SynthesisJournal of neurology2026
Comparative efficacy of non-pharmacological interventions for persistent postural-perceptual dizziness: a systematic review and network meta-analysis of balance, anxiety, and depression outcomes.
Synthesis in Journal of neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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7 authors.
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Abstract
introductionPersistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder characterized by persistent dizziness, postural instability, and visual hypersensitivity. Although several non-pharmacological interventions have been proposed, their comparative efficacy remains unclear.
methodsPubMed, Embase, and the Cochrane Library were searched from inception to January 2026 for randomized controlled trials involving adults with PPPD or equivalent conditions. Interventions included CBT, vestibular rehabilitation therapy (VRT), neuromodulation, galvanic vestibular stimulation (GVS), and combined approaches. Random-effects network meta-analysis was performed using standardized mean differences (SMDs) and 95% confidence intervals (CIs).
resultsEleven RCTs comprising 518 patients were included. For balance outcomes (518 participants), neuromodulation significantly outperformed control (SMD -1.22, 95% CI -1.90 to -0.54). It also demonstrated superiority over CBT (SMD -1.03, 95% CI -1.96 to -0.09) and VRT (SMD -1.33, 95% CI -2.49 to -0.18). For anxiety outcomes (518 participants), neuromodulation demonstrated significant superiority over control (SMD -0.87, 95% CI -1.40 to -0.33), CBT (SMD -0.88, 95% CI -1.62 to -0.14), and Advanced VRT (SMD -1.36, 95% CI -2.31 to -0.41). No significant effects were observed for any intervention on depression outcomes; moderate-to-substantial heterogeneity was detected (I
conclusionsNeuromodulation may provide relative benefits for balance and anxiety in PPPD, whereas evidence for alleviation of depression remains inconclusive. Given the limited and low-quality evidence base, further high-quality randomized controlled trials are needed. REGISTRATION: PROSPERO (CRD420261285141).
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