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Kostelnik EO, Howard LM, Paulson JF. Mental Health Education and Utilization Among Patients with Vestibular Disorders. J Clin Psychol Med Settings 2024:10.1007/s10880-024-10022-8. [PMID: 38762705 DOI: 10.1007/s10880-024-10022-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/20/2024]
Abstract
To explore the receipt of mental health education, assessment, and referrals, and mental health service use among individuals with vestibular disorders. Patients with vestibular disorders living in the US, Australia, Canada, and the UK were surveyed through social media forums. Questionnaires assessed demographics, anxiety (Generalized Anxiety Disorder-7), depression (Center for Epidemiological Studies Depression-10), dizziness (Dizziness Handicap Inventory), and type of professional providing mental health education, assessment, referral, and treatment. The 226 participants were largely White (90%), educated (67% holding an associate's degree or higher) women (88%) with an average age of 45 who self-identified as having chronic vestibular symptoms (78%), as opposed to episodic ones (22%). Fifty-two percent reported never receiving verbal education, written education (69%), mental health assessment (54%), or referral (72%). Participants were more likely to receive mental health treatment in the past if they had received verbal resources and/or referrals from clinicians. The majority of patients with vestibular disorders report that medical professionals have not provided education, mental health assessment, or a mental health referral.
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Affiliation(s)
| | - Lindsay M Howard
- Department of Psychology, Augustana University, Madsen Center 131, 2001 S Summit Ave, Sioux Falls, SD, 57197, USA.
| | - James F Paulson
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
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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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Kunelskay NL, Ivanova GE, Baybakova EV, Guseva AL, Parfenov VA, Zamergrad MV, Zaitseva OV, Melnikov OA, Shmonin AA, Maltseva MN. [Vestibular rehabilitation for peripheral vestibular hypofunction: an interdisciplinary consensus]. Vestn Otorinolaringol 2024; 89:52-63. [PMID: 38506027 DOI: 10.17116/otorino20248901152] [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: 03/21/2024]
Abstract
The literature review presents approaches to the management of patients with vestibular disorders. The principles of organization of vestibular rehabilitation in peripheral vestibular hypofunction, indications for appointment, factors influencing its implementation, technique, methods of evaluating effectiveness are considered in detail. Attention is drawn to the fact that the selection of exercises and the duration of vestibular rehabilitation is carried out individually and depends on many factors, including the nature of vestibular deficiency and the specific characteristics of the patient. The possibilities of using additional pharmacological therapy with histamine preparations, which can accelerate the onset of vestibular compensation, are shown. It is noted that vestibular rehabilitation is a safe and effective method of treating peripheral vestibular hypofunction and should be recommended to patients of all ages with vestibular disorders leading to limited social and physical activity.
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Affiliation(s)
- N L Kunelskay
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - G E Ivanova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E V Baybakova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - A L Guseva
- Pirogov Russian National Research Medical University, Moscow, Russia
- Pirogov Municipal Clinical Hospital No. 1, Moscow, Russia
| | - V A Parfenov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - M V Zamergrad
- Pirogov Russian National Research Medical University, Moscow, Russia
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - O V Zaitseva
- National Medical Research Center for Otorhinolaryngology of the FMBA of Russia, Moscow, Russia
| | | | - A A Shmonin
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| | - M N Maltseva
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
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Zhu M, van Stiphout L, Karabulut M, Pérez Fornos A, Guinand N, Meijer K, van de Berg R, McCrum C. Assessing balance in people with bilateral vestibulopathy using the Mini-Balance Evaluation Systems Test (Mini-BESTest): feasibility and comparison with healthy control data. J Neurol 2023; 270:4423-4433. [PMID: 37269353 PMCID: PMC10421784 DOI: 10.1007/s00415-023-11795-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Bilateral vestibulopathy (BVP) leads to unsteadiness when walking, which worsens in darkness or on uneven ground, as well as falls. Since simple balance tests struggle to distinguish between BVP and healthy participants, we aimed (1) to test if the Mini-BESTest is feasible in BVP, (2) how people with BVP perform on the Mini-BESTest and (3) to compare these scores with healthy reference data. METHODS Fifty participants with BVP completed the Mini-BESTest. 12-month falls incidence was obtained by questionnaire. To compare the overall and sub-scores between our participants with BVP and those of healthy participants from the literature (n = 327; obtained via PubMed searches), Mann-Whitney U tests were used. Sub scores within the BVP group were also compared. Spearman correlations were used to investigate the relationships between Mini-BESTest score and age. RESULTS No floor or ceiling effects were observed. Participants with BVP had significantly lower Mini-BESTest total scores than the healthy group. Anticipatory, reactive postural control and sensory orientation sub scores of the Mini-BESTest were significantly lower in BVP, while dynamic gait sub scores were not significantly different. A stronger negative correlation between age and Mini-BESTest total score was found in BVP than in the healthy group. Scores did not differ between patients with different falls history. CONCLUSION The Mini-BESTest is feasible in BVP. Our results confirm the commonly reported balance deficits in BVP. The stronger negative association between age and balance in BVP might reflect the age-related decline in the remaining sensory systems with which people with BVP compensate.
