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\begin{document}

\title{The Effect of Repositioning Maneuvers on Quality of Life, Vertigo
Symptoms and Dizziness in Patients with Benign Paroxysmal Positional
Vertigo}



\author[1]{Deniz Uğur Cengiz}%
\author[1]{İsmail Demir}%
\author[1]{Sanem Can Çolak}%
\author[2]{Mehmet Tan}%
\author[3]{Arzu Çalışkan Demir}%
\author[4]{Tuba Bayindir}%
\affil[1]{İnönü Üniversitesi}%
\affil[2]{Inonu University Medical Faculty}%
\affil[3]{İnönü Üniversitesi Tıp Fakültesi Araştırma Hastanesi}%
\affil[4]{Inonu University}%


\vspace{-1em}



  
  \date{May 27, 2024}


\begingroup
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\selectlanguage{english}
\begin{abstract}
Aim: The aim of this study is to evaluate the effect of repositioning
maneuvers on quality of life, vertigo symptoms and dizziness in patients
diagnosed with BPPV through Dix-Hallpike and Head Roll maneuvers.
Methods: The study included 67 patients diagnosed with BPPV through Dix-
Hallpike and Head Roll maneuvers. The vertigo dizziness imbalance scale,
dizziness handicap inventory and visual analog scale were applied before
and one week after repositioning maneuvers (to those whose nystagmus
completely disappeared). Results: A statistically significant difference
was determined in the scores obtained from the Dizziness Handicap
Inventory (physical, functional and emotional and total scores), Vertigo
Imbalance Scale (Quality of life and Symptom scores) and visual analog
scale after repositioning maneuvers (p\textless{}0.05). Conclusion: This
study revealed the positive effects of repositioning maneuvers on
quality of life, vertigo symptoms and dizziness in patients with BPPV.%
\end{abstract}%



\sloppy


\textbf{The Effect of Repositioning Maneuvers on Quality of Life,
Vertigo Symptoms and Dizziness in Patients with Benign Paroxysmal
Positional Vertigo}

\textbf{Abstract}

\textbf{Objectives:} The aim of this study is to evaluate the effect of
repositioning maneuvers on quality of life, vertigo symptoms and
dizziness in patients diagnosed with BPPV through Dix-Hallpike and Head
Roll maneuvers.

\textbf{Design:} The vertigo dizziness imbalance scale, dizziness
handicap inventory and visual analog scale were applied before and one
week after repositioning maneuvers (to those whose nystagmus completely
disappeared).

\textbf{Setting:} A single specialist university hospital.

\textbf{Participants} : The study included 67 patients diagnosed with
BPPV through Dix- Hallpike and Head Roll maneuvers

\textbf{Main outcome measures:} Of the patients included in the study,
29 were diagnosed with posterior canal canalithiasis and 8 were
diagnosed with posterior canal cupulolithiasis according to the affected
side when they met the following criteria in the Dix-Hallpike maneuver
with VNG. Repositioning maneuvers were performed on the patients
diagnosed with BPPV

\textbf{Results:} A statistically significant difference was determined
in the scores obtained from the Dizziness Handicap Inventory (physical,
functional and emotional and total scores), Vertigo Imbalance Scale
(Quality of life and Symptom scores) and visual analog scale after
repositioning maneuvers (p\textless{}0.05).

\textbf{Conclusion:} This study revealed the positive effects of
repositioning maneuvers on quality of life, vertigo symptoms and
dizziness in patients with BPPV.

\textbf{Keywords:} BPPV, dizziness, repositioning maneuvers, quality of
life, vertigo symptoms

\textbf{KEY POINTS}

\begin{itemize}
\tightlist
\item
  Vertigo, dizziness and imbalance are frequent symptoms among patients
  in clinical practice.
\item
  Vertigo is a health problem that greatly affects the quality of life.
\item
  The dizziness handicap inventory provides a useful and reliable with
  dizziness.
\item
  Literature suggest that the Vertigo Imbalance Scale questionnaire is a
  reliable, valid and responsive instrument for patients with vertigo,
  dizziness or imbalance.
\item
  Repositioning maneuvers have positive effects on quality of life,
  vertigo symptoms and dizziness in patients with BPPV.
\end{itemize}

