Toward a Digital Health Intervention for Vestibular Rehabilitation: Usability and Subjective Outcomes of a Novel Platform

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.

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

“…D'Silva et al reported that their older female participants (aged 60–74 years) found that the Vestibular Rehabilitation App TM was easy to learn in a single session, the game format was enjoyable due to the graphics and colors, the score was motivating, and the game feedback would improve performance ( 27 ). Likewise, Meldrum et al reported that participants with dizziness (mean age = 59 years, range: 38–76 years) found a digital VRT app to be easy to use (SUS = 82.7 = A), useful in learning about their vestibular condition, and enjoyable due to the color scheme and clear layout ( 28 ). Developers of technology based VRT, do need to consider adult preferences in their game design.…”

“…Experienced VRT clinician participants felt that a VRT app should include features to record and track head/eye movement, monitor symptoms, score the accuracy of task performance, and measure and improve adherence to a prescribed home exercise program. Despite clinicians' desire to be able to track both head and eye movements, to date most VRT apps only monitor head movement ( 27 , 28 ); thus, the ability to assess accurate performance of gaze stabilization exercises is limited. To the best of our knowledge, VestAid is the only other VRT system in development to monitor eye movement ( 30 ).…”

How do patients with chronic dizziness experience a web-based home rehabilitation programme for customised vestibular therapy ('WeBaVeR')? A qualitative study

“…Thus, telemedicine -with the recent covid-19 pandemic -is getting more attention than ever before [48][49][50]. The benefits include making healthcare more accessible and reducing patient costs.…”

Effectiveness of Telerehabilitation in Dizziness: A Systematic Review with Meta-Analysis

“…The secondary outcomes included improvement of quality of life measured with the Dizziness Handicap Inventory (DHI) [46] and psychological impairments such as anxiety and depression measured with the Patient Health Questionnaire (PHQ) subscale [47], Hospital Anxiety and Depression Scale (HADS) [48][49][50], Generalized Anxiety Disorder assessment (GAD-7) [51] and Beck Depression Inventory Scale (BDI-II) [52,53]. More in detail, the Dizziness Handicap Inventory (DHI) and Vertigo Symptom Scale-short form (VSS-SF) are among the most commonly cited PRO instruments in clinical vestibular research [54], with the former one widely used even in the clinical context [41]. Whilst DHI explores each of the three ICF domains (activity, participation, body function and structures), VSS-SF focuses only on "body functions and structures" [54].…”

“…While there is an increasing number of available studies on the evaluation [36,37] and management of dizziness through telemedicine [38,39], systematic reviews investigating the effectiveness of telerehabilitation in dizziness are still lacking, despite promising prospects [40,41] and the spread of TR services [27,28]. Therefore, this systematic review had two primary objectives: firstly, to provide an up-to-date overview of the topic, and secondly, to conduct a quantitative assessment of the effectiveness of telerehabilitation in treating dizziness.…”