Background and Purpose: Benign paroxysmal positional vertigo (BPPV) is one of the most common vestibular disorders, and is treated effectively with particle repositioning maneuvers (PRM). The aim of this study was to assess the influence of BPPV and treatment effects of PRM on gait, falls, and fear of falling. Methods: Three databases and the reference lists of included articles were systematically searched for studies comparing gait and/or falls between (1) people with BPPV (pwBPPV) and controls and (2) pre- and posttreatment with PRM. The Joanna Briggs Institute critical appraisal tools were used to assess risk of bias. Results: Twenty of the 25 included studies were suitable for meta-analysis. Quality assessment resulted in 2 studies with high risk of bias, 13 with moderate risk, and 10 with low risk. PwBPPV walked slower and demonstrated more sway during tandem walking compared with controls. PwBPPV also walked slower during head rotations. After PRM, gait velocity during level walking increased significantly, and gait became safer according to gait assessment scales. Impairments during tandem walking and walking with head rotations did not improve. The number of fallers was significantly higher for pwBPPV than for controls. After treatment, the number of falls, number of pwBPPV who fell, and fear of falling decreased. Discussion and Conclusions: BPPV increases the odds of falls and negatively impacts spatiotemporal parameters of gait. PRM improves falls, fear of falling, and gait during level walking. Additional rehabilitation might be necessary to improve gait while walking with head movements or tandem walking. Video Abstract available for more insights from the authors (see the Supplemental Digital Content Video, available at: http://links.lww.com/JNPT/A421).

Background/Objectives: Benign Paroxysmal Positioning Vertigo (BPPV), diagnosed in 46% of older adults with complaints of dizziness, causes movement-related vertigo. This case-control study compared physical activity, frailty and subjective well-being between older adults with BPPV (oaBPPV) and controls. Methods: Thirty-seven oaBPPV (mean age 73.13 (4.8)) were compared to 22 matched controls (mean age 73.5 (4.5)). Physical activity was measured using the MOX accelerometer and the International Physical Activity Questionnaire. Modified Fried criteria assessed frailty. The Dizziness Handicap Inventory, Falls Efficacy Scale, and 15-item Geriatric Depression Scale assessed subjective well-being. A post-hoc sub-analysis compared all variables compared between frail oaBPPV, robust oaBPPV and robust controls. Significance level was set at α = 0.05. Results: oaBPPV were significantly less physically active and were more (pre-)frail (p < 0.001) compared to controls. They performed significantly less active bouts (p = 0.002) and more sedentary bouts (p = 0.002), and a significantly different pattern of physical activity during the day. OaBPPV reported significantly less time in transportation activities (p = 0.003), leisure (p < 0.001), walking (p < 0.001) and moderate-intensity activities (p = 0.004) compared to controls. Frail oaBPPV were even less active (p = 0.01) and experienced more fear of falling (p < 0.001) and feelings of depression (p < 0.001) than robust oaBPPV and controls. Conclusions: BPPV can induce a vicious cycle of fear of provoking symptoms, decreased physical activity, well-being and consequently frailty. It is also possible that frail and less physically active older adults have an increased prevalence of BPPV. Post-treatment follow-up should assess BPPV, frailty and physical activity to determine if further rehabilitation is needed.

Background: Vestibular hypofunction occurs in 29.5% of older adults with benign paroxysmal positional vertigo (BPPV), but its impact on postural control, well-being and frailty was not studied before. This study compared the well-being, frailty and postural control between older adults with BPPV and vestibular hypofunction (oaBPPV+), and older adults with only BPPV (oaBPPV). Methods: Thirty-one older adults (≥65 years old) diagnosed with BPPV were recruited. Unilateral vestibular hypofunction was defined as a >25% caloric asymmetry, and bilateral vestibular hypofunction as a total response <6°/s per ear, using bithermal caloric irrigations. The oaBPPV+ group was compared to the oaBPPV group using the measures of well-being (Dizziness Handicap Inventory, Falls Efficacy Scale and 15-item Geriatric Depression Scale), frailty (Modified Fried Criteria), and postural control (timed chair stand test, mini-Balance Evaluation Systems test and Clinical Test of Sensory Interaction on Balance (CTSIB)). Falls and the number of repositioning maneuvers were documented. Significance level was set at α = 0.05. Results: Unilateral vestibular hypofunction was present in 32% of participants, mainly in females (p = 0.04). Bilateral vestibular hypofunction was not found. The oaBPPV+ group (n = 10, mean age 72.5 (4.5)) experienced more comorbidities (p = 0.02) than the oaBPPV group (n = 21, mean age 72.6 (4.9)). Groups did not differ regarding dizziness symptoms (p = 0.46), fear of falling (p = 0.44), depression (p = 0.48), falls (p = 0.08) or frailty (p = 0.36). However, the oaBPPV+ group showed significantly worse postural control under vestibular-dependent conditions (p < 0.001). Conclusions: Despite equally impaired well-being and frailty, the oaBPPV+ group showed greater sensory orientation deficits. Clinicians and researchers should be alert for co-existing vestibular hypofunction in older adults with BPPV, since this may exacerbate their already impaired postural control more than only BPPV.