VeRMiS is a multi-centre randomised controlled study to assess the effectiveness of vestibular rehabilitation in people with MS.
This website provides a range of information about the study, and will include resources both for people affected by MS and physiotherapists once our results are available in early 2022.
The study began recruiting participants in February 2019 and the final follow up assessments are due in September 2021. Our protocol paper was published in November 2020.
If there is additional information that you would find helpful please let us know via email so that we can improve the site for everyone.
Vertigo, dizziness, poor balance and abnormalities in the control of eye movements are symptoms that may be associated with vestibular problems. Such symptoms are common in people with multiple sclerosis (pwMS), can lead to falls, injury, and a restriction in outdoor mobility, and subsequently may affect social participation and quality of life.
The vestibular system is complex. It consists of the inner ear and vestibular nerve (the peripheral pathways) and pathways in the brain (central pathways) that process information about head and body position. Damage to any of these pathways can result in symptoms of vertigo, dizziness, poor balance and abnormalities of eye movement.
Vestibular rehabilitation (VR) is the standard of care for persons with vestibular problems. VR involves progressive exercises including eye, head, and body movements in sitting, standing, and walking. Given the complexity of symptom presentation in people with MS, such as muscle weakness, spasticity, sensory loss and ataxia, it may be that customised exercises are more effective and cost-effective than home-based generic exercises delivered via a booklet, as is current usual practice.
Although MS affects the central nervous system, approximately 50% of cases of vertigo are caused by a condition called benign paroxysmal positional vertigo (BPPV). In these cases, calcium carbonate crystals from part of the inner ear (otoliths) become dislodged and enter into another part of the inner ear (semi-circular canal) causing symptoms of vertigo on certain head and body movements. BPPV can be diagnosed and treated at the bedside using specific manoeuvres that aim to move these crystals back into position. Currently these testing and repositioning manoeuvres for BPPV are not routinely performed in pwMS and the success and re-occurrence rates are unclear.
The VeRMiS study will involve 140 ambulant pwMS who present with vertigo and/ or dizziness across two study centres: Plymouth and London, UK. Participants who are able to take part will attend an initial assessment and then be enrolled in to one of two trial based upon the assessment findings.
- Trial one: A pragmatic multi-centre randomised controlled trial to compare the clinical and cost effectiveness of a 12 week customised VR programme vs generic VR.
- Trial two: An observational study to determine the success and re-occurrence rate of BPPV symptoms with repositioning manoeuvres.
A range of outcomes, including self-report and clinical tests of dizziness, mobility and quality of life will be measured at intervals throughout the study.
- Professor Jonathan Marsden (Chief Investigator), Professor in Rehabilitation, University of Plymouth
- Dr Marousa Pavlou, Lecturer in Physiotherapy, King's College London
- Professor Jenny Freeman, Professor of Physiotherapy and Rehabilitation, University of Plymouth
- Professor Chris Harris, Professor of Neuroscience, University of Plymouth
- Dr Doris-Eva Bamiou, Reader, Ear Institute, University College London
- Dr Annie Hawton, Senior Research Fellow in Health Economics, University of Exeter
- Siobhan Creanor, Director of PenCTU and Associate Professor (Reader) in Clinical Trials & Medical Statistics, University of Plymouth
- University of Plymouth
- Kings College London
- University College London
This study has been funded by the MS Society of Great Britain and Northern Ireland, grant reference 71.
The sponsor for this study is the University of Plymouth.
The trial is registered with the ISRCTN: 27374299