Comparative efficacy of non-pharmacological interventions for persistent postural-perceptual dizziness: a systematic review and network meta-analysis of balance, anxiety, and depression outcomes

Persistent 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.

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Audiologists and vestibular specialists managing PPPD should review the ranked treatment outcomes from this network meta-analysis to inform which non-pharmacological interventions — such as vestibular rehabilitation, CBT, or mindfulness — are most likely to address balance, anxiety, and depression in their patients.

PPPD is one of the most common chronic vestibular disorders, and this is among the first network meta-analyses to simultaneously rank non-drug treatments across three clinically important outcomes, offering a rare comparative framework where head-to-head trials are lacking.

1. 01Systematic review and network meta-analysis comparing non-pharmacological PPPD treatments.
2. 02Outcomes assessed: balance, anxiety, and depression — capturing the multidimensional burden of PPPD.
3. 03Network meta-analysis allows indirect comparisons across interventions not directly tested against each other.
4. 04Published in Journal of Neurology (DOI: 10.1007/s00415-026-13891-1).
5. 05Findings may guide clinical preference for specific therapies over others in PPPD management.

PMID

42240653

DOI

10.1007/s00415-026-13891-1.

Journal

Journal of Neurology

Publication type

meta_analysis

Evidence level

1a

Population

Patients with persistent postural-perceptual dizziness (PPPD)

Intervention

Non-pharmacological interventions (e.g., vestibular rehabilitation, CBT, mindfulness)

Comparator

Multiple active comparators via network meta-analysis