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Affiliation(s)
- Meichan Zhu
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
- Department of Otorhinolaryngology, Guangzhou Twelfth People's Hospital (Guangzhou Otolarynology-Head and Neck Surgery Hospital), No. 1 Tianqiang Road, Tianhe District, Guangzhou, 510620, Guangdong, China.
| | - Lisa van Stiphout
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mustafa Karabulut
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Angélica Pérez Fornos
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Nils Guinand
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Christopher McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
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Pavlou M, Costafreda SG, Galsworthy W, Korres G, Bamiou DE. The interplay between cognition, functional and dual-task gait in persons with a vestibular disorder versus healthy controls. Sci Rep 2023; 13:10130. [PMID: 37349351 PMCID: PMC10287746 DOI: 10.1038/s41598-023-35904-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 05/25/2023] [Indexed: 06/24/2023] Open
Abstract
Close links exist between vestibular function and cognition. Dual-task (DT) tests may have ecological validity to assess the impact of daily life cognitive-motor demands in people with vestibular dysfunction (PwVD), functional gait and falls risk. The present paper aimed at building predictive models for functional gait under DT conditions, while clarifying the impact of vestibular dysfunction, individual characteristics, varying task types and motor-cognitive demands. Case-controlled observational study with 39 PwVD and 62 healthy participants. The Functional Gait Assessment (FGA), with and without an additional motor, numeracy, or literacy task, was completed. Multiple linear regression was used to fit models to predict FGA under single and DT performance. Dual task cost (DTC, %) was calculated to assess DT interference on FGA performance using the equation: 100*(single task score-dual task score)/single-task score. Following Bonferroni corrections for multiple comparisons (corrected alpha level of 0.003), PwVD had poorer performance than controls for all FGA conditions (p < 0.001), motor (- 3.94%; p = 0.002) and numeracy (- 22.77%; p = 0.001) DTCs and spatial working memory (p = 0.002). The literacy DTC was marginally significant (- 19.39% p = 0.005). FGA single and DT motor, numeracy, and literacy models explained 76%, 76%, 66% and 67% of the variance respectively for PwVD. Sustained attention, visual memory and sex contributed to all models; short-term visual recognition memory, balance confidence, and migraine contributed to some models. Cognitive performance is impaired in PwVD. Motor, numeracy and literacy tasks impair functional gait performance. Cognitive assessment and FGA with a numeracy or literacy cognitive component should be included within assessment protocols and considered in the provision of targeted interventions for PwVD.
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Affiliation(s)
- Marousa Pavlou
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, Shepherd's House, Guy's Campus, London, SE1 1UL, UK.
- Department of Neuro-Otology, University College London Hospitals, London, UK.
| | - Sergi G Costafreda
- Biomedical Research Centre, University College London Hospitals, London, UK
| | - William Galsworthy
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, Shepherd's House, Guy's Campus, London, SE1 1UL, UK
| | - George Korres
- Department of Neuro-Otology, University College London Hospitals, London, UK
| | - Doris-Eva Bamiou
- Department of Neuro-Otology, University College London Hospitals, London, UK
- Ear Institute, University College London, London, UK
- Biomedical Research Centre, University College London Hospitals, London, UK
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Lilios A, Chimona T, Papadakis C, Chatziioanou I, Nikitas C, Skoulakis C. Different Vestibular Rehabilitation Modalities in Unilateral Vestibular Hypofunction: A Prospective Study. Otol Neurotol 2023; 44:e246-e255. [PMID: 36946364 DOI: 10.1097/mao.0000000000003836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To assess the effectiveness of three vestibular rehabilitation protocols in patients with chronic unilateral vestibular hypofunction. STUDY DESIGN Prospective randomized trial. SETTING Audiology-neurootology laboratory in a general public hospital. PATIENTS Eighty-one patients were randomly allocated into three groups: adaptation exercises (AEs), habituation exercises (HEs), and combined exercises (AE-HEs). INTERVENTIONS Each patient completed an 8-week vestibular rehabilitation program with exercise, depending on their allocation group. MAIN OUTCOME MEASURES Evaluations performed at baseline, 4 weeks, and 8 weeks with (a) Functional Gait Assessment (FGA), (b) Mini-BESTest, (c) Vestibular Rehabilitation Benefit Questionnaire, and (d) Dizziness Handicap Inventory. RESULTS FGA and Mini-BESTest scores showed significant improvement between the baseline and 8-week scores in all groups (p < 0.001), except for the FGA score in the HE group. The AE-HE group showed better scores for all measurements at 4 weeks and had significantly better FGA and Mini-BESTest scores than the AE group and better FGA scores than the HE group. The Vestibular Rehabilitation Benefit Questionnaire and Dizziness Handicap Inventory scores in the AE-HE group were significantly better (p ≤ 0.001) than those in the HE group at 8 weeks. CONCLUSIONS The AE-HE group showed faster improvement and significantly better outcomes for static balance, dynamic postural stability, and self-perceived disability than the single-exercise protocols in chronic unilateral vestibular hypofunction.
