Remote assessment and management of patients with dizziness: development, validation, and feasibility of a gamified vestibular rehabilitation therapy platform.

Autor:	Hall CD; Mountain Home Hearing and Balance Research Program, James H. Quillen Veterans Affairs Medical Center, Mountain Home, TN, United States.; Physical Therapy Program, College of Clinical and Rehabilitative Health Sciences, East Tennessee State University, Johnson City, TN, United States., Flynn S; Blue Marble Health, Altadena, CA, United States., Clendaniel RA; Department of Orthopedic Surgery, Physical Therapy Division, Duke University Medical Center, Durham, NC, United States.; Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC, United States., Roberts DC; Department of Neurology, Johns Hopkins University, Baltimore, MD, United States., Stressman KD; Mountain Home Hearing and Balance Research Program, James H. Quillen Veterans Affairs Medical Center, Mountain Home, TN, United States., Pu W; Blue Marble Health, Altadena, CA, United States., Mershon D; Blue Marble Health, Altadena, CA, United States., Schubert MC; Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, United States.
Jazyk:	angličtina
Zdroj:	Frontiers in neurology [Front Neurol] 2024 May 30; Vol. 15, pp. 1367582. Date of Electronic Publication: 2024 May 30 (Print Publication: 2024).
DOI:	10.3389/fneur.2024.1367582
Abstrakt:	Introduction: Dizziness is a growing public health concern with as many as 95 million adults in Europe and the United States experiencing vestibular hypofunction, which is associated with reduced quality of life, poorer health, and falls. Vestibular rehabilitation therapy (VRT) is effective in reducing symptoms and improving balance; however, limited access to qualified clinicians and poor patient adherence impedes optimal delivery. The goal of this study was to develop and evaluate the feasibility of a remote therapeutic monitoring VRT Platform application (APP) for the assessment and treatment of vestibular dysfunction. Methods: User-centered iterative design process was used to gather and integrate the needs of users (clinicians and patients) into the design at each stage of development. Commonly used vestibular patient-reported outcome measures (PROs) were integrated into the APP and adults with chronic dizziness were enrolled to evaluate validity and reliability of the APP compared to standard clinical measures (CLIN). Gaze stabilization exercises were gamified to provide an engaging experience and an off-the-shelf sensor captured eye and head movement to provide feedback on accuracy of performance. A prospective, pilot study design with pre-and post-treatment assessment assessed feasibility of the APP compared to standard VRT (CLIN). Results: Participants with dizziness wanted a summary rehabilitation report shared with their clinicians, felt that an app could help with accountability, and believed that a gaming format might help with exercise adherence. Clinicians felt that the app should include features to record and track eye and head movement, monitor symptoms, score accuracy of task performance, and measure adherence. Validity and reliability of the digital PROs (APP) were compared to scores from CLIN across two sessions and found to have good validity, good to excellent test-retest reliability, and excellent usability (≥88%ile). The pilot study demonstrated feasibility for use of the APP compared to CLIN for treatment of vestibular hypofunction. The mean standard system usability score of the APP was 82.5 indicating excellent usability. Discussion: Both adult patients with chronic dizziness and VRT clinicians were receptive to the use of technology for VRT. The HiM-V APP is a feasible alternative to clinical management of adults with chronic peripheral vestibular hypofunction. Competing Interests: This research will be commercialized, and SF is the CEO of Blue Marble Health Co. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision. (Copyright © 2024 Hall, Flynn, Clendaniel, Roberts, Stressman, Pu, Mershon and Schubert.)
Databáze:	MEDLINE
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