\textbf{INTRODUCTION}

Vertigo is divided into two as central and peripheral. Although central
vertigo is accompanied by neurological symptoms such as diplopia,
dysarthria, coordination disorder, drowsiness and weakness, the symptoms
are milder but last longer than peripheral vertigo. More than 90\% of
peripheral vertigo cases consist of benign paroxysmal positional vertigo
(BPPV), acute peripheral vestibulopathy and Meniere's
disease\textsuperscript{1}. BPPV is the most common among these
diseases. BPPV is diagnosed in 17-42\% of patients exhibiting symptoms
of peripheral dizziness . In BPPV, dizziness attacks lasting for seconds
occur during the angular acceleration motions of the head, but the
disease is completely asymptomatic between the attacks. Dizziness that
occurs during attacks can be accompanied by symptoms such as imbalance,
nausea and vomiting. As a result of these symptoms, the quality of life
of the patient is considerably affected \textsuperscript{2}.

Although the symptoms of BPPV can resolve spontaneously, they may last
for days, weeks, months or years and even recur.

When patients with positional vertigo are analyzed, it is seen that the
incidence of BPPV affecting the posterior or horizontal canal is more
frequent. Of the BPPV cases, about 85-90\% are considered to be of
posterior canal origin, while approximately 5-15\% are considered to be
of horizontal canal origin \textsuperscript{3}. The incidence of BPPV
subtypes in which the anterior canal and multiple canals are affected,
is seen to be less than 5\% of the cases \textsuperscript{4}. When
determining the affected channel in BPPV, the patient's history and the
features of the nystagmus that occur during the diagnostic maneuvers
also have an important place in the diagnosis . While the diagnostic
maneuvers of BPPV include the Dix--Hallpike and side-lying maneuvers for
vertical channels and head roll maneuvers for lateral channels, the
canalith repositioning maneuvers include the Epley and Semont maneuvers
for vertical channels and the Barbecue and Gufoni maneuvers for lateral
channels \textsuperscript{5}.

The aim of this clinical study is to evaluate the effect of
repositioning maneuvers on quality of life, vertigo symptoms and
dizziness in patients admitted to our clinic and diagnosed with BPPV.

\textbf{MATERIALS AND METHODS}

This study was designed as a prospective study. The study included
patients who were admitted to the Faculty of Medicine, Department of
Otorhinolaryngology, in a local University between November 2019 and
February 2020. A total of 67 patients aged 18-65 years, who underwent
routine ENT examinations and diagnosed with benign paroxysmal positional
vertigo (BPPV) as a result of medical history and positional tests, were
included. Patients who were not previously treated with a maneuver for
dizziness, had no history of ototoxic drug use and had normal hearing
were included in the study. Patients with Meniere's disease,
migraine-associated dizziness, vertebrobasilar insufficiency, postural
hypotension, neurological or systemic disease, and traumatic BPPV were
excluded from the study. Of the patients included in the study, 29 were
diagnosed with posterior canal canalithiasis and 8 were diagnosed with
posterior canal cupulolithiasis according to the affected side when they
met the following criteria in the Dix-Hallpike maneuver with VNG: the
presence of rotational nystagmus lasting less than 60 seconds in the
counterclockwise direction when the right ear is downward and in the
clockwise direction when the left ear is downward after a latency period
of 10-15 sec; the presence of rotational nystagmus usually lasting
longer than 60 sec in the counterclockwise direction when the right ear
is downward and in the clockwise direction when the left ear is downward
with no latency period; the development of reverse nystagmus when the
patient is placed in the sitting position \textsuperscript{6}.

Of the patients, 14 were diagnosed with lateral canal canalithiasis and
16 were diagnosed with lateral canal cupulolithiasis according to the
affected side when they met the following criteria in the Head Roll
maneuver with videonystagmography: the presence of nystagmus, which is
geotropic nystagmus decaying in a short time, when the right ear or left
ear is downward after a latent period of 10-15 seconds; the presence of
nystagmus, which is ageotropic nystagmus lasting longer than geotropic
nystagmus, when the right ear or left ear is downward with no latency
period; and the presence of simultaneous vertigo with
nystagmus\textsuperscript{7}.

