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Zakadan PS, Fortuine HA. Physical therapist beliefs and practice of vestibular rehabilitation in Egypt: a cross-sectional survey study. Disabil Rehabil 2025:1-5. [PMID: 40340497 DOI: 10.1080/09638288.2025.2501657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Revised: 04/28/2025] [Accepted: 04/29/2025] [Indexed: 05/10/2025]
Abstract
PURPOSE Vestibular rehabilitation (VR) is an important area of physical therapy (PT) practice globally. Information about the practice of VR among physical therapists (PTs) in Egypt and the MENA region is unknown. This study investigated the current beliefs and practices related to VR among licensed PTs in Egypt. MATERIALS & METHODS A 28-question online survey was distributed to PTs practicing throughout Egypt. Questions addressed background, opinions about VR practice, and specifics concerning VR practice. Descriptive and inferential statistics were used to analyze results. RESULTS The majority of respondents (85%) believed that PTs in Egypt are able to practice VR, with nearly 40% reporting to practice VR. Those practicing VR did not use or were unaware of typical assessment and treatment tests for benign paroxysmal positional vertigo (BPPV), such as Dix-Hallpike test (73.3%) and the Epley maneuver (53.3%). CONCLUSIONS This survey offers an initial understanding of VR beliefs and practice among PTs in Egypt. PTs in Egypt, though aware of VR, are not practicing it in the same way as their global peers.
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Affiliation(s)
- Pretty S Zakadan
- Physiotherapy Program School of Health and Social Work, University of Hertfordshire, Egypt (UH-GAF), New Administrative Capital, Egypt
| | - Heather A Fortuine
- Department of Rehabilitation Science, Concordia University Wisconsin, Milwaukee, WI, USA
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David EA, Shahnaz N. Posturographic sensory ratios provide evidence for neuroplasticity after computerized vestibular rehabilitation therapy in a single group interventional trial. J Neuroeng Rehabil 2025; 22:81. [PMID: 40217271 PMCID: PMC11987360 DOI: 10.1186/s12984-025-01608-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/17/2025] [Indexed: 04/14/2025] Open
Abstract
BACKGROUND Vestibular deficits are common and debilitating. Many patients do not achieve satisfactory resolution of their symptoms with standard rehabilitation techniques. This study seeks to measure changes in computerized dynamic posturography sensory ratio information after computerized vestibular retraining therapy (CVRT). METHODS This prospective, single group, interventional study enrolled adult participants with stable, unilateral vestibular deficits. Before and after twelve twice weekly sessions of CVRT, and 4-6 and 10-12 months post-treatment, participants completed the Sensory Organization Test, from which sensory ratios (somatosensory - SOM, visual - VIS, vestibular - VEST, and visual preference - PREF) were calculated. RESULTS 13 participants completed the intervention and post-retraining assessment; 9 completed the 4-6 and 10-12 month assessments. After CVRT, VIS increased by 11.6 (1.6 to 21.7) and VEST increased by 9.5 (0.6 to 18.3) and both remained significantly above baseline 10-12 months after treatment. The SOM and PREF ratios changed negligibly. Participants with mild disability (DHI ≤ 30) showed no change while participants with moderate-to-severe disability (DHI > 30) had significantly greater improvements in VIS (P = 0.0006) and VEST (P = 0.02) across all three post-treatment assessments. CONCLUSIONS CVRT was associated with durable improvement in VIS and VEST sensory ratios and improved postural control under conditions that favour use of vestibular information, consistent with increased weighting of vestibular information over vision. TRIAL REGISTRATION Clinicaltrials.gov registration NCT04875013; 04/27/2021.
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Affiliation(s)
- Eytan A David
- Otology, Neurotology, Skull Base Surgery, Clinical Instructor, Department of Surgery, University of British Columbia, Vancouver, Canada.
| | - Navid Shahnaz
- Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
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Arbel Y, Gimmon Y, Shmueli L. Evaluating the Potential of Large Language Models for Vestibular Rehabilitation Education: A Comparison of ChatGPT, Google Gemini, and Clinicians. Phys Ther 2025; 105:pzaf010. [PMID: 39932784 PMCID: PMC11994992 DOI: 10.1093/ptj/pzaf010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 09/13/2024] [Accepted: 10/09/2024] [Indexed: 02/13/2025]
Abstract
OBJECTIVE This study aimed to compare the performance of 2 large language models, ChatGPT (Generative Pre-trained Transformer) and Google Gemini, against experienced physical therapists and students in responding to multiple-choice questions related to vestibular rehabilitation. The study further aimed to assess the accuracy of ChatGPT's responses by board-certified otoneurologists. METHODS This study was conducted among 30 physical therapist professionals experienced with vestibular rehabilitation and 30 physical therapist students. They were asked to complete a vestibular knowledge test (VKT) consisting of 20 multiple-choice questions that were divided into 3 categories: (1) Clinical Knowledge, (2) Basic Clinical Practice, and (3) Clinical Reasoning. ChatGPT and Google Gemini were tasked with answering the same 20 VKT questions. Three board-certified otoneurologists independently evaluated the accuracy of each response using a 4-level scale, ranging from comprehensive to completely incorrect. RESULTS ChatGPT outperformed Google Gemini with a 70% score on the VKT test, while Gemini scored 60%. Both excelled in Clinical Knowledge scoring 100% but struggled in Clinical Reasoning with ChatGPT scoring 50% and Gemini scoring 25%. According to 3 otoneurologic experts, ChatGPT's accuracy was considered "comprehensive" in 45% of the 20 questions, while 25% were found to be completely incorrect. ChatGPT provided "comprehensive" responses in 50% of Clinical Knowledge and Basic Clinical Practice questions, but only 25% in Clinical Reasoning. CONCLUSION Caution is advised when using ChatGPT and Google Gemini due to their limited accuracy in clinical reasoning. While they provide accurate responses concerning Clinical Knowledge, their reliance on web information may lead to inconsistencies. ChatGPT performed better than Gemini. Health care professionals should carefully formulate questions and be aware of the potential influence of the online prevalence of information on ChatGPT's and Google Gemini's responses. Combining clinical expertise and clinical guidelines with ChatGPT and Google Gemini can maximize benefits while mitigating limitations. The results are based on current models of ChatGPT3.5 and Google Gemini. Future iterations of these models are expected to offer improved accuracy as the underlying modeling and algorithms are further refined. IMPACT This study highlights the potential utility of large language models like ChatGPT in supplementing clinical knowledge for physical therapists, while underscoring the need for caution in domains requiring complex clinical reasoning. The findings emphasize the importance of integrating technological tools carefully with human expertise to enhance patient care and rehabilitation outcomes.
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Affiliation(s)
- Yael Arbel
- Department of Management, Bar-Ilan University, Ramat-Gan 52900, Israel
| | - Yoav Gimmon
- Department of Physical Therapy, Faculty of Social Welfare & Health Studies, University of Haifa, Haifa, Israel
- Department of Otolaryngology–Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer, Israel
| | - Liora Shmueli
- Department of Management, Bar-Ilan University, Ramat-Gan 52900, Israel
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ALShammari M, ALSharif DS, Aldaihan MM, Whitney SL. Vestibular Rehabilitation in Saudi Arabia: Practice, Knowledge, and Beliefs of Physical Therapists. J Clin Med 2025; 14:2295. [PMID: 40217744 PMCID: PMC11989527 DOI: 10.3390/jcm14072295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2025] [Revised: 03/17/2025] [Accepted: 03/19/2025] [Indexed: 04/14/2025] Open
Abstract
Background: Vestibular physical therapy is a specific type of exercise intervention that is designed to treat symptoms caused by vestibular disorders and to enhance postural control. The level of expertise in the practice of vestibular rehabilitation therapy (VRT) varies widely around the world. The practice of VRT is advanced in some countries, yet practice may be less advanced in others. No previous studies have evaluated the knowledge and beliefs of vestibular rehabilitation in the Kingdom of Saudi Arabia (KSA) to date. Objective. This study aimed to evaluate the knowledge and beliefs about VRT among physical therapists in the KSA. Methods: We used an electronic cross-sectional survey containing 25 questions and divided into four sections: demographics, clinical experience, vestibular rehabilitation knowledge, and physical therapists' beliefs. The survey was answered by 219 licensed physical therapists. Results: Of the 219 responders, 59 (27%) physical therapists reported having experience with VRT. A total of 119 (54%) participants felt confident talking to other medical members when managing persons with dizziness. Only 59 (26%) clinicians were using vestibular assessment techniques, and 103 (47%) clinicians used VRT if they had patients with vestibular disorders. The majority of physical therapists believed in the efficacy of vestibular rehabilitation. Conclusions: Although the majority of physical therapists consider vestibular rehabilitation a crucial aspect of their practice, they acknowledge having limited knowledge of vestibular disorders and treatment techniques.
