ArticleFrontiers in neurology2026
Dose-response and recovery trajectories of fall prevention rehabilitation in older patients with vertigo: a retrospective cohort study based on vestibular and gait impairment phenotypes.
Article in Frontiers in 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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Abstract
Background: Vertigo and dizziness are common in older adults and are associated with a significantly increased risk of falls. Fall prevention rehabilitation therapy (FPRT) is recommended, but current prescriptions remain largely empirical and do not account for heterogeneity in baseline vestibular and gait impairments. The dose-response relationship between rehabilitation hours and functional improvement, and how baseline phenotypes are associated with recovery trajectories, are poorly understood. Methods: This retrospective longitudinal cohort study, conducted in accordance with STROBE guidelines, included 756 older patients with vertigo (mean age 68.4 ± 8.2 years) who completed a standardized 10-week FPRT program. The primary outcome was the change in Timed Up and Go (TUG) test over 10 weeks. Group-based trajectory modeling (GBTM) was used to identify distinct functional recovery trajectories. Restricted cubic splines (RCS) within generalized estimating equation models were used in a planned exploratory secondary analysis to explore nonlinear dose-response relationships between time-varying cumulative rehabilitation hours and achievement of the minimal clinically important difference (MCID). Results: Three distinct recovery trajectories were identified: rapid responders (34.1%), gradual responders (47.5%), and poor responders (18.4%). Baseline impairment phenotypes were associated with trajectory membership. Patients with isolated vestibular impairment were enriched among Rapid Responders, whereas age ≥75 years (OR = 3.45, 95% CI = 2.12-5.61) and complex mixed impairment involving vestibular, dynamic gait, and proprioceptive deficits (OR = 4.85, 95% CI = 2.95-7.98) were independently associated with Poor Responder membership. The dose-response relationship was nonlinear. The probability of achieving MCID (≥80%) required 35-40 cumulative hours for rapid responders, 55-60 h for gradual responders, and showed a plateau with minimal benefit beyond 70 h for poor responders. Conclusions: Baseline vestibular, dynamic gait, and proprioceptive impairment phenotypes were associated with longitudinal recovery trajectories and exploratory dose-response patterns in older patients with vertigo. The observed 80% MCID probability points, approximately 35-40 h for Rapid Responders and 55-60 h for Gradual Responders, should be interpreted as hypothesis-generating estimates rather than definitive prescription targets. These findings may inform future prospective studies of phenotype-informed fall prevention rehabilitation.
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