Table 1 Summary of findings: primary-care clinic

Epley manoeuvre compared with the control for BPPV

Patient or population:

Patients with definite diagnosis of BPPV

Setting:

Primary-care clinic

Intervention:

Epley manoeuvre

Comparison:

Sham manoeuvre or no treatment or drug

Outcomes

Anticipated absolute effects ^* (95% CI)

Relative effect

(95% CI)

№ of participants

(studies)

Certainty of the evidence

(GRADE)

Risk with Control

Risk with Epley manoeuvre

Disappearance of subjective symptoms (vertigo)

238 events per 1,000 participants

496 events per 1,000 participants (380 to 611)

RR 3.14 (1.96–5.02)

309

(3 RCTs)

⨁⨁◯◯

Low^a,b

Negative findings

(DH test)

406 events per 1,000 participants

592 events per 1,000 participants (292 to 1,000)

RR 1.46 (0.72–2.97)

206

(2 RCTs)

⨁◯◯◯

Very low^a,c

All adverse events

not pooled

not pooled

-

-

-

Disappearance of objective symptoms (nystagmus)

785 events per 1,000 participants

934 events per 1,000 participants (808 to 1000)

RR 1.19 (1.03–1.38)

127

(1 RCT)

⨁⨁◯◯

Low^c

Dizziness Handicap Inventory

The mean is 0

MD 2 lower

(5.51 lower to 1.51 higher)

-

134

(1 RCT)

⨁⨁◯◯

Low^a,b

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

DH test: Dix–Hallpike test; BPPV: benign paroxysmal positional vertigo; CI: confidence interval; MD: mean difference; RR: risk ratio; SMD: standardised mean difference;

GRADE Working group grades of evidence

High certainty: we are very confident that the true effect lies close to that of the estimate of the effect.

Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.

Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.

Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

Explanations

a. Downgraded one level for risk of bias

b. Downgraded one level for imprecision

c. Downgraded two level for imprecision