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Affiliation(s)
- Maryam ALShammari
- Department of Cochlear Implants, Hafr Albatin Central Hospital, Ministry of Health, Hafar Al Batin 39513, Saudi Arabia;
| | - Doaa S. ALSharif
- Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif 21974, Saudi Arabia
| | - Mishal M. Aldaihan
- Department of Rehabilitation Science, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia;
- King Salman Center for Disability Research, Riyadh 11614, Saudi Arabia
| | - Susan L. Whitney
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA;
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Van Laer L, Hallemans A, De Somer C, Janssens de Varebeke S, Fransen E, Schubert M, Van Rompaey V, Vereeck L. Predictors of Chronic Dizziness in Acute Unilateral Vestibulopathy: A Longitudinal Prospective Cohort Study. Otolaryngol Head Neck Surg 2025; 172:262-272. [PMID: 39224036 DOI: 10.1002/ohn.964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/25/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Chronic dizziness after acute unilateral vestibulopathy (AUVP) causes significant social and economic burdens. This study aims to identify predictors of chronic dizziness. STUDY DESIGN Prospective, longitudinal cohort study. SETTING ENT departments from secondary and tertiary hospitals. METHODS Participants meeting the Barany Society's diagnostic criteria for AUVP were included. Evaluations occurred within 0 to 21 days (T1), and at 4 (T2) and 10 weeks (T3) postonset. The primary outcome measure was the Dizziness Handicap Inventory (DHI) at 6 months, with a score >30 indicating chronic dizziness. Five clusters of predictors were assessed at T1-3: central vestibular compensation, visual dependence, movement exposure, psychological factors, and balance performance. Separate linear regression models for T1, T2, and T3 were constructed to explain the variability in the 6-month DHI score. Receiver operating characteristics analyses were conducted to predict chronic dizziness. RESULTS From June 2021 to January 2024, 103 participants (55.2 ± 16.6 years old, 49 women) were included. The regression models explained the variability in the 6-month DHI score by 33.0% at T1, 47.6% at T2, and 64.0% at T3 (P < .001), including psychological factors (T1, T2, T3), visual dependence (T2, T3), and static balance performance (T3). Cutoff values for the Vestibular Activities Avoidance Instrument (23/54), Visual Vertigo Analog Scale (33.5/100), and Hospital Anxiety and Depression Scale-Anxiety (7.5/21) at 10 weeks postonset predicted chronic dizziness. CONCLUSION Higher psychological burden, increased visual dependence, and poorer static balance performance were associated with chronic dizziness. Cutoff values were determined to identify individuals with AUVP at risk for chronic dizziness.
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Affiliation(s)
- Lien Van Laer
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Science, Multidisciplinary Motor Centre Antwerp (M²OCEAN), University of Antwerp, Antwerp, Belgium
| | - Ann Hallemans
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Science, Multidisciplinary Motor Centre Antwerp (M²OCEAN), University of Antwerp, Antwerp, Belgium
| | - Clara De Somer
- Vzw Sint-Lievenspoort, Centrum voor Ambulante Revalidatie, Ghent, Belgium
| | | | - Erik Fransen
- Center of Medical Genetics, Faculty of Medicine and Health Science, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Michael Schubert
- Department of Otolaryngology-Head and Neck Surgery, Laboratory of Vestibular NeuroAdaptation, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Luc Vereeck
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Science, Multidisciplinary Motor Centre Antwerp (M²OCEAN), University of Antwerp, Antwerp, Belgium
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Ferri N, Morone G, Piermaria J, Manzari L, Turolla A, De Tanti A, Ciancarelli I, Pillastrini P, Tramontano M. Knowledge, Barriers, and Future Directions of Vestibular Rehabilitation Practice in Neurorehabilitation: An Italian Survey. Healthcare (Basel) 2024; 13:22. [PMID: 39791629 PMCID: PMC11719692 DOI: 10.3390/healthcare13010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Revised: 12/22/2024] [Accepted: 12/23/2024] [Indexed: 01/12/2025] Open
Abstract
Background/Objectives: Vestibular rehabilitation, an evidence-based physical therapy approach, plays a crucial role in managing and recovering from gaze and balance disorders, including those of central origin. This study, targeted at the community of Italian healthcare practitioners, is vital in understanding the application of vestibular rehabilitation in neurological disorders and in identifying knowledge gaps, barriers, and future directions. Methods: This is a cross-sectional study directed at healthcare professionals involved in neurorehabilitation in Italy. The survey consisted of 29 items grouped in 4 sections, which was estimated to take approximately 10 min to complete. The questions covered socio-demographic information, professional information, clinical practice, and future perspectives on vestibular rehabilitation. Results: Out of the 435 respondents, 290 completed the survey. Most of the respondents reported either no (32.87%) or little (42.91%) experience in vestibular rehabilitation. However, most participants (72.98%) recognized the importance of vestibular rehabilitation in treating neurological disorders. The most common condition treated was stroke (46.39%), while balance training (52.69%) and visual input exercises (26.35%) were the two most frequently used strategies. The main barriers to implementing vestibular rehabilitation in clinical practice were equipment cost and insufficient skills. Conclusions: Vestibular physical therapy is a promising complementary approach in neurorehabilitation. However, the study reveals a perceived lack of basic training in vestibular assessment and therapy. This suggests that more efforts are needed to bridge this knowledge gap and make necessary equipment more accessible.
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Affiliation(s)
- Nicola Ferri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40138 Bologna, Italy; (N.F.); (A.T.); (P.P.); (M.T.)
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
- San Raffaele Sulmona Institute, 67039 Sulmona, Italy
| | - Jacopo Piermaria
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, 00179 Rome, Italy;
| | | | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40138 Bologna, Italy; (N.F.); (A.T.); (P.P.); (M.T.)
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40138 Bologna, Italy; (N.F.); (A.T.); (P.P.); (M.T.)
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Marco Tramontano
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40138 Bologna, Italy; (N.F.); (A.T.); (P.P.); (M.T.)
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Kalderon L, Kaplan A, Wolfovitz A, Gimmon Y, Levy-Tzedek S. Do we really need this robot? Technology requirements for vestibular rehabilitation: Input from patients and clinicians. INTERNATIONAL JOURNAL OF HUMAN-COMPUTER STUDIES 2024; 192:103356. [DOI: 10.1016/j.ijhcs.2024.103356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Lilios A, Nikitas C, Skoulakis C, Alagianni A, Chatziioannou I, Asimakopoulou P, Chimona T. The Unveiled Potential of Telehealth Practice in Vestibular Rehabilitation: A Comparative Randomized Study. J Clin Med 2024; 13:7015. [PMID: 39685471 DOI: 10.3390/jcm13237015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2024] [Accepted: 11/18/2024] [Indexed: 12/18/2024] Open
Abstract
Background and Objectives: Unilateral vestibular hypofunction (UVH) in cases of insufficient central nervous system compensation leads to chronic dizziness. A customized vestibular rehabilitation (VR) program is more beneficial than a generic set of exercises for patients with chronic UVH. The purpose of the present study is to compare a customized remotely supervised VR program with a customized unsupervised VR program in chronic UVH patients. Methods: Participants were randomly allocated into two groups (Group A and Group B) and received an individualized 6-week home-based VR program that included adaptation and habituation exercises, balance and gait training. All individuals' VR program implementation was evaluated weekly, allowing for exercise modifications. Moreover, Group A received additional remote supervision via phone communication (twice per week). The effectiveness of each VR program was evaluated using the scores of the Mini-BESTest, the Functional Gait Assessment (FGA), and the Dizziness Handicap Inventory (DHI). Results: At the 6-week assessment, participants in Group A had significantly better scores in objective and subjective evaluated parameters than those in Group B (p < 0.001). Group A also showed better compliance with the VR program. On the contrary, participants' conformity in their individualized exercises was not affected by gender, duration of symptoms, or BMI (p > 0.05). Conclusions: Our clinical study highlights the advantages of using telephone communication, with a structured design and implementation, to assist individuals in successfully following a VR protocol.
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Affiliation(s)
- Andreas Lilios
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Larisa, 413 34 Larisa, Greece
| | - Christos Nikitas
- 1st Department of Otolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General Hospital, 115 27 Athens, Greece
| | - Charalampos Skoulakis
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Larisa, 413 34 Larisa, Greece
| | - Aggeliki Alagianni
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Larisa, 413 34 Larisa, Greece
| | - Ioannis Chatziioannou
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Larisa, 413 34 Larisa, Greece
| | - Panagiota Asimakopoulou
- Department of Otolaryngology, Head and Neck Surgery, Chania General Hospital, 733 00 Chania, Greece
| | - Theognosia Chimona
- Department of Otolaryngology, Head and Neck Surgery, Chania General Hospital, 733 00 Chania, Greece
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Tramontano M, Ferri N, Turolla A, Orejel Bustos AS, Casagrande Conti L, Sorge C, Pillastrini P, Manzari L. Video head impulse test in subacute and chronic stroke survivors: new perspectives for implementation of assessment in rehabilitation. Eur Arch Otorhinolaryngol 2024; 281:5129-5134. [PMID: 38758244 DOI: 10.1007/s00405-024-08721-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/03/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION The Video Head Impulse Test (vHIT) is a safe and reliable assessment of peripheral vestibular function. Many studies tested its accuracy in clinical settings for differential diagnosis and quantification of the vestibulo-oculomotor reflex (VOR) in various disorders. However, the results of its application after lesions of the CNS are discordant and have never been studied in rehabilitation. This study aims to assess the VOR performance in a sample of stroke survivors. METHODS This is a cross-sectional study on 36 subacute and chronic stroke survivors; only persons with first-ever stroke and able to walk independently, even with supervision, were included. We performed VOR assessments for each semicircular canal by vHIT and balance assessments by the Berg Balance Scale and the MiniBESTest scale. RESULTS Two hundred and sixteen semicircular canals were assessed using the Head Impulse paradigm (in both the vertical and horizontal planes), while 72 semicircular canals were assessed using the Suppressed Head Impulse paradigm (horizontal plane). There was a high prevalence of participants with dysfunctional canals, particularly for the left anterior and right posterior canals, which were each prevalent in more than one-third of our sample. Furthermore, 16 persons showed an isolated canal dysfunction. The mean VOR gain for the vertical canals had confidence intervals out of the normal values (0.74-0.91 right anterior; 0.74-0.82 right posterior; 0.73-0.87 left anterior). CONCLUSION Our findings suggest that peripheral vestibular function may be impaired in people with stroke; a systematic assessment in a rehabilitation setting could allow a more personalized and patient-centred approach.
