Vestibular schwannoma (VS) is a benign tumour from Schwann cells surrounding the vestibular nerve, which slowly grows within the internal auditory canal and then into the cerebellopontine angle, leading to a gradual vestibular dysfunction. The slowly progressive alteration of vestibular function allows the gradual implementation of central adaptive mechanisms called vestibular compensation. The total unilateral vestibular deafferentation induced by the surgical tumour removal suddenly leads to a decompensation of this previously compensated situation, which explains why most patients report severe vertigo immediately after surgery and which is responsible for perturbations of the postural control (Parietti-Winkler et al., 2006, 2008, 2010, 2011). Recently, Gauchard et al. (2013) suggested that preoperative and regular physical activity would limit the adverse effects of surgical removal on balance control. Also, patients benefited faster and better from the postoperative vestibular rehabilitation. Thus, preoperative vestibular rehabilitation, including physical and balance exercises, could help to limit postoperative balance disorders and promote postoperative balance compensation. This could lead to a decrease in the duration and cost of the postoperative management and faster improvement of quality of life.
To test this hypothesis, the measured and perceived balance control of the patient and the quality of life will be assessed into two groups: one of two groups will receive preoperative vestibular rehabilitation, carried out by a physiotherapist, and the other not. The assessments will be conducted 45 days and 3 days before surgery, and then 8 days, 30 days, 90 days and 365 days after surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
50
12 one-hour sessions with exercises of balance on unstable conditions (foam, tilt of the platform, biofeedback)
University Hospital of Nancy
Nancy, France
RECRUITINGAcute balance compensation
Change in composite equilibrium score from baseline to 8 days after surgery. The baseline corresponds to the day before the preoperative rehabilitation and the composite equilibrium (in %) score is calculated over the six conditions of the Sensory Organization Test (Equitest, Neurocom, USA). Comparison between both groups (preoperative rehabilitation vs. usual).
Time frame: One week after surgery
Balance compensation at short term
Change in composite equilibrium score from baseline to 30 days after surgery. The baseline corresponds to the day before the preoperative rehabilitation and the composite equilibrium (in %) score is calculated over the six conditions of the Sensory Organization Test (Equitest, Neurocom, USA). Comparison between both groups (preoperative rehabilitation vs. usual).
Time frame: One month after surgery
Balance compensation at middle term
Change in composite equilibrium score from baseline to 90 days after surgery. The baseline corresponds to the day before the preoperative rehabilitation and the composite equilibrium (in %) score is calculated over the six conditions of the Sensory Organization Test (Equitest, Neurocom, USA). Comparison between both groups (preoperative rehabilitation vs. usual).
Time frame: Three months after surgery
Balance compensation at long term
Change in composite equilibrium score from baseline to 365 days after surgery. The baseline corresponds to the day before the preoperative rehabilitation and the composite equilibrium (in %) score is calculated over the six conditions of the Sensory Organization Test (Equitest, Neurocom, USA). Comparison between both groups (preoperative rehabilitation vs. usual).
Time frame: One year after surgery
Preoperative balance compensation
Change in composite equilibrium score from baseline to three days before surgery. The baseline corresponds to the day before the preoperative rehabilitation and the composite equilibrium (in %) score is calculated over the six conditions of the Sensory Organization Test (Equitest, Neurocom, USA). Comparison between both groups (preoperative rehabilitation vs. usual).
Time frame: From baseline to three days before surgery
Acute change in self-rated dizziness (measured with the Dizziness Handicap Inventory)
Change in self-rated dizziness (measured with the Dizziness Handicap Inventory) from baseline to 8 days after surgery. The baseline corresponds to the day before the preoperative rehabilitation. Comparison between both groups (preoperative rehabilitation vs. usual).
Time frame: One week after surgery
Change in self-rated dizziness (measured with the Dizziness Handicap Inventory) at short term
Change in self-rated dizziness (measured with the Dizziness Handicap Inventory) from baseline to 30 days after surgery. The baseline corresponds to the day before the preoperative rehabilitation. Comparison between both groups (preoperative rehabilitation vs. usual).
