Economic burden of vertigo: a systematic review

[Unclear chronic vertigo syndromes-experiences with an interdisciplinary inpatient diagnostic concept]

Schwindel ist ein häufiges Leitsymptom. Insbesondere Patienten mit chronischen Schwindelsyndromen erleben eine deutliche Beeinträchtigung der Lebensqualität und bei Berufstätigen eine Einschränkung der Arbeitsfähigkeit. Folgen sind finanzielle und kapazitive Belastungen des Gesundheitssystems aufgrund von häufigen Mehrfachuntersuchungen und Krankschreibungen bis hin zur Erwerbsunfähigkeit der Betroffenen. Bei 150 Patienten mit in der ambulanten Diagnostik unklaren chronischen Schwindelsyndromen wurde auf der Grundlage eines strukturierten interdisziplinären stationären Diagnostikkonzepts bei über 90 % der Fälle mindestens eine die Beschwerden begründende Diagnose erhoben. Chronische Schwindelsyndrome sind häufig multifaktoriell bedingt. Bei mehr als der Hälfte der Patienten fanden sich u. a. psychosomatische (Begleit‑)Diagnosen. Zielführende therapeutische Empfehlungen können nur diagnosespezifisch erfolgen, weshalb in dauerhaft unklaren Fällen auch die Abklärung im Rahmen eines interdisziplinären stationären Diagnostikkonzepts sinnvoll und gerechtfertigt sein kann.

eHealth for Addressing Balance Disorders in the Elderly: Systematic Review

Background

The population is aging on a global scale, triggering vulnerability for chronic multimorbidity, balance disorders, and falls. Falls with injuries are the main cause of accidental death in the elderly population, representing a relevant public health problem. Balance disorder is a major risk factor for falling and represents one of the most frequent reasons for health care demand. The use of information and communication technologies to support distance healthcare (eHealth) represents an opportunity to improve the access and quality of health care services for the elderly. In recent years, several studies have addressed the potential of eHealth devices to assess the balance and risk of falling of elderly people. Remote rehabilitation has also been explored. However, the clinical applicability of these digital solutions for elderly people with balance disorders remains to be studied.

Objective

The aim of this review was to guide the clinical applicability of eHealth devices in providing the screening, assessment, and treatment of elderly people with balance disorders, but without neurological disease.

Methods

A systematic review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement. Data were obtained through searching the PubMed, Google Scholar, Embase, and SciELO databases. Only randomized controlled trials (RCTs) or quasiexperimental studies (QESs) published between January 2015 and December 2019 were included. The quality of the evidence to respond to the research question was assessed using Joanna Briggs Institute (JBI) Critical Appraisal for RCTs and the JBI Critical Appraisal Checklist for QESs. RCTs were assessed using the Cochrane risk of bias tool. We provide a narrative synthesis of the main outcomes from the included studies.

Results

Among 1030 unduplicated articles retrieved, 21 articles were included in this review. Twelve studies explored different technology devices to obtain data about balance and risk of falling. Nine studies focused on different types of balance exercise training. A wide range of clinical tests, functional scales, classifications of faller participants, sensor-based tasks, intervention protocols, and follow-up times were used. Only one study described the clinical conditions of the participants. Instrumental tests of the inner ear were neither used as the gold-standard test nor performed in pre and postrehabilitation assessments.

Conclusions

eHealth has potential for providing additional health care to elderly people with balance disorder and risk of falling. In the included literature, the heterogeneity of populations under study, methodologies, eHealth devices, and time of follow-up did not allow for clear comparison to guide proper clinical applicability. This suggests that more rigorous studies are needed.

Clinical Techniques and Technology: Vestibular Telemetry

When a patient presents to a clinician with dizziness, it can be difficult for the patient to describe their symptoms in a clear manner, and clinical examination often yields entirely normal results. Ideally, it would be favorable to measure key physiological parameters during their episodes of dizziness. From a clinical perspective, this would allow a more timely and more accurate diagnosis. From a research perspective, it would allow a greater understanding of how the vestibular system malfunctions as a consequence of vestibular disease. The authors of this report have been funded by the UK Medical Research Council to develop and test a novel technology to measure, record, and analyze key physiological parameters provided by the dizzy individual during an episode of dizziness while active in the community. We provide the context to evolving work in this field, the outcome of preliminary studies, and a consideration of future opportunities.

Usefulness of Mobile Devices in the Diagnosis and Rehabilitation of Patients with Dizziness and Balance Disorders: A State of the Art Review

Objective

The gold standard for objective body posture examination is posturography. Body movements are detected through the use of force platforms that assess static and dynamic balance (conventional posturography). In recent years, new technologies like wearable sensors (mobile posturography) have been applied during complex dynamic activities to diagnose and rehabilitate balance disorders. They are used in healthy people, especially in the aging population, for detecting falls in the older adults, in the rehabilitation of different neurological, osteoarticular, and muscular system diseases, and in vestibular disorders. Mobile devices are portable, lightweight, and less expensive than conventional posturography. The vibrotactile system can consist of an accelerometer (linear acceleration measurement), gyroscopes (angular acceleration measurement), and magnetometers (heading measurement, relative to the Earth’s magnetic field). The sensors may be mounted to the trunk (most often in the lumbar region of the spine, and the pelvis), wrists, arms, sternum, feet, or shins. Some static and dynamic clinical tests have been performed with the use of wearable sensors. Smartphones are widely used as a mobile computing platform and to evaluate the results or monitor the patient during the movement and rehabilitation. There are various mobile applications for smartphone-based balance systems. Future research should focus on validating the sensitivity and reliability of mobile device measurements compared to conventional posturography.

