Effects of Kampo medicine hangebyakujutsutemmato on persistent postural-perceptual dizziness: A retrospective pilot study

Table 1 Patients’ demographic information (mean ± SD)

	Non-HBT (n = 14)	HBT (n = 24)	P value
Age (yr)	63.5 ± 15.9	58.2 ± 18.7	0.19a
Sex (Male:Female)	3:11	1:23	0.21b
Vestibular disease	Meniere’s disease: 12; BPPV: 2	Meniere’s disease: 23; BPPV: 1	0.23b

^aUnpaired t-test.

^bFisher’s exact test.

HBT: Hangebyakujutsutemmato; SD: Standard deviation; BPPV: Benign paroxysmal positional vertigo.

Table 2 Other factors influenced by hangebyakujutsutemmato treatment in Persistent postural-perceptual dizziness patients

			Non-HBT (n = 14)	HBT (n = 24)	P value1
DHI		Baseline	49.6 ± 24.6	50.8 ± 20.1	0.44
		1 mo	45.7 ± 25.8	43.0 ± 3.0	0.37
		2 mo	42.7 ± 25.0	38.8 ± 24.3	0.32
Subcategory	DHI-P	Baseline	11.9 ± 7.6	14.9 ± 6.2	0.11
		1 mo	11.4 ± 7.1	11.8 ± 7.1	0.43
		2 mo	11.0 ± 6.8	11.3 ± 6.9	0.46
	DHI-E	Baseline	19.6 ± 8.9	16.7 ± 8.6	0.17
		1 mo	17.3 ± 9.7	14.7 ± 9.0	0.21
		2 mo	15.3 ± 9.5	12.7 ± 9.7	0.21
	DHI-F	Baseline	18.1 ± 11.3	19.3 ± 8.8	0.38
		1 mo	17.0 ± 11.8	16.5 ± 10.1	0.45
		2 mo	16.4 ± 10.6	14.8 ± 9.7	0.32
HADS		Baseline	15.8 ± 8.3	15.0 ± 7.3	0.39
		1 mo	15.6 ± 7.8	13.8 ± 8.6	0.25
		2 mo	15.6 ± 8.6	13.0 ± 9.5	0.19
Subcategory	HADS-A	Baseline	8.9 ± 5.0	9.0 ± 4.0	0.49
		1 mo	8.1 ± 4.4	7.8 ± 4.4	0.42
		2 mo	7.9 ± 5.0	7.7 ± 4.8	0.45
	HADS-D	Baseline	6.9 ± 4.1	6.1 ± 4.3	0.29
		1 mo	7.6 ± 4.5	6.0 ± 4.7	0.16
		2 mo	7.7 ± 4.8	5.3 ± 5.3	0.08
OD score		Baseline	6.1 ± 2.2	7.8 ± 5.4	0.08
		1 mo	5.9 ± 2.6	5.9 ± 2.9	0.48
		2 mo	5.6 ± 3.0	5.6 ± 2.6	0.48
Graybiel’s motion sickness score		Baseline	26.0 ± 11.0	25.8 ± 11.2	0.47
		1 mo	19.3 ± 7.6	19.9 ± 8.4	0.41
		2 mo	23.3 ± 12.4	18.1 ± 6.9	0.08
PSQI		Baseline	8.9 ± 3.5	10.0 ± 3.4	0.19
		1 mo	8.6 ± 3.0	9.0 ± 4.6	0.37
		2 mo	8.5 ± 3.1	9.6 ± 4.1	0.19

¹Wilcoxon signed-rank test.

To examine the effects of HBT on other factors, we compared the questionnaire survey at baseline, 1 mo, and 2 mo. No statistically significant differences in the DHI including subcategories, HADS including subcategories, OD scores, Graybiel’s motion sickness scores, or PSQI at baseline were observed between the two groups. HBT: Hangebyakujutsutemmato; DHI: Dizziness handicap inventory; HADS: Hospital anxiety and depression scale; HADS-A: Hospital anxiety and depression scale-anxiety; HADS-D: Hospital anxiety and depression scale–depression subscale; OD: Orthostatic dysregulation; PSQI: Pittsburg sleep quality index.