Time frame: One month after surgery
Change in self-rated dizziness (measured with the Dizziness Handicap Inventory) at middle term
Change in self-rated dizziness (measured with the Dizziness Handicap Inventory) from baseline to 90 days after surgery. The baseline corresponds to the day before the preoperative rehabilitation. Comparison between both groups (preoperative rehabilitation vs. usual).
Time frame: Three months after surgery
Change in self-rated dizziness (measured with the Dizziness Handicap Inventory) at long term
Change in self-rated dizziness (measured with the Dizziness Handicap Inventory) from baseline to 365 days after surgery. The baseline corresponds to the day before the preoperative rehabilitation. Comparison between both groups (preoperative rehabilitation vs. usual).
Time frame: One year after surgery
Acute change in self-rated quality of life (measured with WHOQOL-Bref questionnaire)
Change in self-rated quality of life (measured with WHOQOL-Bref questionnaire) from baseline to 8 days after surgery. The baseline corresponds to the day before the preoperative rehabilitation. Comparison between both groups (preoperative rehabilitation vs. usual).
Time frame: One week after surgery
Change in self-rated quality of life (measured with WHOQOL-Bref questionnaire) at short term
Change in self-rated quality of life (measured with WHOQOL-Bref questionnaire) from baseline to 30 days after surgery. The baseline corresponds to the day before the preoperative rehabilitation. Comparison between both groups (preoperative rehabilitation vs. usual).
Time frame: One month after surgery
Change in self-rated quality of life (measured with WHOQOL-Bref questionnaire) at middle term
Change in self-rated quality of life (measured with WHOQOL-Bref questionnaire) from baseline to 90 days after surgery. The baseline corresponds to the day before the preoperative rehabilitation. Comparison between both groups (preoperative rehabilitation vs. usual).
Time frame: Three months after surgery
Change in self-rated quality of life (measured with WHOQOL-Bref questionnaire) at long term
Change in self-rated quality of life (measured with WHOQOL-Bref questionnaire) from baseline to 365 days after surgery. The baseline corresponds to the day before the preoperative rehabilitation. Comparison between both groups (preoperative rehabilitation vs. usual).
Time frame: One year after surgery
Acute change in vestibular function
Change in vestibular function (measured by means of videonystagmography) from baseline to 8 days after surgery. The baseline corresponds to the day before the preoperative rehabilitation and videonystagmographic tests include both pendular and caloric tests. Comparison between both groups (preoperative rehabilitation vs. usual).
Time frame: One week after surgery
Change in vestibular function at short term
Change in vestibular function (measured by means of videonystagmography) from baseline to 30 days after surgery. The baseline corresponds to the day before the preoperative rehabilitation and videonystagmographic tests include both pendular and caloric tests. Comparison between both groups (preoperative rehabilitation vs. usual).
Time frame: One month after surgery
Change in vestibular function at middle term
Change in vestibular function (measured by means of videonystagmography) from baseline to 90 days after surgery. The baseline corresponds to the day before the preoperative rehabilitation and videonystagmographic tests include both pendular and caloric tests. Comparison between both groups (preoperative rehabilitation vs. usual).
Time frame: Three months after surgery
Change in vestibular function at long term
Change in vestibular function (measured by means of videonystagmography) from baseline to 365 days after surgery. The baseline corresponds to the day before the preoperative rehabilitation and videonystagmographic tests include both pendular and caloric tests. Comparison between both groups (preoperative rehabilitation vs. usual).
Time frame: One year after surgery
Preoperative change in vestibular function
Change in vestibular function (measured by means of videonystagmography) from baseline to three days before surgery. The baseline corresponds to the day before the preoperative rehabilitation and videonystagmographic tests include both pendular and caloric tests. Comparison between both groups (preoperative rehabilitation vs. usual).
Time frame: From baseline to three days before surgery
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