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Affiliation(s)
- Marco Tramontano
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Nicola Ferri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Amaranta Soledad Orejel Bustos
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | | | - Chiara Sorge
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
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Meldrum D, Kearney H, Hutchinson S, McCarthy S, Quinn G. Wearable sensor and smartphone assisted vestibular physical therapy for multiple sclerosis: usability and outcomes. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1406926. [PMID: 39050817 PMCID: PMC11267627 DOI: 10.3389/fresc.2024.1406926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/05/2024] [Indexed: 07/27/2024]
Abstract
Introduction Vertigo, dizziness, gaze instability and disequilibrium are highly prevalent in people with MS (PwMS) and head movement induced dizziness is commonly reported. Vestibular physical therapy (VPT) is a specialised, non-invasive and effective therapy for these problems but usually involves travel for the person to a specialist center with both personal and carbon costs. The use of wearable sensors to track head movement and smartphone applications to deliver and track programs has potential to improve VPT in MS. Methods This study investigated the usability and effects of a commercially available digital VPT system (wearable head sensor, smartphone app and clinician software) to deliver VPT to PwMS. A pre/post treatment design was employed and the primary outcome was the System Usability Scale (SUS). Other patient reported outcomes were the Service User Acceptability Questionnaire (SUTAQ), the Patient Enablement Instrument (PEI) and the Dizziness Handicap Inventory (DHI). Physical outcomes measurements included Mini-BESTest (MB), Modified Dynamic Gait Index (mDGI), Gait Speed (GS), Dynamic Visual Acuity (DVA) and head kinematics and symptoms during exercise. Results Sixteen PwMS (14 female), mean age 44(±14) years were recruited to the study and twelve completed VPT. Mean adherence to exercise, measured digitally was 60% (±18.4). SUS scores were high at 81 (±14) and SUTAQ scores also demonstrated high levels of satisfaction and acceptability of the system. Statistically significant improvements in MB (mean change 2.25; p = 0.004), mDGI (median change 1.00; p = 0.008), DVA (median change -1.00; p = 0.004) were found. Head frequencies significantly improved with concurrent decreased intensity of dizziness during head movements (mean change across 4 gaze stabilization exercises was 23 beats per minute; p < 0.05). Non-significant improvements were seen in DHI (p = 0.07) and GS (p = 0.15). 64.5% of follow up visits were conducted remotely (video or phone), facilitated by the system. Discussion This study had two main outcomes and benefits for PwMS. Firstly, we showed that the system used was both acceptable and could be used by PwMS. Secondly, we demonstrated an improvement in a range of dizziness, balance and gait metrics with remotely delivered care. This system has the potential to positively impact on MS physiotherapy service provision with the potential to deliver effective remote care.
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Affiliation(s)
- D. Meldrum
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - H. Kearney
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- MS Unit, Department of Neurology, St. James’s Hospital, Dublin, Ireland
| | - S. Hutchinson
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- MS Unit, Department of Neurology, St. James’s Hospital, Dublin, Ireland
| | - S. McCarthy
- Physiotherapy Department, St. James’s Hospital, Dublin, Ireland
| | - G. Quinn
- Physiotherapy Department, St. James’s Hospital, Dublin, Ireland
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Mohammed A, Li S, Liu X. Exploring the Potentials of Wearable Technologies in Managing Vestibular Hypofunction. Bioengineering (Basel) 2024; 11:641. [PMID: 39061723 PMCID: PMC11274252 DOI: 10.3390/bioengineering11070641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/26/2024] [Accepted: 05/31/2024] [Indexed: 07/28/2024] Open
Abstract
The vestibular system is dedicated to gaze stabilization, postural balance, and spatial orientation; this makes vestibular function crucial for our ability to interact effectively with our environment. Vestibular hypofunction (VH) progresses over time, and it presents differently in its early and advanced stages. In the initial stages of VH, the effects of VH are mitigated using vestibular rehabilitation therapy (VRT), which can be facilitated with the aid of technology. At more advanced stages of VH, novel techniques that use wearable technologies for sensory augmentation and sensory substitution have been applied to manage VH. Despite this, the potential of assistive technologies for VH management remains underexplored over the past decades. Hence, in this review article, we present the state-of-the-art technologies for facilitating early-stage VRT and for managing advanced-stage VH. Also, challenges and strategies on how these technologies can be improved to enable long-term ambulatory and home use are presented.
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Affiliation(s)
- Ameer Mohammed
- School of Information Science and Technology, Fudan University, Shanghai 200433, China; (A.M.); (S.L.)
- State Key Laboratory of Integrated Chips and Systems, Fudan University, Shanghai 201203, China
| | - Shutong Li
- School of Information Science and Technology, Fudan University, Shanghai 200433, China; (A.M.); (S.L.)
- State Key Laboratory of Integrated Chips and Systems, Fudan University, Shanghai 201203, China
| | - Xiao Liu
- School of Information Science and Technology, Fudan University, Shanghai 200433, China; (A.M.); (S.L.)
- State Key Laboratory of Integrated Chips and Systems, Fudan University, Shanghai 201203, China
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Grillo D, Zitti M, Cieślik B, Vania S, Zangarini S, Bargellesi S, Kiper P. Effectiveness of Telerehabilitation in Dizziness: A Systematic Review with Meta-Analysis. SENSORS (BASEL, SWITZERLAND) 2024; 24:3028. [PMID: 38793883 PMCID: PMC11125243 DOI: 10.3390/s24103028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024]
Abstract
Dizziness can be a debilitating condition with various causes, with at least one episode reported in 17% to 30% of the international adult population. Given the effectiveness of rehabilitation in treating dizziness and the recent advancements in telerehabilitation, this systematic review aims to investigate the effectiveness of telerehabilitation in the treatment of this disorder. The search, conducted across Medline, Cochrane Central Register of Controlled Trials, and PEDro databases, included randomized controlled trials assessing the efficacy of telerehabilitation interventions, delivered synchronously, asynchronously, or via tele-support/monitoring. Primary outcomes focused on dizziness frequency/severity and disability, with secondary outcomes assessing anxiety and depression measures. Seven articles met the eligibility criteria, whereas five articles contributed to the meta-analysis. Significant findings were observed regarding the frequency and severity of dizziness (mean difference of 3.01, p < 0.001), disability (mean difference of -4.25, p < 0.001), and anxiety (standardized mean difference of -0.16, p = 0.02), favoring telerehabilitation. Telerehabilitation shows promise as a treatment for dizziness, aligning with the positive outcomes seen in traditional rehabilitation studies. However, the effectiveness of different telerehabilitation approaches requires further investigation, given the moderate methodological quality and the varied nature of existing methods and programs.
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Affiliation(s)
- Davide Grillo
- Physical Medicine and Rehabilitation Unit, Azienda ULSS 3 Serenissima, 30126 Venice, Italy; (D.G.); (S.Z.); (S.B.)
| | - Mirko Zitti
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, 30126 Venezia, Italy; (M.Z.)
| | - Błażej Cieślik
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, 30126 Venezia, Italy; (M.Z.)
| | - Stefano Vania
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, 17100 Savona, Italy
| | - Silvia Zangarini
- Physical Medicine and Rehabilitation Unit, Azienda ULSS 3 Serenissima, 30126 Venice, Italy; (D.G.); (S.Z.); (S.B.)
| | - Stefano Bargellesi
- Physical Medicine and Rehabilitation Unit, Azienda ULSS 3 Serenissima, 30126 Venice, Italy; (D.G.); (S.Z.); (S.B.)
| | - Pawel Kiper
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, 30126 Venezia, Italy; (M.Z.)
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Kim MK, Yun SY, Lee S, Lee JO, Sung SY, Lee JY, Kim HJ, Park HY, Choi JY, Song JJ, Choi BY, Koo JW, Kim JS. Efficacy of vestibular rehabilitation and its facilitating and hindering factors from real-world clinical data. Front Neurol 2024; 15:1329418. [PMID: 38487329 PMCID: PMC10938910 DOI: 10.3389/fneur.2024.1329418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/22/2024] [Indexed: 03/17/2024] Open
Abstract
Background and purpose Customized vestibular rehabilitation improved dizziness and imbalance in several randomized controlled trials. In the present study, we determined the efficacy of customized vestibular rehabilitation using real-world observational data. Methods In this retrospective observational study, we recruited 64 patients (median age = 60, interquartile range = 48-66.3) who completed the customized vestibular rehabilitation from January to December 2022. The outcomes of rehabilitation were evaluated using the dizziness handicap inventory (DHI) or vestibular disorders activities of daily living scale (VADL). The factors associated with outcomes were assessed with a generalized linear model, of which covariates included patients' age, sex, duration of illness, type of vestibular disorders, initial DHI and VADL scores, exercise compliance, and initial hospital anxiety and depression scale (HADS) scores. Results After the median of 6 (4-6) weeks of rehabilitation, DHI and VADL scores significantly improved in patients with either peripheral or central vestibular disorders (Wilcoxon signed-rank test, p < 0.05). The initial DHI and VADL scores showed a positive while the sum of HADS scores showed a negative correlation with the outcome. In contrast, the age, sex, duration of illness, types of vestibular disorders, and exercise compliance did not affect the outcome. Discussion and conclusion Customized vestibular rehabilitation is effective for central as well as peripheral disorders, especially when the symptoms are severe and the psychological distress is mild.