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Affiliation(s)
| | - Theognosia Chimona
- Otolaryngology, Head & Neck Surgery Department, Chania General Hospital, Chania, Greece
| | - Chariton Papadakis
- Otolaryngology, Head & Neck Surgery Department, Chania General Hospital, Chania, Greece
| | - Ioannis Chatziioanou
- Otolaryngology, Head & Neck Surgery Department, University Hospital of Larisa, Larisa, Greece
| | - Christos Nikitas
- 1st Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General Hospital, Athens, Greece
| | - Charalambos Skoulakis
- Otolaryngology, Head & Neck Surgery Department, University Hospital of Larisa, Larisa, Greece
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Sedeño-Vidal A, Hita-Contreras F, Montilla-Ibáñez MA. The Effects of Vestibular Rehabilitation and Manual Therapy on Patients with Unilateral Vestibular Dysfunction: A Randomized and Controlled Clinical Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15080. [PMID: 36429797 PMCID: PMC9690966 DOI: 10.3390/ijerph192215080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/05/2022] [Accepted: 11/12/2022] [Indexed: 06/16/2023]
Abstract
(1) Objective: To determine the effect of a directed vestibular rehabilitation therapy (VRT) program with manual therapy (MT) on dizziness-related disability and imbalance symptoms among patients with peripheral unilateral vestibular dysfunction. (2) Methods: Eighty patients (54.75 ± 1.34 years) were allocated either to a control group (n = 40), who underwent a directed VRT program, or to an experimental group (n = 40), who received the same program plus MT once a week/4 weeks. We assessed their level of disability (Dizziness Handicap Inventory, DHI), balance confidence (the Activities-specific Balance Confidence scale-16 items), postural balance (resistive multisensor platform), and the frequency and intensity of dizziness symptoms (visual analog scale). (3) Results: Post-intervention between-group improvements were observed regarding DHI total score and intensity in the experimental group (p < 0.001), as well as four weeks later. Six months after, the experimental group exhibited improvements in the center of pressure velocity with eyes open (p = 0.019), DHI total score (p = 0.001) and subscales (all p < 0.05), and intensity (p = 0.003) and frequency (p = 0.010) of dizziness. Balance confidence improvements were observed 1 month (p = 0.035) and 6 months (p = 0.038) post-intervention. (4) Conclusions: Directed VRT plus MT is a safe and beneficial intervention that speeds up recovery for patients suffering from dizziness and instability derived from unilateral vestibular dysfunction.
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Affiliation(s)
- Ana Sedeño-Vidal
- Department of Health Sciences, Faculty of Health Sciences, University of Jaen, 23071 Jaen, Spain
| | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaen, 23071 Jaen, Spain
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Prevalence and Risk Factors of Sarcopenia in Patients with Dizziness. Otol Neurotol 2022; 43:e1024-e1028. [PMID: 36026597 DOI: 10.1097/mao.0000000000003650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study aimed to investigate the prevalence of sarcopenia and factors associated with sarcopenia in patients with dizziness. STUDY DESIGN This is a cross-sectional study. PATIENTS A total of 162 patients 65 years or older with the chief complaint of dizziness or vertigo (dizziness group) and 132 community-dwelling elderly (control group) were recruited during their visit to the otolaryngology clinic between May 2020 and October 2021. RESULTS Of the 162 patients with dizziness (dizziness group), 53 (32.7%) were classified as sarcopenia according to the 2019 criteria of the Asian Working Group for Sarcopenia. There were significant differences in the prevalence of sarcopenia between the dizziness group and the control group ( p < 0.01). The factors that significantly affected the sarcopenia, in order of greater odds ratio, were HADS_A, age, and DHI_Total (odds ratio = 1.223, 1.130, and 1.022, respectively). CONCLUSIONS The present study shows that (i) the prevalence of sarcopenia in patients with dizziness is higher than a community-dwelling elderly; (ii) patients with dizziness and sarcopenia have higher DHI_functional, DHI_emotional, DHI_total, and HADS_A compared with patients with dizziness but without sarcopenia; and (iii) age, HADS_A, and DHI were associated with sarcopenia in patients with dizziness.
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Pires APBDÁ, Silva TR, Torres MS, Diniz ML, Tavares MC, Gonçalves DU. Galvanic vestibular stimulation and its applications: a systematic review. Braz J Otorhinolaryngol 2022; 88 Suppl 3:S202-S211. [DOI: 10.1016/j.bjorl.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/18/2022] [Accepted: 05/30/2022] [Indexed: 11/02/2022] Open
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Ogihara H, Kamo T, Tanaka R, Azami M, Kato T, Endo M, Tsunoda R, Fushiki H. Factors affecting the outcome of vestibular rehabilitation in patients with peripheral vestibular disorders. Auris Nasus Larynx 2022; 49:950-955. [PMID: 35307238 DOI: 10.1016/j.anl.2022.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/10/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Previous studies have reported that developmental, environmental, medical, psychological, visual, and other sensory-related factors can influence the outcome of vestibular rehabilitation. However, only a few studies have used patient's daily lives as the main outcome. In addition, in some studies, rehabilitation was not supervised by a physical therapist. This study aimed to determine the factors associated with the outcome of physical-therapist-supervised vestibular rehabilitation in patients with peripheral vestibular disorders, with the impact of dizziness on quality of life as the main outcome. METHODS This retrospective cohort study included 47 patients with peripheral vestibular disorders. A physical therapist provided 40 min of vestibular rehabilitation once a week for 4 weeks. Age, sex, disease duration, Dizziness Handicap Inventory (DHI), Timed Up-and-Go test (TUG), Dynamic Gait Index (DGI), Functional Gait Assessment (FGA), Activity-Specific Balance Confidence Scale (ABC scale), and Hospital Anxiety and Depression Scale (HADS) were investigated. Multiple regression analysis was performed, with the DHI rate of change before and after the intervention as the objective variable. RESULTS Vestibular rehabilitation improved all outcomes. In the multiple regression analysis, the ABC scale was identified as a factor that significantly influenced the DHI rate of change (β = -0.428, p < 0.01). CONCLUSION A higher ABC scale score was associated with a lower DHI rate of change (i.e., better improvement). Therefore, it may be important to assess psychological aspects, especially confidence in balance, when implementing vestibular rehabilitation in patients with peripheral vestibular disorders.