After 10-15 minutes of resting following the maneuvers, the patients
filled in the Demographic Data Form, Vertigo Dizziness Imbalance Scale,
Dizziness Handicap Inventory, and visual analog scale forms. After 1
week, the diagnostic positional tests were performed again with
videonystagmography and the same forms were again filled by the patients
whose tests were negative.

The ''Dizziness Handicap Inventory'' (DHI) used in our study is a method
used to evaluate the efficacy of otoneurological
treatments\textsuperscript{8}. The Dizziness Handicap Inventory is a
scale consisting of 25 questions that evaluates the quality of life
physically, functionally and emotionally in individuals with dizziness.
The DHI consists of three subscales: physical (7 questions), emotional
(9 questions) and functional (9 questions). The maximum score that can
be taken from the scale is 100 points. A high score indicates that
dizziness has a high impact on the patient's quality of life. The other
scale used in our study is the ``Vertigo Dizziness Imbalance Scale''.
This scale consists of two subscales. These are symptom scale and
quality of life scale. The symptom scale consists of 14 items, while the
quality of life scale consists of 22 items \textsuperscript{9}. Using
the visual analog scale, the global quality of life of the patients was
numerically evaluated between 0 (best) and 10 (worst).

Repositioning maneuvers were performed on the patients diagnosed with
BPPV. The repositioning maneuvers included the Epley maneuver for those
diagnosed with posterior canal canalolithiasis, the Semont maneuver for
those diagnosed with posterior canal cupulolithiasis, the Barbecue
maneuver for those diagnosed with lateral canal canalolithiasis, the
Gufoni maneuver for those diagnosed with lateral canal cupulolithiasis,
followed by the Barbecue maneuver for
canalolithiasis\textsuperscript{10}.

The approval for the study was obtained from the Non-Interventional
Clinical Research Ethics Committee of a local University Institute of
Health Sciences (decision number: 2019/397) and consent was obtained
from all individuals participating in the study.

\textbf{Statistical Analysis}

The data obtained were analyzed by using the SPSS (Statistical Program
in Social Sciences) version 21 software. The normality of the data was
tested by the Shapiro-Wilk test \textsuperscript{11}. The level of
significance for comparison tests was determined as (p) 0.05. In the
variables with two groups (gender, hearing loss, tinnitus, nausea,
vomiting, and fall history), the differences between the groups for the
DHI, QOLS, VDI-SS were analyzed with the Mann-Whitney U Test. In the
variables with multiple groups (age and BPPV), the differences between
the groups for DHI, QOLS, VDI-SS were analyzed with the Kruskal Wallis
test. The scores obtained from the scales before and after the maneuvers
were compared by using the Wilcoxon signed-rank test.

\textbf{RESULTS}

The distribution of patients included in the study according to
demographic variables is summarized in Table 1.

Of the patients participating in the study, 50.7\% (n=34) were female
and 49.3\% (n=33) were male. Of the patients, 35.8\% (n=24) were in the
44-55 age group. It was found that of the patients, 43.3\% (n=29) were
diagnosed with posterior canal canalolithiasis, 19.4\% (n=13) had
hearing loss, 26.9\% (n=18) had tinnitus, 67.2\% (n=45) had nausea,
23.9\% (n=16) had vomiting and 7.5\% (n=5) had a history of fall.

In the statistical analysis carried out for the pre- and
post-repositioning scale scores of the patients, there was a
statistically significant difference between the mean scores of DHI and
all its subscales (physical, functional and emotional)
(p\textless{}0.05).

The mean pre-repositioning DHI and physical, functional, and emotional
subscale scores were higher compared to the post-repositioning scores,
which was statistically significant (p\textless{}0.05).

There was a statistically significant difference between the mean pre-
and post-repositioning VDI-QOLS and VDI-SS scores (p\textless{}0.05). In
both scales, the mean pre-repositioning scores were lower than the
post-repositioning scores, which was statistically significant
(p\textless{}0.05).