Conclusion

Smartphone based mobile devices are limited to one sensor lumbar level posturography and offer basic clinical evaluation. Single or multi sensor mobile posturography is available from different manufacturers and offers single to multi-level measurements, providing more data and in some instances even performing sophisticated clinical balance tests.

Assessment, diagnosis and management of the dizzy patient

Dizziness and balance disorders are very common problems. Having a structured approach, including adequate history taking and clinical examination, in a multidisciplinary environment allows for effective management of patients with these complex symptoms. Hearing assessment is an integral part of the assessment of patients with dizziness, along with the occasional need for further testing. Identifying red flags, along with the ability to involve different medical specialties, are prerequisites for safe management and a successful outcome. While surgical intervention has a small role in the management of balance disorders, vestibular rehabilitation remains the cornerstone of treatment, along with different supportive measures. This article outlines the approach used in the authors' centre to manage patients with dizziness and balance disorders.

Moxibustion for cervical vertigo: A protocol for a systematic review and meta-analysis

BACKGROUND

This systematic review is designed to provide an assessment of the effectiveness and safety of moxibustion therapy for cervical vertigo (CV).

METHODS

Relevant randomized controlled trials (RCTs) will be searched from the databases of PubMed, the Cochrane Library, Embase, the China National Knowledge Infrastructure, Wanfang Database, Chinese Science and Technology Periodical Database, and Chinese Biomedical Literature Database from their inception to June 2020. Two authors will independently select studies, collect data, and assess the methodology quality by the Cochrane risk of bias tool. RevMan V.5.3 software will be used for statistical analysis.

RESULTS

The results of this study will provide an assessment of the current state of moxibustion for CV and aim to prove the effectiveness and safety of moxibustion therapy.

CONCLUSION

This systematic review will provide a credible Evidence-based for the treatment of CV with moxibustion.

STUDY REGISTRATION NUMBER

INPLASY202060004.

Computerized clinical decision system and mobile application with expert support to optimize management of vertigo in primary care: study protocol for a pragmatic cluster-randomized controlled trial

Vertigo and dizziness are amongst the most common symptoms in medicine and often have a major impact on activities of daily life. Although many causes of vertigo and dizziness can easily be recognized, patients often receive inappropriate and ineffective treatment. The reasons for this are various. Because vertigo/dizziness is an interdisciplinary symptom and there is a lack of standardised diagnostic tools, it is easy to lose the overview of the possible differential diagnoses. There is evidence though, that the management of patients with vertigo/dizziness can be optimized using standardized care pathways with digital support. The present study (within the framework of “PoiSe—prevention, online feedback, and interdisciplinary therapy of acute vestibular syndromes by e-health”) aims to evaluate the implementation of a program with several interlocking components. The three main components are a computerized clinical decision system, a mobile application, a counselling and interdisciplinary educational program developed by the German Center for Vertigo and Balance Disorders (DSGZ). The study is a cluster-randomized controlled trial with a parallel-group design, as well as a detailed process evaluation. Clusters comprise of primary care physician practices in Bavaria, Germany. In the scope of the study the effectiveness, acceptability and efficiency of the intervention will be evaluated. It is anticipated that the intervention will improve the quality and efficiency of the management of dizzy patients. A higher diagnostic accuracy, optimized treatment, and disease progression monitoring is expected to improve patient-relevant outcomes and reduce health-care costs.

Seasonality and Cardio-Cerebrovascular Risk Factors for Benign Paroxysmal Positional Vertigo

Background: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, especially in the elderly. Several studies have revealed a possible seasonality to BPPV. However, whether the seasonality of BPPV also exists in China is unclear. The characteristics of cardio-cerebrovascular risk factors for BPPV in the cold season have not yet been investigated. Objectives: (1) To investigate the seasonality of BPPV; (2) To explore the relationship between cardio-cerebrovascular risk factors and seasonality of BPPV. Methods: A retrospective observational study was performed in Beijing Tiantan Hospital from Jan 2016 to Dec 2018. The study included 1,409 new-onset BPPV patients aged 18-88 years. The demographic data, onset time, and medical history of BPPV were collected. The meteorological data, including temperature, atmospheric pressure, rainfall, and insolation, was obtained from Beijing Meteorological service. The x ² goodness of fit test was used to evaluate whether BPPV patients' numbers were significantly different among different months of the year. The Spearman correlation was used to detect the correlation between numbers of BPPV patients diagnosed monthly with each climatic parameter. The chi-square test for linear-by-linear association were used to investigate the relationship between cardio-cerebrovascular risk factor and seasonality of BPPV. Results: November to next March is the top 5 months with higher BPPV patient numbers (P < 0.001). The numbers of BPPV diagnosed monthly were conversely correlated with temperature and rainfall (r = -0.736, P = 0.010; r = -0.650, P = 0.022, respectively), positively correlated with atmospheric pressure (r = 0.708, P = 0.010), but no significant correlated with insolation. BPPV in the cold season (including January, February, March, November, and December) had a higher proportion, accounting for 54.2% of all BPPV patients. Among BPPV patients with ≥2, 1, and none cardio-cerebrovascular risk factors, the cold season accounted for 57.0, 56.0, 49.8%, respectively. As the number of cardio-cerebrovascular risk factors increased, the proportion of patients in the cold season of BPPV increased (P = 0.025). Conclusions: BPPV patients are seen more in the months with low temperature, low rainfall, and high atmospheric pressure. Compared with the non-cold season, BPPV patients have more risk factors for cardio-cerebrovascular diseases in the cold season.