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Affiliation(s)
- Min-Ku Kim
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - So-Yeon Yun
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Seonkyung Lee
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Ja-Ok Lee
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Soo-Yun Sung
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Ju-Young Lee
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Hyo-Jung Kim
- Biomedical Research Institute, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Hye Youn Park
- Department of Psychiatry, Dizziness Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Jeong-Yoon Choi
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Jae-Jin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Dizziness Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Byung Yoon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Dizziness Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Ja-Won Koo
- Department of Otorhinolaryngology-Head and Neck Surgery, Dizziness Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Ji-Soo Kim
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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Shi Q, Wu RJ, Liu J. Effect of health education based on information-motivation-behavioral skills model on patients with unilateral vestibular dysfunction. World J Clin Cases 2024; 12:903-912. [PMID: 38414598 PMCID: PMC10895628 DOI: 10.12998/wjcc.v12.i5.903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/05/2023] [Accepted: 01/19/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Vestibular dysfunction (VH) is a common concomitant symptom of late peripheral vestibular lesions, which can be trauma, poisoning, infection, heredity, and neurodegeneration, but about 50% of the causes are unknown. The study uses the information-motivation-behavioral skills (IMB) model for health education, effectively improve the quality of life, increase their self-confidence, reduce anxiety and depression, and effectively improve the psychological state of patients. AIM To explore the effect of health education based on the IMB model on the degree of vertigo, disability, anxiety and depression in patients with unilateral vestibular hypofunction. METHODS The clinical data of 80 patients with unilateral vestibular hypofunction from January 2019 to December 2021 were selected as the retrospective research objects, and they were divided into the control group and the observation group with 40 cases in each group according to different nursing methods. Among them, the control group was given routine nursing health education and guidance, and the observation group was given health education and guidance based on the IMB model. The changes in self-efficacy, anxiety and depression, and quality of life of patients with unilateral VH were compared between the two groups. RESULTS There was no significant difference in General Self-Efficacy Scale (GSES) scale scores between the two groups of patients before nursing (P > 0.05), which was comparable; after nursing, the GSES scale scores of the two groups were higher than those before nursing. The nursing group was higher than the control group, and the difference was statistically significant (P < 0.05). There was no significant difference in the scores of Hospital Anxiety and Depression Scale (HADS) and anxiety and depression subscales between the two groups before nursing (P > 0.05). After nursing, the HADS score, anxiety, and depression subscale scores of the two groups of patients were lower than those before nursing, and the nursing group was lower than the control group, and the difference was statistically significant (P < 0.05). After nursing, the Dizziness Handicap Inventory (DHI) scale and DHI-P, DHI-E and DHI-F scores in the two groups were decreased, and the scores in the nursing group were lower than those in the control group, and the difference was statistically significant (P < 0.05). CONCLUSION Health education based on the IMB model can effectively improve patients' quality of life, increase self-efficacy of patients with unilateral vestibular hypofunction, enhance patients' confidence, enable patients to resume normal work and life as soon as possible, reduce patients' anxiety and depression, and effectively improve patients' psychological status.
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Affiliation(s)
- Qiong Shi
- Department of Neurology, Wuahan Fourth Hospital, Wuhan 430000, Hubei Province, China
| | - Ruo-Jun Wu
- Department of Critical Care Medicine, Wuhan No. 1 Hospital, Wuhan 430033, Hubei Province, China
| | - Jiang Liu
- Department of Neurology, Wuahan Fourth Hospital, Wuhan 430000, Hubei Province, China
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Van Laer L, Dunlap PM, Vereeck L, Hendriks E, Sluydts M, Whitney SL. Fear avoidance beliefs, anxiety, and depression in healthy individuals and persons with vestibular disorders across cultures. Front Neurol 2023; 14:1296411. [PMID: 38107631 PMCID: PMC10722427 DOI: 10.3389/fneur.2023.1296411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/08/2023] [Indexed: 12/19/2023] Open
Abstract
Background/introduction In persons with vestibular disorders, disturbed vestibular input and accompanying dizziness can be associated with anxiety or depression. To avoid dizziness, persons with vestibular disorders can develop mal-adaptive fear avoidance behaviors which can negatively influence daily life functioning. The aims of this study were to (1) document different psychological factors in patients with vestibular disorders and healthy adults across cultures and (2) to assess the convergent validity of the 9-item Vestibular Activities Avoidance Instrument (VAAI), which quantifies fear avoidance beliefs. Methods Psychological factors and disability were measured in Dutch-speaking healthy adults and English- and Dutch-speaking persons with vestibular disorders using the VAAI, the Dizziness Handicap Inventory (DHI), the Hospital Anxiety and Depression Scale (HADS) and the Activities-Specific Balance Confidence Scale (ABC). The convergent validity of the VAAI was investigated by performing correlation analyses between the VAAI, the DHI, the HADS, and the ABC. Results A total of 151 Dutch-speaking healthy adults, 404 English-speaking participants with vestibular disorders, and 126 Dutch-speaking participants with vestibular disorders were included. Participants with vestibular disorders presented with higher levels of fear avoidance beliefs (VAAI), perceived disability (DHI), anxiety and depression (HADS), and lower confidence during balance activities (ABC) compared to healthy adults. Regarding the convergent validity of the VAAI, there were moderate to strong correlation coefficients (r = 0.39-0.74) between fear avoidance and the DHI, HADS, and ABC in participants with vestibular disorders. Conclusions Participants with vestibular disorders report a higher psychological burden compared to healthy adults. These results emphasize the importance of assessing psychological factors in persons with vestibular disorders. In addition, evidence was provided for convergent validity, supporting the VAAI as a valid outcome measure across cultures.
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Affiliation(s)
- Lien Van Laer
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Pamela M. Dunlap
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Luc Vereeck
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Erwin Hendriks
- Unit of Physiotherapy, Organizational Part of the Orthopedics Department, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Morgana Sluydts
- European Institute for Otorhinolaryngology—Head and Neck Surgery (ORL-HNS), Sint-Augustinus Hospital Antwerp, Antwerp, Belgium
| | - Susan L. Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States
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David EA, Shahnaz N. Dynamic posturography after computerized vestibular retraining for stable unilateral vestibular deficits. Acta Otolaryngol 2023; 143:396-401. [PMID: 37173291 DOI: 10.1080/00016489.2023.2208615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Balance deficits increase the risk of falls and compromise quality of life. Current treatment modalities do not resolve symptoms for many patients. AIMS/OBJECTIVES To measure changes in objective posturography after a computerized vestibular retraining therapy protocol. MATERIALS AND METHODS This was a single-arm interventional study of individuals with a stable unilateral vestibular deficit present for greater than six months. Participants underwent 12 twice-weekly sessions of computerized vestibular retraining therapy. Objective response was measured by the Sensory Organization Test and questionnaires were administered to measure subjective changes. RESULTS We enrolled 13 participants (5 females and 8 males) with a median age of 51 years (range 18 to 67). After retraining, the Sensory Organization Test composite score improved by 8.8 (95% CI 0.6 to 19.1) and this correlated with improvement in the Falls Efficacy Scale-International questionnaire (rs -0.6472; 95% CI -0.8872 to - 0.1316). Participants with moderate-to-severe disability at baseline (n = 7) demonstrated greater improvement in the composite score (14.6; 95% CI 7.0 to 36.9). CONCLUSIONS AND SIGNIFICANCE Computerized vestibular retraining therapy for stable unilateral vestibular deficits is associated with improvement in dynamic balance performance. Posturography improvements correlated with a reduction in perceived fall risk.Trial Registration Information Clinicaltrials.gov registration NCT04875013; 04/27/2021.
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Affiliation(s)
- Eytan A David
- Department of Surgery, Otology, Neurotology, Skull Base Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Navid Shahnaz
- Audiology and Speech Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Haciabbasoğlu R, Araci A, Günizi H. Are Telerehabilitation Exercise Practices Effective in Patients Diagnosed with Benign Paroxysmal Positional Vertigo? Indian J Otolaryngol Head Neck Surg 2023; 75:557-567. [PMID: 37200900 PMCID: PMC10016185 DOI: 10.1007/s12070-023-03631-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/23/2023] [Indexed: 03/17/2023] Open
Abstract
The aim of this study was to investigate the effectiveness of classical Vestibular Rehabilitation Exercises (Control Group-CG) given as home exercise program and VR + balance exercises (Experimental Group-EG) applied with telerehabilitation method on patients with Benign Paroxysmal Positional Vertigo (BPPV). Material and Methods: The patients were randomly divided into 2 therapy groups in the ALKU Hospital (CG; 21 patients, and EG;22 patients). Pre- and post-test experimental design was adopted and a six-week training was offered. The participants' balance ability (Romberg, tandem and semi-tandem tests), vertigo severity (Vertigo Symptom Scale-VSS, VAS), vertigo-related disability level (Dizziness Handicap Inventory-DHI), anxiety (Beck Anxiety Inventory-BAI) and quality of life (Vertigo Dizziness Imbalance Questionnaire-VDI) were assessed. Regarding the balance ability, findings in tandem and semi-tandem tests were significantly increased in the EG compared to CG (p < 0.05). According to VAS, the severity of dizziness decreased significantly compared to the CG (p < 0.05). Regarding the DHI score, symptoms of vertigo were reduced considerably after the treatment compared to the CG (p < 0.05). A significant improvement was observed in the quality of life of the EG group according to VDI scoring (p < 0.05). Although gains were observed in both groups, it was observed that the EG group obtained more effective improvement in the severity of vertigo, disability level due to vertigo, and quality of life compared to the home exercise group.These results confirmed the hypothesis that EG applications are effective and clinically applicable in patients with BPPV.