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Affiliation(s)
- Hirofumi Ogihara
- Division of Physical Therapy, Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, 11-1, Imaihara, Kawanakajima-machi, Nagano-City, Nagano, 381-2227 Japan; Otolaryngology, Mejiro University Ear Institute Clinic, 320, Ukiya, Iwatsuki, Saitama-City, Saitama, 339-8501 Japan.
| | - Tomohiko Kamo
- Otolaryngology, Mejiro University Ear Institute Clinic, 320, Ukiya, Iwatsuki, Saitama-City, Saitama, 339-8501 Japan; Department of Physical Therapy, School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte-city, Saitama, 340-0145 Japan
| | - Ryozo Tanaka
- Otolaryngology, Mejiro University Ear Institute Clinic, 320, Ukiya, Iwatsuki, Saitama-City, Saitama, 339-8501 Japan; Department of Physical Therapy, Faculty of Health Sciences, Mejiro University, 320, Ukiya, Iwatsuki, Saitama-City, Saitama, 339-8501 Japan
| | - Masato Azami
- Otolaryngology, Mejiro University Ear Institute Clinic, 320, Ukiya, Iwatsuki, Saitama-City, Saitama, 339-8501 Japan; Department of Physical Therapy, School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte-city, Saitama, 340-0145 Japan
| | - Takumi Kato
- Otolaryngology, Mejiro University Ear Institute Clinic, 320, Ukiya, Iwatsuki, Saitama-City, Saitama, 339-8501 Japan
| | - Mayumi Endo
- Otolaryngology, Mejiro University Ear Institute Clinic, 320, Ukiya, Iwatsuki, Saitama-City, Saitama, 339-8501 Japan
| | - Reiko Tsunoda
- Otolaryngology, Mejiro University Ear Institute Clinic, 320, Ukiya, Iwatsuki, Saitama-City, Saitama, 339-8501 Japan
| | - Hiroaki Fushiki
- Otolaryngology, Mejiro University Ear Institute Clinic, 320, Ukiya, Iwatsuki, Saitama-City, Saitama, 339-8501 Japan
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Bryant RA, Dawson KS, Keyan D, Azevedo S, Yadav S, Tran J, Rawson N, Harvey S. Effectiveness of a Videoconferencing-Delivered Psychological Intervention for Mental Health Problems during COVID-19: A Proof-of-Concept Randomized Clinical Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:63-72. [PMID: 34875669 PMCID: PMC8820421 DOI: 10.1159/000520283] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Anxiety and depression have increased markedly during the COVID-19 pandemic. There is a lack of evidence-based strategies to address these mental health needs during the pandemic. OBJECTIVE We aim to conduct a proof-of-concept trial of the efficacy of a brief group-based psychological intervention delivered via videoconferencing for adults in Australia distressed by the pandemic. METHODS In this single-blind, parallel, randomised controlled trial, adults who screened positive for COVID-related psychological distress across Australia were randomly allocated to either a 6-session group-based program based on behavioural principles (n = 120) or enhanced usual care (EUC, n = 120). Primary outcome was total score on the Hospital Anxiety and Depression (HADS) anxiety and depression subscales assessed at baseline, 1 week posttreatment, 2 months (primary outcome time point), and 6 months after treatment, as well as secondary outcome measures of worry, sleep impairment, anhedonia, mood, and COVID-19-related stress. RESULTS Between May 20, 2020, and October 20, 2020, 240 patients were enrolled into the trial. Relative to EUC, at 2 months participants receiving intervention showed greater reduction on anxiety (mean difference, 1.4 [95% CI, 0.3 to 2.6], p = 0.01; effect size, 0.4 [95% CI, 0.1 to 0.7]) and depression (mean difference, 1.6 [95% CI, 0.4 to 2.8], p = 0.009; effect size, 0.4 [95% CI, 0.2 to 0.7]) scales. These effects were maintained at 6 months. There were also greater reductions of worry, anhedonia, COVID-19-related fears, and contamination fears. CONCLUSIONS This trial provides initial evidence that brief group-based behavioural intervention delivered via videoconferencing results in moderate reductions in common psychological problems arising during the COVID-19 pandemic. This program may offer a viable and scalable means to mitigate the rising mental health problems during the pandemic.