Table 3 Equilibrium test factors related to Niigata persistent postural-perceptual dizziness questionnaire improvement at 2 mo

		Estimate	SE	t value	P value
	(Intercept)	-0.18	0.31	-0.58	0.571
Static stabilometry	ACF	-0.01	0.005	-2.53	0.02a
	VRF	-0.30	0.19	-1.55	0.14
	ARF	0.33	0.11	2.99	0.01a
	VFCF	0.33	0.14	2.29	0.03a
	AFCF	-0.09	0.04	-2.34	0.03a
Dynamic stabilometry	FT value in closed eye	-0.03	0.02	-1.29	0.21
Vestibular function	CP (%) of caloric test	0.004	0.002	2.28	0.03a
	AR (%) of cVEMP	0.005	0.003	1.46	0.16
	AR (%) of oVEMP	-0.008	0.005	-1.47	0.16
Autonomic function	OD	0.77	0.11	6.65	< 0.001b

^aP < 0.05.

^bP < 0.01.

VCF: Center of pressure velocity in the eyes closed/foam rubber condition; ACF: Envelopment area tracing by movement of the center of pressure in the eyes closed/foam rubber condition; VRF: Romberg’s ratio of velocity with foam rubber; ARF: Romberg’s ratio of area with foam rubber; VFCF: Foam ratio of velocity in the eyes closed/foam rubber condition; FCF: Foam ratio of area in the eyes closed/foam rubber condition; FT value: Foulage test value; CP (%): Canal paresis in caloric test; AR (%): Asymmetry ratio; cVEMP: Cervical vestibular evoked myogenic responses; oVEMP: Ocular vestibular-evoked myogenic responses; OD: Orthostatic dysregulation. Residual standard error = 0.20 (df = 13; multiple R-squared = 0.81; adjusted R-squared = 0.67, F-statistic = 5.77 (df, 10 and 13; P value = 0.002, Akaike information criterion = -68.7).

Table 4 Head-up tilt test factors related to Niigata persistent postural-perceptual dizziness questionnaire improvement at 2 mo

	Variable	Estimate	SE	t value	P value
	(Intercept)	-16.8	4.78	-3.51	0.004b
	Age	0.01	0.006	2.04	0.06
	Sex	-0.78	0.60	-1.31	0.21
INOH	Immediate change ratio (sBP)	2.41	1.42	1.69	0.11
	Immediate change ratio (dBP)	2.82	1.72	1.63	0.13
Delayed OH	Delayed change ratio (sBP)	1.36	0.94	1.44	0.17
	Delayed change ratio (dBP)	1.67	1.04	1.60	0.13
PoTS	Immediate change ratio (HR)	4.39	1.40	3.13	0.009b
Parasympathetic nervous system	Immediate change ratio (CVRR)	0.88	0.37	2.36	0.03a
	Delayed change ratio (HF)	2.27	0.68	3.34	0.006b
Sympathetic nervous system	Immediate change ratio (L/H)	0.09	0.07	1.21	0.24
	Delayed change ratio (L/H)	0.59	0.26	2.26	0.04a

^aP < 0.05.

^bP < 0.01.

Residual standard error = 0.29 (df = 11); multiple R-squared = 0.66; adjusted R-squared = 0.32; F-statistic = 1.95 (df, 11 and 11); P value = 0.14; Akaike information criterion = -49.7. HF: High-frequency component; L/H: Low-frequency component/high-frequency component; CVRR: Coefficient of variation of the R-R interval; INOH: Instantaneous orthostatic hypotension; OH: Orthostatic hypotension; PoTS: Postural tachycardia syndrome; NPQ: Niigata PPPD questionnaire; HBT: Hangebyakujutsutemmato; PPPD: Persistent postural-perceptual dizziness.

Table 5 Questionnaire survey factors related to Niigata persistent postural-perceptual dizziness questionnaire improvement at 2 mo

Variables	Estimate	SE	t value	P value
(Intercept)	1.28	0.22	5.59	0.00002c
DHI-E	0.03	0.01	2.56	0.01a
DHI-F	-0.02	0.01	-1.86	0.07
HADS-A	-0.05	0.01	-3.30	0.003b
PSQI	-0.05	0.01	-2.80	0.01a

^aP < 0.05.

^bP < 0.01.

^cP < 0.001.

Residual standard error = 0.27 (df = 19); multiple R-squared = 0.51; adjusted R-squared = 0.41; F-statistic = 5.02 (df, 4 and 19); P value = 0.006; Akaike information criterion = -57.4. DHI-E: Dizziness handicap index–emotional; DHI-F: Dizziness handicap index–functional; HADS-A: Hospital anxiety and depression scale-anxiety; PSQI: Pittsburg sleep quality index.