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Affiliation(s)
- Reyyan Haciabbasoğlu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Üsküdar University, Istanbul, Turkey
| | - Ayça Araci
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Alanya Alaaddin keykubat University (ALKU), Kestel mh. Cimento cd no:80, Alanya, Antalya Turkey
| | - Hüseyin Günizi
- Department of Otolaryngology, Faculty of Medicine, Alanya Alaaddin Keykubat University, Alanya, Turkey
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Gill-Lussier J, Saliba I, Barthélemy D. Proprioceptive Cervicogenic Dizziness Care Trajectories in Patient Subpopulations: A Scoping Review. J Clin Med 2023; 12:1884. [PMID: 36902670 PMCID: PMC10003866 DOI: 10.3390/jcm12051884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/12/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
Proprioceptive cervicogenic dizziness (PCGD) is the most prevalent subcategory of cervicogenic dizziness. There is considerable confusion regarding this clinical syndrome's differential diagnosis, evaluation, and treatment strategy. Our objectives were to conduct a systematic search to map out characteristics of the literature and of potential subpopulations of PCGD, and to classify accordingly the knowledge contained in the literature regarding interventions, outcomes and diagnosis. A Joanna Briggs Institute methodology-informed scoping review of the French, English, Spanish, Portuguese and Italian literature from January 2000 to June 2021 was undertaken on PsycInfo, Medline (Ovid), Embase (Ovid), All EBM Reviews (Ovid), CINAHL (Ebsco), Web of Science and Scopus databases. All pertinent randomized control trials, case studies, literature reviews, meta-analyses, and observational studies were retrieved. Evidence-charting methods were executed by two independent researchers at each stage of the scoping review. The search yielded 156 articles. Based on the potential etiology of the clinical syndrome, the analysis identified four main subpopulations of PCGD: chronic cervicalgia, traumatic, degenerative cervical disease, and occupational. The three most commonly occurring differential diagnosis categories are central causes, benign paroxysmal positional vertigo and otologic pathologies. The four most cited measures of change were the dizziness handicap inventory, visual analog scale for neck pain, cervical range of motion, and posturography. Across subpopulations, exercise therapy and manual therapy are the most commonly encountered interventions in the literature. PCGD patients have heterogeneous etiologies which can impact their care trajectory. Adapted care trajectories should be used for the different subpopulations by optimizing differential diagnosis, treatment, and evaluation of outcomes.
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Affiliation(s)
- Joseph Gill-Lussier
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC H3N 1X7, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (IURDPM), CRIR, CIUSSS South-Center, Montreal, QC H3S 1M9, Canada
- Collège d’Études Ostéopathique de Montréal (CEOM), Montréal, QC H3G 1W7, Canada
| | - Issam Saliba
- Division of Otolaryngology, Head and Neck Surgery—Otology and Neurotology, Montreal University Hospital Center (CHUM), University of Montreal, Montreal, QC H2X 3E4, Canada
| | - Dorothy Barthélemy
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC H3N 1X7, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (IURDPM), CRIR, CIUSSS South-Center, Montreal, QC H3S 1M9, Canada
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How do patients with chronic dizziness experience a web-based home rehabilitation programme for customised vestibular therapy ('WeBaVeR')? A qualitative study. Int J Med Inform 2023; 170:104927. [PMID: 36462397 DOI: 10.1016/j.ijmedinf.2022.104927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/26/2022] [Accepted: 11/09/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Vestibular rehabilitation therapy (VRT) is the first choice approach for chronic dizziness. However, current home treatment programmes often lack attention to the individual needs of the patient and the integration of visual desensitisation therapy. We therefore developed a customised web-based VRT programme containing visual desensitisation exercises. OBJECTIVE To assess the user experience (usability, satisfaction, acceptability, and quality) of patients with chronic dizziness with the customised WEb-BAsed VEstibular Rehabilitation, further called 'WeBaVeR'. METHODS Patients with chronic dizziness, attending the Department of Otorhinolaryngology of the Antwerp University Hospital (period September 2021 to May 2022), received a customised programme, i.e. exercises supported by our web application and booklet. The programme lasted 6 weeks, with weekly supervision by phone. Patients' user experience was examined with the System Usability Scale (SUS), Client Satisfaction Questionnaire (CSQ), Service User Technology Acceptability Questionnaire (SUTAQ), and the User version of the Mobile Application Rating Scale (uMARS). RESULTS Twelve patients with chronic dizziness (mean age: 45.33 ± 13.26 years) participated. The overall rated level of perceived usability (mean SUS score: 78.75 ± 8.95 points), satisfaction (mean CSQ score: 33.08 ± 3.37 points), acceptability (mean SUTAQ score: 105.67 ± 13.40 points) and quality (mean uMARS score: 94.58 ± 10.69 points) was good. The main remarks concerned the user interface and the interactive capabilities of the web application, and that WeBaVeR does not increase health awareness, or accessibility to health care providers. CONCLUSION Patients with chronic dizziness consider WeBaVeR as useful, acceptable, satisfactory and of good quality. To facilitate implementation in practice, further optimisation of WeBaVeR based on the feedback received, is useful.
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Smith RM, Burgess C, Tahtis V, Marsden J, Seemungal BM. Why are patients with acute traumatic brain injury not routinely assessed or treated for vestibular dysfunction in the UK? A qualitative study. BMJ Open 2023; 13:e067967. [PMID: 36592999 PMCID: PMC9809272 DOI: 10.1136/bmjopen-2022-067967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/15/2022] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Vestibular dysfunction is common in patients with acute traumatic brain injury (aTBI). Persisting vestibular symptoms (ie, dizziness and imbalance) are linked to poor physical, psychological and socioeconomic outcomes. However, routine management of vestibular dysfunction in aTBI is not always standard practice. We aimed to identify and explore any healthcare professional barriers or facilitators to managing vestibular dysfunction in aTBI. DESIGN A qualitative approach was used. Data were collected using face to face, semi-structured interviews and analysed using the Framework approach. SETTING Two major trauma centres in London, UK. PARTICIPANTS 28 healthcare professionals participated: 11 occupational therapists, 8 physiotherapists and 9 surgical/trauma doctors. RESULTS Vestibular assessment and treatment were not routinely undertaken by trauma ward staff. Uncertainty regarding responsibility for vestibular management on the trauma ward was perceived to lead to gaps in patient care. Interestingly, the term dizziness was sometimes perceived as an 'invisible' and vague phenomenon, leading to difficulties identifying or 'proving' dizziness and a tendency for making non-specific diagnoses. Barriers to routine assessment and treatment included limited knowledge and skills, a lack of local or national guidelines, insufficient training and concerns regarding the practical aspects of managing vestibular dysfunction. Of current trauma ward staff, therapists were identified as appropriate healthcare professionals to adopt new behaviours regarding management of a common form of vestibular dysfunction (benign paroxysmal positional vertigo). Strategies to support this behaviour change include heightened clarity around role, implementation of local or national guidelines, improved access to training and multidisciplinary support from experts in vestibular dysfunction. CONCLUSIONS This study has highlighted that role and knowledge barriers exist to multidisciplinary management of vestibular dysfunction in aTBI. Trauma ward therapists were identified as the most appropriate healthcare professionals to adopt new behaviours. Several strategies are proposed to facilitate such behaviour change. TRIAL REGISTRATION NUMBER ISRCTN91943864.
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Affiliation(s)
- Rebecca M Smith
- Brain and Vestibular Group, Centre for Vestibular Neurology, Imperial College London, London, UK
| | - Caroline Burgess
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | | | | | - Barry M Seemungal
- Brain and Vestibular Group, Centre for Vestibular Neurology, Imperial College London, London, UK
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Kellerer S, Amberger T, Schlick C, Dlugaiczyk J, Wuehr M, Jahn K. Specific and individualized instructions improve the efficacy of booklet-based vestibular rehabilitation at home - a randomized controlled trial (RCT). J Vestib Res 2023; 33:349-361. [PMID: 37182850 DOI: 10.3233/ves-220122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Vestibular rehabilitation therapy (VRT) is effective for most patients with dizziness and imbalance. Home exercise programs are widely used. It is unknown, however, how specific the instructions for exercises have to be. OBJECTIVE To evaluate the effects of expert assessment and instructions in a booklet-based home VRT program for patients with chronic dizziness. METHODS Randomized controlled study on 74 participants with disabling dizziness for >3 months. All study participants received a booklet-based VRT for training at home. Participants were prescribed 20 minutes of exercise, twice a day. The intervention group (n = 37) received specific instructions (expert physiotherapist). The control group (n = 37) practiced without specific instructions. Primary outcome was the total score of the Dizziness Handicap Inventory (DHI-G). All outcomes were assessed at baseline, after 4 weeks, and at follow up 4 weeks later. RESULTS Both groups improved (DHI-G 43.94±18.89 at inclusion to 33.06±19.67 at follow-up in controls and 42.82±16.60 to 22.65±19.12 in the intervention group). The intervention group, however, improved more (p = 0.014). CONCLUSIONS We show a significant effect of expert physiotherapy guidance in home-based VRT. This strengthens the role of the physiotherapist in VRT: Tailored, personalized instructions are needed to get the best effect of VRT.