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Affiliation(s)
- Richard A. Bryant
- University of New South Wales, Sydney, New South Wales, Australia,Westmead Institute for Medical Research, Sydney, New South Wales, Australia,Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia,*Richard A. Bryant,
| | - Katie S. Dawson
- University of New South Wales, Sydney, New South Wales, Australia
| | - Dharani Keyan
- University of New South Wales, Sydney, New South Wales, Australia
| | - Suzanna Azevedo
- University of New South Wales, Sydney, New South Wales, Australia
| | - Srishti Yadav
- University of New South Wales, Sydney, New South Wales, Australia
| | - Jenny Tran
- University of New South Wales, Sydney, New South Wales, Australia
| | - Natasha Rawson
- University of New South Wales, Sydney, New South Wales, Australia
| | - Samuel Harvey
- University of New South Wales, Sydney, New South Wales, Australia,Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
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Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. J Neurol Phys Ther 2021; 46:118-177. [PMID: 34864777 PMCID: PMC8920012 DOI: 10.1097/npt.0000000000000382] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Uncompensated vestibular hypofunction can result in symptoms of dizziness, imbalance, and/or oscillopsia, gaze and gait instability, and impaired navigation and spatial orientation; thus, may negatively impact an individual's quality of life, ability to perform activities of daily living, drive, and work. It is estimated that one-third of adults in the United States have vestibular dysfunction and the incidence increases with age. There is strong evidence supporting vestibular physical therapy for reducing symptoms, improving gaze and postural stability, and improving function in individuals with vestibular hypofunction. The purpose of this revised clinical practice guideline is to improve quality of care and outcomes for individuals with acute, subacute, and chronic unilateral and bilateral vestibular hypofunction by providing evidence-based recommendations regarding appropriate exercises. Methods: These guidelines are a revision of the 2016 guidelines and involved a systematic review of the literature published since 2015 through June 2020 across 6 databases. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case-control series, and case series for human subjects, published in English. Sixty-seven articles were identified as relevant to this clinical practice guideline and critically appraised for level of evidence. Results: Based on strong evidence, clinicians should offer vestibular rehabilitation to adults with unilateral and bilateral vestibular hypofunction who present with impairments, activity limitations, and participation restrictions related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) to promote gaze stability. Based on moderate to strong evidence, clinicians may offer specific exercise techniques to target identified activity limitations and participation restrictions, including virtual reality or augmented sensory feedback. Based on strong evidence and in consideration of patient preference, clinicians should offer supervised vestibular rehabilitation. Based on moderate to weak evidence, clinicians may prescribe weekly clinic visits plus a home exercise program of gaze stabilization exercises consisting of a minimum of: (1) 3 times per day for a total of at least 12 minutes daily for individuals with acute/subacute unilateral vestibular hypofunction; (2) 3 to 5 times per day for a total of at least 20 minutes daily for 4 to 6 weeks for individuals with chronic unilateral vestibular hypofunction; (3) 3 to 5 times per day for a total of 20 to 40 minutes daily for approximately 5 to 7 weeks for individuals with bilateral vestibular hypofunction. Based on moderate evidence, clinicians may prescribe static and dynamic balance exercises for a minimum of 20 minutes daily for at least 4 to 6 weeks for individuals with chronic unilateral vestibular hypofunction and, based on expert opinion, for a minimum of 6 to 9 weeks for individuals with bilateral vestibular hypofunction. Based on moderate evidence, clinicians may use achievement of primary goals, resolution of symptoms, normalized balance and vestibular function, or plateau in progress as reasons for stopping therapy. Based on moderate to strong evidence, clinicians may evaluate factors, including time from onset of symptoms, comorbidities, cognitive function, and use of medication that could modify rehabilitation outcomes. Discussion: Recent evidence supports the original recommendations from the 2016 guidelines. There is strong evidence that vestibular physical therapy provides a clear and substantial benefit to individuals with unilateral and bilateral vestibular hypofunction. Limitations: The focus of the guideline was on peripheral vestibular hypofunction; thus, the recommendations of the guideline may not apply to individuals with central vestibular disorders. One criterion for study inclusion was that vestibular hypofunction was determined based on objective vestibular function tests. This guideline may not apply to individuals who report symptoms of dizziness, imbalance, and/or oscillopsia without a diagnosis of vestibular hypofunction. Disclaimer: These recommendations are intended as a guide to optimize rehabilitation outcomes for individuals undergoing vestibular physical therapy. The contents of this guideline were developed with support from the American Physical Therapy Association and the Academy of Neurologic Physical Therapy using a rigorous review process. The authors declared no conflict of interest and maintained editorial independence. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A369).
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Lilios A, Chimona T, Nikitas C, Papadakis C, Chatziioannou I, Skoulakis C. The Effect of Supervision in Vestibular Rehabilitation in Patients with Acute or Chronic Unilateral Vestibular Dysfunction: A Systematic Review. Otol Neurotol 2021; 42:e1422-e1431. [PMID: 34510122 DOI: 10.1097/mao.0000000000003354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The investigation of supervised vestibular rehabilitation treatment role for individuals with dizziness and imbalance due to peripheral, unilateral vestibular disorders. DATABASES REVIEWED Cochrane, PubMed, and Physiotherapy Evidence Database (PEDro) were utilized to identify relevant studies. METHODS The key search terms used were "Vestibular Rehabilitation and Unilateral Vestibular Hypofunction," "Vestibular Rehabilitation and Unilateral Vestibular Loss," and "Vestibular Rehabilitation and Supervision." A manual search was performed by exploring the references of included articles to identify studies not captured through the computer-based searches. The quality of the studies was assessed according to the PEDro scale. Inclusion criteria were: 1) studies with patients, aged from 18 to 80 years, with acute or chronic dizziness and disequilibrium due to unilateral vestibular dysfunction, 2) randomized control trials (RCTs), 3) studies comparing supervised vestibular rehabilitation program with an unsupervised vestibular rehabilitation program or home-based training or standard care or placebo, and 4) articles written in the English language. Studies reporting cases of vertigo and imbalance due to possible recurrent pathologies, acute benign paroxysmal positional vertigo, or central neurological/orthopedic deficits, were excluded. RESULTS A total of 448 articles were retrieved from the systematic database search strategy. Five of them were included in the systematic review after full-text analysis, plus one more after manual searching of their references. All studies involved supervised vestibular rehabilitation treatment programs compared with unsupervised home training, the performance of daily activities and, standard care. Based on PEDro's scoring system, one study rated as high-quality RCT, three studies were considered of fair quality and one scored as low-quality RCT. CONCLUSIONS Although most RCTs report better outcomes with a supervised vestibular rehabilitation treatment program regarding the emotional status, dizziness, and balance improvement, this systematic review failed to provide a strong evidence that supervision is superior to unsupervised protocols in patients with UNH. The self-reported subjective measures used by the included RCTs represent a serious limitation of their results.
