterdam
  • Maarsingh, Otto, Co-supervisor
  • van der Wouden, Hans, Co-supervisor
  • van der Horst, Henriette, Supervisor
Award date18 Dec 2020
Publication statusPublished - 2020

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