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Affiliation(s)
- Silvy Kellerer
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich (LMU), Munich, Germany
| | - Tamara Amberger
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich (LMU), Munich, Germany
| | - Cornelia Schlick
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich (LMU), Munich, Germany
| | - Julia Dlugaiczyk
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich (LMU), Munich, Germany
- Department of Ear, Nose, Throat and Facial Surgery, Interdisciplinary Center for Vertigo and Neurological Visual Disorders, University Hospital Zurich, Zurich, Switzerland
| | - Max Wuehr
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich (LMU), Munich, Germany
| | - Klaus Jahn
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich (LMU), Munich, Germany
- Department of Neurology, Schön Klinik Bad Aibling, Bad Aibling, Germany
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22
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Aldawsary N, Almarwani M. The combined effect of gaze stability and balance exercises using telerehabilitation in individuals with vestibular disorders during the COVID-19 pandemic: A pilot study. PLoS One 2023; 18:e0282189. [PMID: 37146078 PMCID: PMC10162509 DOI: 10.1371/journal.pone.0282189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/04/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Vestibular rehabilitation is recognized as the most effective intervention to relieve symptoms of dizziness and imbalance related to vestibular disorders. OBJECTIVE This study aimed to examine the combined effect of gaze stability and balance exercises using telerehabilitation in individuals with vestibular disorders during the COVID-19 pandemic. METHODS This pilot study was a quasi-experimental, single-group design pre- to post-telerehabilitation intervention. Individuals with vestibular disorders between the ages of 25-60 participated in this study (n = 10). Participants underwent four weeks of combined gaze stability and balance exercises using telerehabilitation at their homes. The Arabic version of the Activities-Specific Balance Confidence scale (A-ABC), Berg Balance Scale (BBS), and the Arabic version of the Dizziness Handicap Inventory (A-DHI) were assessed pre- and post-vestibular telerehabilitation. Wilcoxon signed rank test was used to examine the magnitude of difference pre- and post-intervention scores of outcome measures. The effect size (r) for the Wilcoxon signed rank was calculated. RESULTS After four weeks of vestibular telerehabilitation, there was an improvement in BBS and A-DHI outcome measures (p < .001), with moderate effect size for both scales (r = 0.6). However, A-ABC showed no significant improvement among participants. CONCLUSION This pilot study found that the combined effect of gaze stability and balance exercises using telerehabilitation appear to be effective in improving balance and activities of daily living in individuals with vestibular disorders.
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Affiliation(s)
- Nada Aldawsary
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- Department of Medical Rehabilitation, Physical Therapy Department, Ministry of Health, Riyadh, Saudi Arabia
| | - Maha Almarwani
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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赵 颖, 王 利, 李 伟, 孙 怡. [The value of high intensity stimulation training of semicircular canal of SRM-Ⅳ vertigo diagnosis and treatment system in the rehabilitation of vestibular neuritis]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:925-929. [PMID: 36543400 PMCID: PMC10128281 DOI: 10.13201/j.issn.2096-7993.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Indexed: 12/24/2022]
Abstract
Objective:To evaluate the value of high intensity stimulation training of semicircular canal of SRM-Ⅳ vertigo diagnosis and treatment system in the rehabilitation of vestibular neuritis. Methods:To analyze 68 patients with vestibular neuritis treated in Department of Otorhinolaryngology Head and Neck Surgery, Shijiazhuang People's Hospital from January 2020 to January 2021, conduct spontaneous nystagmus and head toss test, and perform spontaneous nystagmus and rotation test of SRM-Ⅳvertigo system, compare the positive rate of the side of disease was between the two. To randomly divide 68 patients into treatment group 1, 2 and control group, the control group with drugs, treatment group 1 with drugs and vestibular rehabilitation training exercise, treatment group 2 with additional high intensity stimulation training of semicircular canal at one week after onset, on the basis of drug therapy and vestibular rehabilitation training exercise. At 2 weeks and 1 month, through swivel chair test negative rate, DHI score, compare the efficacy of the three groups. Results:Spontaneous nystagmus combined with head toss test confirmed 80.9% of the side of the disease, spontaneous nystagmus and rotation test of SRM-Ⅳ vertigo system confirmed 100%, the difference is statistically significant(P<0.05). Compared with the control group and the treatment group 1, the negative conversion rate of the rotation test in the treatment group 2 at the second week and the first month of treatment, the difference is statistically significant(P<0.05, the second week χ²=6.474, the first month χ²=6.245); the DHI score of treatment group 2 was statistically significant compared with that of control group and treatment group 1 at the second week and first month of treatment(P<0.05, the second week F=13.578, the first month F=28.599). Conclusion:SRM-Ⅳ vertigo diagnosis and treatment system semicircular canal high intensity stimulation training has a certain role in the rehabilitation treatment of vestibular neuritis. It is simple to operate, patient tolerance and compliance are good, and it is worth promoting.
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Affiliation(s)
- 颖 赵
- 河北省石家庄市人民医院耳鼻咽喉头颈外科(石家庄, 050000)Department of Otorhinolaryngology Head and Neck Surgery, Shijiazhuang People's Hospital, Shijiazhuang, 050000, China
| | - 利军 王
- 河北省石家庄市人民医院耳鼻咽喉头颈外科(石家庄, 050000)Department of Otorhinolaryngology Head and Neck Surgery, Shijiazhuang People's Hospital, Shijiazhuang, 050000, China
| | - 伟 李
- 河北省石家庄市人民医院耳鼻咽喉头颈外科(石家庄, 050000)Department of Otorhinolaryngology Head and Neck Surgery, Shijiazhuang People's Hospital, Shijiazhuang, 050000, China
| | - 怡君 孙
- 河北省石家庄市人民医院耳鼻咽喉头颈外科(石家庄, 050000)Department of Otorhinolaryngology Head and Neck Surgery, Shijiazhuang People's Hospital, Shijiazhuang, 050000, China
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De Hertogh W, Castien R, Jacxsens L, De Pauw J, Vereeck L. Outcome for dizzy patients in a physiotherapy practice: an observational study. Ann Med 2022; 54:1787-1796. [PMID: 35786105 PMCID: PMC9258437 DOI: 10.1080/07853890.2022.2091790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Dizziness is a common reason for referral to physiotherapy. Additional information on clinical characteristics, treatment effect and prognostic indicators in physiotherapy practice are needed. METHODS A retrospective observational study. Based on a standardised clinical evaluation patients were labelled as having Benign Paroxysmal Positioning Vertigo (BPPV) or not (no-BPPV). BPPV was treated with repositioning manoeuvres and exercises. In no-BPPV, treatment was based on additional clinical tests. Treatment was provided once per week and considered successful when the patient was free of symptoms confirmed by negative positional tests. RESULTS From 148 referred patients, 88 were labelled as having BPPV, 60 as no-BPPV. The symptom of a short-lasting spinning sensation provoked by head movements was highly suggestive of BPPV. On average, in BPPV treatment was completed after 2.27 ± 1.68 treatments, in no-BPPV this was after 4.91 ± 3.46 treatments. The delayed outcome was related to higher 'age' and 'concomitant neck pain' in BPPV and with higher 'age' only in no-BPPV. Favourable outcome was related to the feature 'dizziness provoked by movements in the horizontal plane' in BPPV. CONCLUSIONS Clinical evaluation and treatment in physiotherapy practice can be an effective and safe option for patients with dizziness. Several clinical variables with prognostic values were identified.Key messagesClinical evaluation and treatment in physiotherapy practice can be part of low threshold care for dizzy patients.Despite prior medical screening, one-third of patients without signs of BPPV were sent back for further evaluation, illustrating the need for interdisciplinary collaboration.Based on the description of the dizziness symptom (vertigo rather than light-headedness), provocation of the dizziness by movements, and a short duration of the dizziness attack, and positive clinical vestibular tests, BPPV treatment could be initiated.
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Affiliation(s)
- Willem De Hertogh
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Primary Care Rehabilitation Practice Kineglazenleeuw, Beveren, Belgium
| | - René Castien
- Department of General Practice and Elderly Care Medicine, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Healthcare Center Haarlemmermeer, Hoofddorp, The Netherlands
| | - Laura Jacxsens
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Joke De Pauw
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Luc Vereeck
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Zaidi SFM, Shafiabady N, Afifi S, Beilby J. V-CarE: A Conceptual Design Model for Providing (COVID-19) Pandemic Awareness - a Proposal for Virtual Reality Design Approach to Facilitate People with Persistent Postural-Perceptual Dizziness (Preprint). JMIR Res Protoc 2022. [PMID: 37224279 PMCID: PMC10377449 DOI: 10.2196/38369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Virtual reality (VR) technology has been solidifying its ground since its existence, where engagement and a sense of presence are key. The contemporary field of development has captured the attention of researchers due to its flexibility and compatibility attributes. During the COVID-19 pandemic, several research outputs have shown promising prospects of continuing research in the field of VR design and development-in health sciences including learning and training. OBJECTIVE In this paper, we aim to propose a conceptual development model named V-CarE (Virtual Care Experience) that can facilitate the understanding of pandemics when it comes to a crisis, taking precautionary measures where needed, and getting used to certain actions for preventing pandemic spread through habituation. Moreover, this conceptual model is useful to expand the development strategy to incorporate different types of users and technological aid as per need and requirement. METHODS For a detailed understanding of the proposed model, we have developed a novel design strategy to bring awareness to the user about the current COVID-19 pandemic. VR research in health sciences has shown that with appropriate management and development, VR technology can efficiently support people with health issues and special needs, which motivated our attempts to explore the possibility of employing our proposed model to treat Persistent Postural-Perceptual Dizziness (PPPD)-a persistent nonvertiginous dizziness that could last for 3 months or more. The purpose of including patients with PPPD is to get them engaged in the learning experience and to make them comfortable with VR. We believe this confidence and habituation would help them get engaged with VR for treatment (dizziness alleviation) while practicing the preventive measures during the pandemic in an interactive environment without actually facing any pandemic directly. Subsequently, for advanced development using the V-CarE model, we have briefly discussed that even contemporary technology like internet of things (IoT) for handling devices, can be incorporated without disrupting the complete 3D-immersive experience. RESULTS In our discussion, we have shown that the proposed model represents a significant step toward the accessibility of VR technology by creating a pathway toward awareness of pandemics and, also, an effective care strategy for PPPD people. Moreover, by introducing advanced technology, we will only further enhance the development for wider accessibility of VR technology while keeping the core purpose of the development intact. CONCLUSIONS V-CarE-based developed VR projects are designed with all the core elements of health sciences, technology, and training making it accessible and engaging for the users and improving their lifestyle by safely experiencing the unknown. We suggest that with further design-based research, the proposed V-CarE model has the potential to be a valuable tool connecting different fields to wider communities.