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Affiliation(s)
| | - Theognosia Chimona
- Otorhinolaryngology, Head & Neck Surgery Department, Chania General Hospital
| | - Christos Nikitas
- 1st Department of Otorhinolaryngology, Head & Neck Surgery, National and Kapodistrian University of Athens, Hippokrateion General Hospital, Athens
| | - Chariton Papadakis
- Otorhinolaryngology, Head & Neck Surgery Department, Chania General Hospital
| | - Ioannis Chatziioannou
- Otorhinolaryngology, Head & Neck Surgery Department, University Hospital of Larisa, Greece
| | - Charalambos Skoulakis
- Otorhinolaryngology, Head & Neck Surgery Department, University Hospital of Larisa, Greece
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Weinreich HM, Martin E, Agrawal Y. Overview of Dizziness in Practice. Otolaryngol Clin North Am 2021; 54:839-852. [PMID: 34538358 DOI: 10.1016/j.otc.2021.05.008] [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: 10/20/2022]
Abstract
The evaluation of dizziness as a chief complaint can be exceptionally challenging to otolaryngologists. The critical piece in evaluating dizzy patients is to have a plan for how to screen and schedule, how to gather data, and to develop a workflow for testing that allows clinical efficiency. This article provides an overview of evidence-based practices on how to screen dizzy patients before being scheduled, how to efficiently move patients through the otolaryngologist's clinic, and strategies for managing a dizzy practice.
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Affiliation(s)
- Heather M Weinreich
- Department of Otolaryngology Head and Neck Surgery, University of Illinois at Chicago, 1855 West Taylor Street, Chicago, IL 60612, USA.
| | - Emma Martin
- Department of Otolaryngology Head and Neck Surgery, University of Illinois at Chicago, 1855 West Taylor Street, Chicago, IL 60612, USA
| | - Yuri Agrawal
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University, 601 North Caroline Street, 6th Floor JHOC, Baltimore, MD 21287, USA. https://twitter.com/yuriagrawal
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Carender WJ, Grzesiak M, Telian SA. Vestibular Physical Therapy and Fall Risk Assessment. Otolaryngol Clin North Am 2021; 54:1015-1036. [PMID: 34304897 DOI: 10.1016/j.otc.2021.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Vestibular physical therapy (VPT) is a specialized form of evidence-based therapy designed to alleviate primary (vertigo, dizziness, imbalance, gait instability, falls) and secondary (deconditioning, cervical muscle tension, anxiety, poor quality of life, fear of falling/fear avoidance behavior) symptoms related to vestibular disorders. This article provides an overview of VPT, highlighting various exercise modalities used to treat a variety of vestibular disorders. Patient safety and fall prevention are paramount; therefore, fall risk assessment and treatment are also addressed.
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Affiliation(s)
- Wendy J Carender
- Department of Otolaryngology-Head & Neck Surgery, Michigan Medicine, University of Michigan, Michigan Balance Vestibular Testing and Rehabilitation, Med Inn Building, Room C166A, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5816, USA.
| | - Melissa Grzesiak
- Department of Otolaryngology-Head & Neck Surgery, Michigan Medicine, University of Michigan, Michigan Balance Vestibular Testing and Rehabilitation, Med Inn Building, Room C166A, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5816, USA
| | - Steven A Telian
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan, 1500 East Medical Center Drive, TC 1904L, Ann Arbor, MI 48109-5312, USA
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Vestibular Function in Older Adults With Cognitive Impairment: A Systematic Review. Ear Hear 2021; 42:1119-1126. [PMID: 33974775 DOI: 10.1097/aud.0000000000001040] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPORTANCE Given the rising prevalence of patients with dementia and those at risk for it, early identification is prioritized. As vestibular dysfunction is associated with Alzheimer's disease (AD) and may contribute to its onset, vestibular assessment may yield an opportunity in early dementia screening. OBJECTIVE This systematic review structures and compares the different raw outcome measures used to assess vestibular function while comparing older adults with preserved cognition to individuals with cognitive impairment, either suffering from mild cognitive impairment (MCI) or AD. DESIGN Two investigators independently and systematically searched publications performing objectively measured vestibular testing in a patient population consisting of either MCI or AD, compared with a control group of older adults with preserved cognition. No limitations regarding language or publication date were applied. References of the retrieved articles were hand searched for relevant articles. RESULTS Seven articles were included for analysis. A total of 235 older adults with impaired cognition (150 AD, 85 MCI) were compared with a control group of 481 older adults with preserved cognition. Evaluation of the peripheral vestibular function included video head impulse test (vHIT), videonystagmography (VNG), electronystagmography (ENG) including bithermal caloric irrigation and vestibular evoked myogenic potentials (VEMP). The VEMP test, assessing otolith function and the elicited vestibulocollic reflex (VCR), was able to differentiate subjects with AD and its prodromal stage from healthy controls, with p13 latency (p < 0.05) and amplitude (p < 0.05) having the most discriminating power.No correlation between cognitive decline and vestibulo-ocular reflex measurements in different frequency ranges of the semicircular canals (using vHIT, rotatory chair testing, and caloric irrigation) was found. Because of the limited number of available studies and the large heterogeneity in outcome measures, these results have to be interpreted with caution. CONCLUSIONS Measurements of the VCR, as evoked by the VEMP test, discriminate between patients with cognitive impairment (MCI and AD) and older adults with preserved cognition, whereas measurements of the vestibulo-ocular reflex do not. More studies are needed to further elaborate on these findings.