There was a statistically significant difference between the mean pre-
and post-repositioning dizziness intensity scores (p\textless{}0.05).
The mean pre-repositioning score was higher than the mean
post-repositioning score, which was statistically significant
(p\textless{}0.05).

The results of the pre- and post-repositioning DHI, VDI-QOLS and VDI-SS
scores are summarized in Table 2.

\textbf{DISCUSSION}

Although the ages of the patients included in our study ranged between
18-65, it was found that a significant portion of the patients was in
the 44-55 age range (35.8\%, n=24) \textsuperscript{12,13}. In line with
the literature, it was found that the incidence of BPPV in our study
increased with increasing age \textsuperscript{14}. Given the gender
distribution of patients, there was no statistically significant
difference between the two genders. Although results similar to our
study have been reported in the literature, some studies have reported
that BPPV is more common among women than in men\textsuperscript{12,14}.
Considering the symptoms of the patients, the presence of nausea in
67.2\% (n=45), vomiting in 23.9\% (n=16), and history of fall in 7.5\%
(n=5) of the patients show similar rates with the studies in the
literature \textsuperscript{15,16}. These symptoms arising when the
vestibular system is affected are evaluated as the results of BPPV.

In accordance with the literature, the diagnosis was determined to be
posterior canal canalolithiasis in 43.3\% (n=29) of the patients
diagnosed with BPPV in our study \textsuperscript{3}. The highest
incidence of BPPV in the posterior canal is due to its anatomical
position. In addition to the posterior canal canalolithiasis group,
11.9\% (n=8) of the cases were diagnosed with posterior canal
cupulolithiasis, 20.9\% (n=14) with lateral canal canalolithiasis, and
23.9\% (n=16) with lateral canal cupulolithiasis. The rate of diagnosis
of lateral canal pathologies (canalolithiasis/cupulolithiasis) is found
to be very low in some studies in the literature\textsuperscript{17,18},
while in some studies, the rate of diagnosis of lateral canal
pathologies (canalolithiasis/cupulolithiasis) is found to be much
higher, as in our study. These high rates are believed to be associated
with the use of the VNG for the diagnosis of BPPV in recent years. The
use of VNG prevents missing lateral canal pathologies. Thus, higher
rates of diagnosis are achieved compared to previous
years\textsuperscript{3,4}. The incidence of hearing loss in 19.4\%
(n=13) and tinnitus in 26.9\% (n=18) of the patients in our study is
consistent with the studies in the literature. However, these symptoms
are considered not to be directly associated with BPPV
\textsuperscript{19}.

In line with the literature, it was found in our study that there was a
statistically significant decrease in the post-repositioning scores of
DHI and all subscales of the scale (physical, functional and
emotional)\textsuperscript{20}. It is thought that the considerable
reduction in the negative feelings of individuals is caused by the
efficacy of the repositioning maneuvers on the BPPV pathology .

In our study, there was a statistically significant decrease in the
post-repositioning dizziness intensity (VAS) scores. When the literature
is reviewed, the statistically significant decrease in the VAS scores in
various studies including BPPV patients diagnosed with posterior canal
canalolithiasis \textsuperscript{21}, patients diagnosed with
BPPV\textsuperscript{19} and patients with subjective BPPV is similar to
our study.

The patients in our study got the highest scores from the functional,
emotional and physical subscales of the DIH before and after
repositioning maneuvers, respectively. Contrary to our study, Whitney et
al. reported that there was no statistically significant difference
among the subscale scores of the DIH in patients diagnosed with
BPPV\textsuperscript{22}. In some of the studies, the highest scores
taken from the subscales were physical, functional and emotional groups,
respectively \textsuperscript{20}. Some of the studies reported that
patients with BPPV got the pre- and post-repositioning highest scores
from the physical subscale \textsuperscript{23}. When we compared the
scores obtained from the subscales of the DIH in the literature review,
similar and different aspects were determined with our study. In the
literature, it is thought that the differences in the scores obtained
from the subscales of the DIH may be related to the differences of the
regions where the studies were conducted and the sociocultural levels
and educational levels of patients.