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Meldrum D, Murray D, Vance R, Coleman S, McConnell S, Hardiman O, McConn Walsh R. Toward a Digital Health Intervention for Vestibular Rehabilitation: Usability and Subjective Outcomes of a Novel Platform. Front Neurol 2022; 13:836796. [PMID: 35422750 PMCID: PMC9001890 DOI: 10.3389/fneur.2022.836796] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Digital technologies are increasingly available and are reducing in cost. There is an opportunity to move to a digital health approach in vestibular rehabilitation (VR), but there is a paucity of suitable systems available and a consequent lack of evidence to support their use. This study aimed to investigate a novel digital platform developed specifically for VR (comprising clinician software, a wearable sensor, and a patient-facing app). Participants (n = 14, 9F:5M, mean age 59) with vestibular dysfunction and imbalance used the app for treatment, and therapists (n = 4) used the platform to deliver VR in the form of individualized exercise programmes over a mean of 17.4 ± 8.8 weeks. Outcomes included the system usability scale, the patient enablement instrument (PEI), change in subjective symptoms (numerical rating scales), percentage adherence to prescribed exercise, and a semi-structured interview on utility. A significant reduction was found in symptoms of vertigo/dizziness (p < 0.004), imbalance (p < 0.002), oscillopsia (p < 0.04), and anxiety (p < 0.02) after use. System usability scores were high for both clinicians (mean 85/100) and participants (mean 82.7/100) and high enablement was reported (mean PEI 6.5/12). Overall percentage adherence to the exercise prescription was highly variable and ranged from 4 to 78% when measured digitally. At semi-structured interviews, participants reported a high level of acceptance and satisfaction with digital delivery, and no adverse events were recorded. When COVID-19 restrictions eased, 2 participants trialed the head sensor with the application and found it highly usable. Further research is required to investigate the efficacy and how the wearable sensor impacts the delivery of care.
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Affiliation(s)
- Dara Meldrum
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- *Correspondence: Dara Meldrum
| | - Deirdre Murray
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Physiotherapy Department, Beaumont Hospital, Dublin, Ireland
| | - Roisin Vance
- Physiotherapy Department, Beaumont Hospital, Dublin, Ireland
| | - Sarah Coleman
- Physiotherapy Department, Beaumont Hospital, Dublin, Ireland
| | - Sonya McConnell
- Physiotherapy Department, Beaumont Hospital, Dublin, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Rory McConn Walsh
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Otorhinolaryngology, Beaumont Hospital, Dublin, Ireland
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Alyahya D, Kashoo FZ. Perception, knowledge, and attitude of medical doctors in Saudi Arabia about the role of physiotherapists in vestibular rehabilitation: a cross-sectional survey. PeerJ 2022; 10:e13035. [PMID: 35282282 PMCID: PMC8908887 DOI: 10.7717/peerj.13035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/08/2022] [Indexed: 01/11/2023] Open
Abstract
Objectives There is compelling scientific evidence about the role of physiotherapists in vestibular rehabilitation. However, patients with vestibular-associated dizziness and balance disturbances are seldom referred to physiotherapists in Saudi Arabia. Therefore, this study aims to achieve insight into perceptions, knowledge, attitudes, and referral practices among Saudi Arabian medical doctors relating to the role of physiotherapists in vestibular rehabilitation. Methods A sample of 381 medical doctors practicing in Saudi Arabia participated in this nationwide cross-sectional study. The sample was obtained from 226 hospitals across 13 provinces of Saudi Arabia by stratified sampling method. The 23-item questionnaire developed by a team of experts was emailed to medical doctors practicing in various hospitals across Saudi Arabia. Results Out of 1,231 medical doctors invited, 381 medical doctors responded, giving a response rate of 30.9%. One hundred ninety-three (50.6%) medical doctors reported managing patients with vestibular rehabilitation. The most preferred specialist for managing patients with vestibular disorders was an Ear Nose Throat (ENT) specialist (n = 173, 89.6%). Related Sample Cochran's Q test showed statistically significant difference between preferred specialist for managing patients with vestibular disorders (ENT specialists, physiotherapists, nurses, occupational therapists and audiologists) (χ2(4) = 482.476, p = 0.001). Out of 193 medical doctors, 153 (79.2%) reported no role of the physiotherapist in vestibular rehabilitation. One hundred forty-five (75.1%) of medical doctors reported that they were not aware of the role of physiotherapists in vestibular rehabilitation. Only 27 (15.5%) medical doctors reported referring patients with vestibular disorders to physiotherapists. Conclusion The study reports that physiotherapy services are underutilized in vestibular rehabilitation due to limited referral from Saudi Arabian medical doctors. Therefore, there is a need to increase the awareness among Saudi Arabian doctors about the physiotherapist's role in vestibular rehabilitation.
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Marroney N, Beattie J, Hildebrand N, Flint T, Smith RM. Does training therapists to manage benign paroxysmal positional vertigo in patients with acute traumatic brain injury reduce vestibular neurology referrals? Brain Inj 2022; 36:822-826. [PMID: 35133230 DOI: 10.1080/02699052.2022.2034955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Dizziness is common in patients with acute traumatic brain injury (aTBI). However, patients are not always managed by the ward team but instead are referred to a visiting vestibular neurology team or referred for outpatient follow-up. We aimed to ascertain whether training trauma ward therapists to manage a common form of post-traumatic dizziness (Benign paroxysmal positional vertigo [BPPV]) reduced referrals to a visiting vestibular neurology team. DESIGN Referrals of patients with aTBI with complaints of dizziness to the visiting vestibular neurology team were audited from the Major Trauma Centre at Imperial College Healthcare NHS Foundation Trust, London, UK. Ward therapists subsequently received training on management of BPPV. Referrals to the vestibular neurology service were re-audited. Therapist confidence in assessing and treating BPPV was also assessed pre and post-training. RESULTS Pre-training, referral rate to the visiting vestibular neurology service was eight patients per month. Following training, referrals to the vestibular neurology service reduced by 35%. Therapist confidence improved significantly following training. CONCLUSIONS Training trauma ward therapists to manage BPPV reduced referrals to a visiting vestibular neurology service. Further research is necessary to assess implications for service and patient level parameters, such as length of stay and time to discharge.
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Affiliation(s)
- Natalie Marroney
- Physiotherapy Department, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Jenna Beattie
- Occupational Therapy Department, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Natalie Hildebrand
- Physiotherapy Department, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Thomas Flint
- Physiotherapy Department, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Rebecca M Smith
- Brain and Vestibular Group, Neuro-otology Unit, Department of Brain Sciences, Imperial College London, London, UK
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The utilization and demographic characteristics of in-hospital rehabilitation for acute vestibular neuritis in Japan. Auris Nasus Larynx 2022; 49:762-767. [DOI: 10.1016/j.anl.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 11/21/2022]
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García-Muñoz C, Casuso-Holgado MJ, Hernández-Rodríguez JC, Pinero-Pinto E, Palomo-Carrión R, Cortés-Vega MD. Feasibility and safety of an immersive virtual reality-based vestibular rehabilitation programme in people with multiple sclerosis experiencing vestibular impairment: a protocol for a pilot randomised controlled trial. BMJ Open 2021; 11:e051478. [PMID: 34810187 PMCID: PMC8609940 DOI: 10.1136/bmjopen-2021-051478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/22/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Vestibular system damage in patients with multiple sclerosis (MS) may have a central and/or peripheral origin. Subsequent vestibular impairments may contribute to dizziness, balance disorders and fatigue in this population. Vestibular rehabilitation targeting vestibular impairments may improve these symptoms. Furthermore, as a successful tool in neurological rehabilitation, immersive virtual reality (VRi) could also be implemented within a vestibular rehabilitation intervention. METHODS AND ANALYSIS This protocol describes a parallel-arm, pilot randomised controlled trial, with blinded assessments, in 30 patients with MS with vestibular impairment (Dizziness Handicap Inventory ≥16). The experimental group will receive a VRi vestibular rehabilitation intervention based on the conventional Cawthorne-Cooksey protocol; the control group will perform the conventional protocol. The duration of the intervention in both groups will be 7 weeks (20 sessions, 3 sessions/week). The primary outcomes are the feasibility and safety of the vestibular VRi intervention in patients with MS. Secondary outcome measures are dizziness symptoms, balance performance, fatigue and quality of life. Quantitative assessment will be carried out at baseline (T0), immediately after intervention (T1), and after a follow-up period of 3 and 6 months (T2 and T3). Additionally, in order to further examine the feasibility of the intervention, a qualitative assessment will be performed at T1. ETHICS AND DISSEMINATION The study was approved by the Andalusian Review Board and Ethics Committee, Virgen Macarena-Virgen del Rocio Hospitals (ID 2148-N-19, 25 March 2020). Informed consent will be collected from participants who wish to participate in the research. The results of this research will be disseminated by publication in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT04497025.