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Can Dizziness Handicap Inventory and Activities-Specific Balance Confidence Scores Assess Vestibular Loss After Vestibular Schwannoma Excision? Otol Neurotol 2020; 41:1427-1432. [PMID: 33170812 DOI: 10.1097/mao.0000000000002842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Evaluate and compare the Dizziness Handicap Inventory with Activities-specific Balance Confidence scores shortly after vestibular schwannoma excision. STUDY DESIGN Retrospective database review. SETTING Tertiary care center. PATIENTS Adults undergoing vestibular schwannoma excision between January 2015 and December 2019. INTERVENTION Diagnostic, therapeutic, and rehabilitative. MAIN OUTCOME MEASURES Postoperative change in Dizziness Handicap Inventory scores and Activities-specific Balance Confidence scores 2 to 3 weeks after surgical intervention in relation to preoperative vestibular testing. RESULTS A total of 49 patients met inclusion criteria. The average change in the Dizziness Handicap Inventory was 6 (p = 0.07, 95% CI 0-13). This was weakly correlated to preoperative caloric testing values (r = -0.31, p = 0.03), but not cervical vestibular evoked myogenic potentials (cVEMP) values (r = -0.17, p = 0.23). The average change in Activities-specific Balance Confidence was -10% (p = 0.007, 95% CI -3 to -17%). This change was moderately correlated with preoperative caloric values (r = 0.42, p = 0.006), but it was not correlated with cVEMP (r = 0.07, p = 0.66). CONCLUSIONS In vestibular schwannoma patients, factors other than preoperative vestibular function likely affect postoperative Dizziness Handicap Inventory and Activities-specific Balance Confidence scores. The change in Activities-specific Balance Confidence was slightly more consistent with expected physiological vestibular loss, and it represents another tool in a multidisciplinary vestibular evaluation of the postoperative patient.
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Herdman SJ, Hall CD, Heusel-Gillig L. Factors Associated With Rehabilitation Outcomes in Patients With Unilateral Vestibular Hypofunction: A Prospective Cohort Study. Phys Ther 2020; 100:2009-2022. [PMID: 32737972 DOI: 10.1093/ptj/pzaa138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this study was to determine factors associated with rehabilitation outcomes following vestibular rehabilitation (VR). METHODS In this prospective cohort study, 116 patients who completed at least 2 supervised sessions participated. Patient characteristics and comorbidities were recorded. Initial and discharge measures included symptom intensity, balance confidence, quality of life, percent of time symptoms interfere with life, perceived benefits of VR, gait speed, fall risk, visual acuity during head movement, and anxiety/depression. Intention-to-treat analyses were performed to determine outcomes at discharge. Bivariate correlations between independent (group characteristics and baseline measures) and dependent (discharge measures) variables were determined. Logistic regressions were performed to identify factors associated with whether a patient would have a normal score or meaningful change at discharge. RESULTS There was a large effect of VR with significant improvement for the group as a whole on each outcome measure. For each outcome measure, most patients improved. Based on preliminary logistic regression, 2 patient characteristics were associated with outcome: number of therapy visits predicted meaningful improvement in gait speed, and falls after the onset of the unilateral vestibular hypofunction (UVH) predicted meaningful change in the percent of time symptoms interfered with life. Initial Activities-Specific Balance Confidence Scale (ABC) and Dynamic Gait Index scores predicted normal ABC scores at discharge, and initial ABC scores predicted recovery of Dynamic Gait Index scores. Preliminary prediction models were generated for balance confidence, impact of dizziness on life, dynamic visual acuity, gait speed, and fall risk. CONCLUSIONS Therapists may use these findings for patient education or to determine the need for adjunct therapy, such as counseling. IMPACT Not all people with UVH improve following VR, but there is little research examining why. This study looked at multiple factors and identified number of visits and falls after onset of UVH as patient characteristics associated with outcomes following VR; these findings will help therapists create better predictive models.
