Risk factors for persistent postural-perceptual dizziness after successful manual repositioning in patients with benign paroxysmal positional vertigo: A nomogram model

Abstract

Objectives: To identify risk factors for persistent postural-perceptual dizziness (PPPD) within one year after successful manual repositioning in patients with benign paroxysmal positional vertigo (BPPV) and to develop a nomogram model.

Methodology: Clinical records of 140 patients diagnosed with BPPV and achieving successful manual repositioning in the Department of Neurology, Huzhou Third Municipal Hospital from January 2022 to December 2024 were retrospectively reviewed and analyzed. According to the occurrence of PPPD during the one-year follow-up, patients were divided into the PPPD group (n=40) and the non-PPPD group (n=100). Univariate analysis and multivariate logistic regression were used to identify risk factors for PPPD after successful manual repositioning of BPPV. The nomogram model was constructed using the “rms” package of R software (version 4.0.1).

Results: Disease duration ≥ 7 days (OR = 3.596, 95% CI: 1.275–10.142; P = 0.016), residual dizziness (OR = 2.687, 95% CI: 1.056–6.840; P = 0.038), and anxiety (OR = 2.872, 95% CI: 1.096–7.528; P = 0.032) were independent risk factors for PPPD within one year after successful manual repositioning of BPPV, whereas standardized vestibular rehabilitation training was an independent protective factor (OR = 0.148, 95% CI: 0.044–0.492; P = 0.002). The nomogram yielded an area under the receiver operating characteristic curve of 0.827 (95% CI: 0.747–0.907) and a bootstrap-corrected C-index of 0.813 (95% CI: 0.730–0.896). The calibration curve showed good agreement between the predicted and observed probabilities, and decision curve analysis indicated a potential net benefit across threshold probabilities ranging from 0.09 to 0.83.

Conclusion: Long disease duration (≥ 7 days), residual dizziness, and anxiety were independently associated with higher odds of PPPD within one year after successful manual repositioning of BPPV, whereas standardized vestibular rehabilitation training was independently associated with lower odds. The constructed nomogram may assist in preliminary risk stratification, but further external validation is required.