Effect of Virtual Reality (VR) Versus Conventional Vestibular Rehabilitation and Progressive Muscle Relaxation (PMR) to Improve Balance and Stress Among Patients of Persistent Postural Perceptual Dizziness (PPPD)

Abstract

Background: Persistent postural-perceptual dizziness combines chronic dizziness, impaired balance, visual-motion sensitivity, and psychological distress. Virtual-reality training and progressive muscle relaxation may address different components of the disorder. Objective: To compare virtual-reality-based vestibular rehabilitation with progressive muscle relaxation combined with conventional vestibular rehabilitation. Methods: Twenty-four adults with persistent postural-perceptual dizziness were allocated equally to two treatment groups. Dizziness Handicap Inventory (DHI), Mini-BESTest, Perceived Stress Scale (PSS), and Visual Vertigo Analogue Scale (VVAS) were assessed before and after eight weeks. Results: Both groups improved on all four outcomes (paired p < 0.05). Mean changes with virtual reality versus combined treatment were −8.25 versus −24.67 for DHI, +3.34 versus +11.08 for Mini-BESTest, −3.00 versus −13.50 for PSS, and −11.25 versus −26.84 for VVAS. Recalculated post-treatment differences favored combined treatment for DHI (−11.67, 95% CI −18.96 to −4.38; p = 0.003), Mini-BESTest (+7.16, 95% CI 4.84 to 9.48; p < 0.001), PSS (−8.34, 95% CI −11.22 to −5.46; p < 0.001), and VVAS (−16.92, 95% CI −24.15 to −9.69; p < 0.001). Conclusion: Combined relaxation and vestibular rehabilitation produced larger short-term improvements than virtual reality alone