Epley manoeuvre compared with the control for BPPV | |||||
Patient or population: Patients with definite diagnosis of BPPV Setting: Otolaryngology or subspecialty settings 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) | 314 events per 1,000 participants | 760 events per 1,000 participants (515 to 1,000) | RR 2.42 (1.64–3.56) | 829 (16 RCTs) | ⨁⨁◯◯ Lowa,b |
Negative findings (DH test) | 443 events per 1,000 participants | 802 events per 1,000 participants (621 to 1,000) | RR 1.81 (1.40–2.34) | 912 (16 RCTs) | ⨁⨁◯◯ Lowa,b |
All adverse events | One study reported all adverse event: 2/24 (Epley manoeuvre group) and 0/26 (control group) | RR 5.40 (0.27–107.09) | 50 (1 RCT) | ⨁◯◯◯ Very lowa,d | |
Disappearance of objective symptoms (nystagmus) | 448 events per 1,000 participants | 758 events per 1,000 participants (484 to 1,000) | RR 1.69 (1.08–2.66) | 58 (1 RCT) | ⨁⨁◯◯ Lowd |
Dizziness Handicap Inventory | The mean is 0 | MD 8.24 lower (28 lower to 11.51 higher) | - | 70 (2 RCTs) | ⨁◯◯◯ Very lowa,c,d |
*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 publication bias c. Downgraded one level for inconsistency d. Downgraded two levels for imprecision |