It was found in our study that the total mean scores obtained from the
VDI-QOL and VDI-SS increased statistically significantly after
repositioning maneuvers. The fact that the study by Kulcu et al. (2008)
found statistically significant positive improvements in quality of life
of individuals diagnosed with BPPV after repositioning maneuvers and
vestibular rehabilitation exercises supports our study .

Given the literature, it was found that patients diagnosed with BPPV
showed statistically significant positive improvements in their vertigo
symptoms after repositioning maneuvers and vestibular rehabilitation
exercises. These results demonstrate the strong effect of reposition
maneuvers on quality of life and vertigo
symptoms\textsuperscript{24,25}.

\textbf{CONCLUSION}

Our study revealed that repositioning maneuvers positively affected the
quality of life of patients with BPPV and reduced the symptoms of
vertigo and dizziness. Since our study was conducted with
videonystagmography, we were able to more accurately identify the
subtypes of BPPV. For further studies, it will be useful to compare the
subtypes of BPPV in terms of variables such as quality of life, symptoms
of vertigo and dizziness levels by studying on a larger sample group
with videonystagmography.

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\textbf{Table 1. Distribution of Demographic Variables (n=67)}\selectlanguage{english}
\begin{longtable}[]{@{}llll@{}}
\toprule
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\textbf{Variables}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\textbf{Variables}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\textbf{Number (n)}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\textbf{Percentage (\%)}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{Gender}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Male\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
33\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
49.3\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Female\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
34\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
50.7\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{Age}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
18-30 years\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
10\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
14.9\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
31-43 years\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
19\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
28.4\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
44-55 years\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
24\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
35.8\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
57 years and above\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
14\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
20.9\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{BPPV Type}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Posterior Canal Canalolithiasis\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
29\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
43.3\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Posterior Canal Cupulalithiasis\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
11.9\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Lateral Canal Canalolithiasis\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
14\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
20.9\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Lateral Canal Cupulalithiasis\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
16\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
23.9\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{Hearing Loss}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
54\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
80.6\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
13\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
19.4\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{Tinnitus}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
49\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
73.1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
18\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
26.9\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{Nausea}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
22\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
32.8\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
45\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
67.2\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{Vomiting}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
51\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
76.1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
16\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
23.9\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{Fall History}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
62\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
92.5\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
5\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
7.5\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\textbf{Table 2:} \textbf{Comparison of Pre- and Post-Repositioning
Scale Scores}\selectlanguage{english}
\begin{longtable}[]{@{}lllllll@{}}
\toprule
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Measurement Variables}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Mean}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{SD}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Lowest}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Highest}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Median}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{p value}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Pre-DHI\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
75.88\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
10.144\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
52\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
96\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
76.00\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.001*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Post-DHI\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
10.46\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
7.968\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
46\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
10.00\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Pre-DHI Physical\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
25.58\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
2.797\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
16\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
28\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
26.00\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.001*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Post-DHI Physical\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
3.69\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
2.950\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
12\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
4.00\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Pre-DHI Functional\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
32.00\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
3.303\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
22\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
36\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
32.00\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.001*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Post-DHI Functional\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
3.94\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
3.171\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
14\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
4.00\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Pre-DHI Emotional\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
18.30\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
6.617\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
6\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
32\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
18.00\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.001*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Post-DHI Emotional\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
2.84\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
3.306\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
20\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
2.00\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Pre-VDI-QOLS\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
32.64\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
14.584\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
5\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
71\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
29.00\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.001*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Post-VDI-QOLS\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
93.10\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
9.249\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
57\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
108\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
95.00\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Pre-VDI-SS\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
21.30\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
11.981\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
2\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
56\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
19.00\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.001*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Post-VDI-SS\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
65.48\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
4.446\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
51\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
70\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
66.00\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Pre-VAS Score\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
8.52\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1.700\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
4\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
10\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
9\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.001*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Post-VAS Score\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1.06\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.903\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
4\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

*p\textless{}0.05 DHI = Dizziness Handicap Inventory, VDI = Vertigo
Dizziness Imbalance Scale,

QOL = Quality of Life Scale, SS= Symptom Scale, VAS= Visual Analog Scale

\selectlanguage{english}
\FloatBarrier
\end{document}

