Neetu Rani Dhiman

Title: A systematic review and meta-analysis of new discovered maneuvers for the treatment of Posterior Canal BPPV

Abstract

Background:

Benign Paroxysmal Positional Vertigo (BPPV) of the posterior canal is commonly treated using the Epley Maneuver (EM). New maneuvers have been developed with potential benefits in ease and self-administration.

Objective:

To evaluate and compare the effectiveness of the Epley Maneuver with newly developed alternative maneuvers for treating posterior canal BPPV.

Methods:

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing EM or placebo with new treatment maneuvers for posterior canal BPPV. Electronic databases (Scopus, PubMed, ScienceDirect, OVID MEDLINE, PROSPERO, and Cochrane Library) were searched. A pairwise meta-analysis using random-effects models was performed, and risk difference (RD) with 95% confidence intervals (CI) was calculated. Doi plots and the Luis Furuya-Kanamori (LFK) index were used to assess publication bias.

Results:

Five RCTs involving 422 patients were identified; three studies met criteria for meta-analysis. The pooled immediate treatment effect showed a rate ratio of 1.66 (95% CI: 0.534–5.151), and the follow-up effect showed a rate ratio of 1.64 (95% CI: 0.520–5.152), indicating that the new maneuvers (Half Somersault, Li Maneuver, and other alternates) demonstrated treatment outcomes comparable to the Epley Maneuver, while the wide confidence intervals reflect the limited number of available studies. The LFK indices were 1.74 (immediate) and 2.16 (follow-up), suggesting minor and major publication bias, respectively.

Conclusions:

Preliminary evidence suggests that newly developed maneuvers for posterior canal BPPV may offer comparable short-term and 6–12-month outcomes to the Epley Maneuver. These techniques appear simple, self-administered, and generally well-tolerated, indicating their potential as alternative options to the traditional EM; however, more robust and maneuver-specific studies are needed before firm conclusions can be drawn.

What will the audience take away from your presentation?

• The audience will learn that several newly developed maneuvers may be as effective as the Epley Maneuver, giving them more flexible, patient-friendly treatment options, especially for individuals who cannot tolerate EM.


• Clinicians can expand their therapeutic toolkit, improving patient care, especially for individuals unable to tolerate EM by teaching simpler, self-administrable maneuvers that reduce clinic dependency.


• Faculty can use this evidence to update teaching materials, develop new training modules in vestibular rehabilitation, and design further research on maneuver-specific outcomes.


• This research provides practical solutions for managing BPPV in patients with mobility restrictions or cervical limitations, simplifying decision-making and enhancing efficiency in treatment planning.


• The findings support more accurate, evidence-based selection of maneuvers and highlight areas needing further investigation, guiding better clinical design of individualized rehabilitation plans.

• List all other benefits.

• Encourages patient empowerment through home-based management


• Reduces healthcare burden by offering self-treatment options


• Identifies research gaps, helping shape future high-quality studies


• Promotes innovation in vestibular rehabilitation techniques