The following is a summary of “Epley manoeuvre’s efficacy for benign paroxysmal positional vertigo (BPPV) in primary-care and subspecialty settings: a systematic review and meta-analysis,” published in the December 2023 issue of Primary Care by Saishoji, et al.

Despite reports of general inexperience with the Epley maneuver (EM) among general physicians, more comprehensive evaluations are needed on the effect of EM on benign paroxysmal positional vertigo (BPPV) in primary care. For a systematic review and meta-analysis, researchers sought to determine the efficacy of EM for treating posterior canal BPPV across primary-care and subspecialty settings.

The study conducted a systematic review and meta-analysis of randomized sham-controlled trials focusing on EM for posterior canal BPPV. Primary-care settings included practices led by general practitioners, primary-care doctors, or family doctors. A systematic search was conducted across various databases in January 2022, and outcomes assessed included the disappearance of subjective symptoms (vertigo), negative findings (Dix–Hallpike test), and adverse events. Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach.

The analysis of 27 randomized controlled trials revealed that in primary-care settings, EM significantly reduced subjective symptoms (RR 3.14; 95% CI 1.96–5.02), although there was no applicable data for adverse events. In subspecialty settings, EM effectively reduced subjective symptoms (RR 2.42; 95% CI 1.64–3.56) and increased negative findings (RR 1.81; 95% CI 1.40–2.34). However, there was uncertainty regarding the effect of EM on negative findings in primary-care settings and adverse events in subspecialty settings.

The study concluded that EM for BPPV is effective regardless of primary care or subspecialty settings. The findings highlighted the significance of performing EM for BPPV in primary-care settings, potentially preventing unnecessary referrals to higher tertiary-care facilities and hospitalizations for follow-up.

Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-023-02217-z