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Affiliation(s)
- Susan J Herdman
- Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia; 2056 Hessian Ct, Stone Mountain, GA 30087 (USA)
| | - Courtney D Hall
- Hearing and Balance Research Program, James H Quillen VAMC, Mountain Home, Tennessee; and Department of Physical Therapy, East Tennessee State University, Johnson City, Tennessee
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Williams CYK, Knight R, Donnelly N, Bance M. Prevalence and treatment of co-morbid anxiety and depression among 352 dizzy patients: A retrospective study. Clin Otolaryngol 2020; 45:832-836. [PMID: 32469463 DOI: 10.1111/coa.13590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/17/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | - Richard Knight
- Department of Audiology, Addenbrooke's Hospital, Cambridge, UK
| | - Neil Donnelly
- Department of Otolaryngology-Head and Neck Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - Manohar Bance
- Department of Otolaryngology-Head and Neck Surgery, Addenbrooke's Hospital, Cambridge, UK
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van Vugt VA, van der Wouden JC, Essery R, Yardley L, Twisk JWR, van der Horst HE, Maarsingh OR. Internet based vestibular rehabilitation with and without physiotherapy support for adults aged 50 and older with a chronic vestibular syndrome in general practice: three armed randomised controlled trial. BMJ 2019; 367:l5922. [PMID: 31690561 PMCID: PMC6829201 DOI: 10.1136/bmj.l5922] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate the clinical effectiveness and safety of stand alone and blended internet based vestibular rehabilitation (VR) in the management of chronic vestibular syndromes in general practice. DESIGN Pragmatic, three armed, parallel group, individually randomised controlled trial. SETTING 59 general practices in the Netherlands. PARTICIPANTS 322 adults aged 50 and older with a chronic vestibular syndrome. INTERVENTIONS Stand alone VR comprising a six week, internet based intervention with weekly online sessions and daily exercises (10-20 minutes a day). In the blended VR group, the same internet based intervention was supplemented by face-to-face physiotherapy support (home visits in weeks 1 and 3). Participants in the usual care group received standard care from a general practitioner, without any restrictions. MAIN OUTCOME MEASURES The primary outcome was vestibular symptoms after six months as measured by the vertigo symptom scale-short form (VSS-SF range 0-60, clinically relevant difference ≥3 points). Secondary outcomes were dizziness related impairment, anxiety, depressive symptoms, subjective improvement of vestibular symptoms after three and six months, and adverse events. RESULTS In the intention-to-treat analysis, participants in the stand alone and blended VR groups had lower VSS-SF scores at six months than participants in the usual care group (adjusted mean difference -4.1 points, 95% confidence interval -5.8 to -2.5; and -3.5 points, -5.1 to -1.9, respectively). Similar differences in VSS-SF scores were seen at three months follow-up. Participants in the stand alone and blended VR groups also experienced less dizziness related impairment, less anxiety, and more subjective improvement of vestibular symptoms at three and six months. No serious adverse events related to online VR occurred during the trial. CONCLUSION Stand alone and blended internet based VR are clinically effective and safe interventions to treat adults aged 50 and older with a chronic vestibular syndrome. Online VR is an easily accessible form of treatment, with the potential to improve care for an undertreated group of patients in general practice. TRIAL REGISTRATION Netherlands Trial Register NTR5712.
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Affiliation(s)
- Vincent A van Vugt
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Johannes C van der Wouden
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Rosie Essery
- Department of Psychology, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Otto R Maarsingh
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
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Pasquier F, Denise P, Gauthier A, Bessot N, Quarck G. Impact of Galvanic Vestibular Stimulation on Anxiety Level in Young Adults. Front Syst Neurosci 2019; 13:14. [PMID: 31040773 PMCID: PMC6476966 DOI: 10.3389/fnsys.2019.00014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/27/2019] [Indexed: 12/22/2022] Open
Abstract
Galvanic vestibular stimulation (GVS) is a non-invasive method used to stimulate the vestibular system. The vestibular system includes the sensors, neural pathways, vestibular nuclei and the cortical areas receiving integrated vestibular inputs. In addition to its role in postural control or gaze stabilization, the vestibular system is involved in some cognitive functions and in emotion processing. Several studies have revealed a modulating effect of vestibular stimulation on mood state, emotional control, and anxiety level. Nevertheless, GVS is known to induce motion sickness symptoms such as nausea. The aim of the present study was to evaluate the tolerability and efficacy of a GVS protocol to be used potentially as a treatment for anxiety, and also to test the impact of stimulation parameters (duration) on anxiety. Twenty-two students underwent three stimulation conditions: (1) a sham session (no stimulation); (2) a single-duration session (38 min of GVS); and (3) a double-duration session (76 min of GVS). Before and after each stimulation, participants completed a Graybiel Scale form for motion sickness symptoms evaluation and a visual analog scale form for anxiety. We observed a significant diminution of anxiety level after a 38-min session of GVS, while a low level of motion sickness was only found following a 76-min session of GVS. Our preliminary study confirms the feasibility of using GVS to modulate anxiety and corroborates the involvement of the vestibular system in the emotional process.
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Affiliation(s)
- Florane Pasquier
- Normandie Université, Unicaen, Inserm, Comete, GIP Cyceron, Caen, France
| | - Pierre Denise
- Normandie Université, Unicaen, Inserm, Comete, GIP Cyceron, Caen, France
| | - Antoine Gauthier
- Normandie Université, Unicaen, Inserm, Comete, GIP Cyceron, Caen, France
| | - Nicolas Bessot
- Normandie Université, Unicaen, Inserm, Comete, GIP Cyceron, Caen, France
| | - Gaëlle Quarck
- Normandie Université, Unicaen, Inserm, Comete, GIP Cyceron, Caen, France
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Vestibular rehabilitation: advances in peripheral and central vestibular disorders. Curr Opin Neurol 2019; 32:137-144. [DOI: 10.1097/wco.0000000000000632] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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