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Affiliation(s)
| | | | | | | | - Rocío Palomo-Carrión
- Department of Nursery, Physiotherapy and Occupational Therapy, University of Castilla-La Mancha, Toledo, Spain
- GIFTO, Physiotherapy Research Group, Toledo, Spain
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Mikkonen J, Leinonen V, Luomajoki H, Kaski D, Kupari S, Tarvainen M, Selander T, Airaksinen O. Cross-Cultural Adaptation, Reliability, and Psychophysical Validation of the Pain and Sleep Questionnaire Three-Item Index in Finnish. J Clin Med 2021; 10:jcm10214887. [PMID: 34768407 PMCID: PMC8584796 DOI: 10.3390/jcm10214887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/17/2021] [Accepted: 10/20/2021] [Indexed: 12/28/2022] Open
Abstract
Reciprocal relationships between chronic musculoskeletal pain and various sleep disturbances are well established. The Pain and Sleep Questionnaire three-item index (PSQ-3) is a concise, valid, and reliable patient-reported outcome measure (PROM) that directly evaluates how sleep is affected by chronic low back pain (CLBP). Translation and cross-cultural validation of The Pain and Sleep Questionnaire three-item index Finnish version (PSQ-3-FI) were conducted according to established guidelines. The validation sample was 229 subjects, including 42 pain-free controls and 187 subjects with chronic musculoskeletal pain. Our aims were to evaluate internal consistency, test-retest reliability, measurement error, structural validity, convergent validity, and discriminative validity and, furthermore, to study the relationships between dizziness, postural control on a force plate, and objective sleep quality metrics and total PSQ-3-FI score. The PSQ-3-FI demonstrated good internal consistency, excellent test-retest reliability, and small measurement error. Confirmatory factor analysis confirmed acceptable fit indices to a one-factor model. Convergent validity indicated fair to good correlation with pain history and well-established pain-related PROMs. The PSQ-3-FI total score successfully distinguished between the groups with no pain, single-site pain, and multisite pain. A higher prevalence of dizziness, more impaired postural control, and a general trend towards poorer sleep quality were observed among subjects with higher PSQ-3-FI scores. Postural control instability was more evident in eyes-open tests. The Finnish PSQ-3 translation was successfully cross-culturally adapted and validated. The PSQ-3-FI appears to be a valid and reliable PROM for the Finnish-speaking CLBP population. More widespread implementation of PSQ-3 would lead to better understanding of the direct effects of pain on sleep.
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Affiliation(s)
- Jani Mikkonen
- Private Practice, Helsinki, Finland
- Department of Surgery (Incl. Physiatry), Institute of Clinical Medicine, University of Eastern Finland, 70211 Kuopio, Finland;
- Correspondence:
| | - Ville Leinonen
- Institute of Clinical Medicine-Neurosurgery, University of Eastern Finland, 70211 Kuopio, Finland;
- Department of Neurosurgery, Kuopio University Hospital,70211 Kuopio, Finland
| | - Hannu Luomajoki
- ZHAW School of Health Professions, Zurich University of Applied Sciences, CH-8401 Winterthur, Switzerland;
| | - Diego Kaski
- Department of Clinical and Movement Neurosciences, University College London, London WC1E 6BT, UK;
| | - Saana Kupari
- Department of Applied Physics, University of Eastern Finland, 70211 Kuopio, Finland; (S.K.); (M.T.)
| | - Mika Tarvainen
- Department of Applied Physics, University of Eastern Finland, 70211 Kuopio, Finland; (S.K.); (M.T.)
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, 70211 Kuopio, Finland
| | - Tuomas Selander
- Science Service Center, Kuopio University Hospital, 70211 Kuopio, Finland;
| | - Olavi Airaksinen
- Department of Surgery (Incl. Physiatry), Institute of Clinical Medicine, University of Eastern Finland, 70211 Kuopio, Finland;
- Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, 70211 Kuopio, Finland
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García-Muñoz C, Cortés-Vega MD, Hernández-Rodríguez JC, Fernández-Seguín LM, Escobio-Prieto I, Casuso-Holgado MJ. Immersive Virtual Reality and Vestibular Rehabilitation in Multiple Sclerosis: Case Report. JMIR Serious Games 2021; 10:e31020. [PMID: 34766551 PMCID: PMC8892276 DOI: 10.2196/31020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/07/2021] [Accepted: 10/12/2021] [Indexed: 02/06/2023] Open
Abstract
Background Dizziness and imbalance are common and disabling symptoms in patients with multiple sclerosis (MS) and are caused by a central, peripheral, or mixed vestibulopathy. Central vestibular disorder is the most frequently reported vestibular problem in the MS population due to demyelination. Vestibular rehabilitation ameliorates these symptoms and their repercussions and improves quality of life. Immersive virtual reality (VRi) is an emerging tool in this field; however, no previous research has been performed studying its effects in MS. Objective The aim of this study was to apply a VRi vestibular training protocol to a patient with MS and assess the effects induced by the experimental intervention. Methods This case study included a 54-year-old woman with relapsing-remitting MS. We developed a standardized VRi exercise protocol for vestibular rehabilitation based on the gold-standard Cawthorne-Cooksey vestibular training protocol. The 20-session intervention was made up of 10 initial sessions and 10 advanced sessions. Each 50-minute session was performed two to three times per week for 7 weeks. Four evaluations were carried out over the study period: at baseline (T0), between initial and advances phases (T1), postintervention (T2), and 1 month after the experimental procedure (T3). The research outcomes were dizziness, balance, gait, impact of fatigue, quality of life, repercussions in muscular tone, and usability of the head-mounted display device. Results After implementing the VRi vestibular protocol, improvements were seen in the following patient parameters: Dizziness Handicap Inventory score (62 points at T0; 4 points at T2); Berg Balance Scale score (47 points at T0; 54 points at T2); instrumented Timed Up and Go time (8.35 seconds at T0; 5.57 seconds at T2); muscular tone of the erector spinae, rectus femoris, and soleus; Modified Fatigue Impact Scale score (61 points at T0; 37 points at T2); and Multiple Sclerosis Quality of Life-54 values (67.16% in the physical health area at T2; 33.56% in the mental health area at T2). The patient rated the usability of the system as 90%, based on the System Usability Scale, and gave the system a grade of A. Conclusions Although further research is needed, this study provided initial evidence that the first VRi vestibular protocol for the MS population can improve dizziness, balance, gait, impact of fatigue, quality of life, and muscular tone through an exergame intervention. This study may help establish a standardized VRi protocol for vestibular rehabilitation.
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Affiliation(s)
- Cristina García-Muñoz
- Physiotherapy Department. Faculty of Nursing, Physiotherapy and Podiatry., University of Seville, C/ Avicena S/N, Seville, ES
| | - María-Dolores Cortés-Vega
- Physiotherapy Department. Faculty of Nursing, Physiotherapy and Podiatry., University of Seville, C/ Avicena S/N, Seville, ES
| | | | - Lourdes M Fernández-Seguín
- Physiotherapy Department. Faculty of Nursing, Physiotherapy and Podiatry., University of Seville, C/ Avicena S/N, Seville, ES
| | - Isabel Escobio-Prieto
- Physiotherapy Department. Faculty of Nursing, Physiotherapy and Podiatry., University of Seville, C/ Avicena S/N, Seville, ES
| | - María Jesús Casuso-Holgado
- Physiotherapy Department. Faculty of Nursing, Physiotherapy and Podiatry., University of Seville, C/ Avicena S/N, Seville, ES
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A review of primary care referrals for patients with dizziness and vertigo: prevalence and demographics. Ir J Med Sci 2021; 191:385-389. [PMID: 33675015 DOI: 10.1007/s11845-021-02575-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/26/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND International studies show that dizziness and vertigo are a significant burden on the general population, with 20-30% experiencing symptoms over a lifetime. There are no Irish studies indicating prevalence. The aim of this study was to review primary care referrals for patients with dizziness and vertigo to an otolaryngology tertiary centre. METHODS A review of an out-patient department waiting list was performed on primary care referrals for dizziness and vertigo to an otolaryngology tertiary centre. Demographic information was recorded on all patients referred between May 2017 and August 2019. RESULTS Two hundred fifteen patients out of 901 patients (24%) referred to an otologist between May 2017 and August 2019 were referred with dizziness as a presenting complaint. The average age was 51 years. F/M ratio was 3:2. The average waiting time was 441 days. The most common associated otological symptom was tinnitus (42%). Relevant comorbidities included anxiety, depression, migraine/headaches and cardiac disease. CONCLUSION This study demonstrates that a significant number of patients referred to an otologist from primary care are referred with dizziness and vertigo and supports the need for the establishment of multi-disciplinary vestibular/balance centres to address and manage these patients.
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Zamyslowska-Szmytke E, Politanski P, Jozefowicz-Korczynska M. Dizziness Handicap Inventory in Clinical Evaluation of Dizzy Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052210. [PMID: 33668099 PMCID: PMC7956648 DOI: 10.3390/ijerph18052210] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/29/2022]
Abstract
(1) Objectives: The evaluation of dizzy patients is difficult due to nonspecific symptoms that require a multi-specialist approach. The Dizziness Handicap Inventory (DHI) is widely used in the assessment of dizziness-related disability, but its clinical efficacy needs further expansion. The aim of this study was to identify the subscales of DHI that may correlate with some vestibular or nonvestibular dysfunctions. (2) Material and methods: This observational study included 343 dizzy patients with one of the following clinical conditions: Vestibular impairment noncompensated or compensated, central or bilateral, benign paroxysmal positional vertigo (BPPV), migraine and psychogenic dizziness. Principal component analysis was used to examine the factorial structure of the questionnaire. (3) Results: The DHI questionnaire total scoring and its vestibular subscale distinguished between patients with compensated and uncompensated vestibular dysfunction with positive predictive values of 76% and 79%, respectively. The DHI items composing the F3 (positional) subscale revealed the highest scoring in the BPPV group with 75% sensitivity and 92% negative predictive value (NPV) in reference to Dix–Hallpike tests. The DHI total score and the subscales scores correlated with anxiety-depression, and the highest correlation coefficients were calculated for vestibular (F2 0.56) and anxiety (F5 0.51) subscales. (4) Conclusions: Our analysis revealed that the DHI vestibular subscale distinguishes between patients with compensated and uncompensated vestibular dysfunction. The positional subscale showed the highest scoring in the BPPV group with high sensitivity and low specificity of the test. The DHI is highly correlated with patients’ psychological status.
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Affiliation(s)
- Ewa Zamyslowska-Szmytke
- Balance Disorders Unit, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland
- Correspondence: ; Tel.: +48-42-6314748
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