PMID- 35357406
OWN - NLM
STAT- MEDLINE
DCOM- 20220517
LR  - 20230401
IS  - 2168-619X (Electronic)
IS  - 2168-6181 (Print)
IS  - 2168-6181 (Linking)
VI  - 148
IP  - 5
DP  - 2022 May 1
TI  - Patient-Reported Disability After Computerized Posturographic Vestibular 
      Retraining for Stable Unilateral Vestibular Deficit.
PG  - 426-433
LID - 10.1001/jamaoto.2022.0167 [doi]
AB  - IMPORTANCE: Individuals with persistent unilateral vestibular deficits experience 
      loss of quality of life and increased risk of falling, and they have few 
      well-supported options for effective treatment. OBJECTIVES: To evaluate whether 
      vestibular retraining using computerized dynamic posturography is associated with 
      reduced participant-reported disability for patients with an objectively assessed 
      unilateral peripheral vestibular deficit and to assess the feasibility of 
      conducting a randomized clinical trial of vestibular retraining using 
      computerized dynamic posturography. DESIGN, SETTING, AND PARTICIPANTS: This 
      single-group cohort study was conducted from April 29 to July 23, 2021, in a 
      tertiary neurotology clinic among 13 individuals with a stable unilateral 
      vestibular deficit present for more than 6 months, confirmed with 
      videonystagmography and vestibular evoked myogenic potential testing. Statistical 
      analysis was performed from July 7, 2021, to January 25, 2022. INTERVENTIONS: 
      Twelve twice-weekly sessions of posturography-assisted vestibular retraining with 
      prescribed weight shifting tasks guided by an interactive display. MAIN OUTCOMES 
      AND MEASURES: Change in scores on the Dizziness Handicap Inventory (DHI), the 
      Activities-Specific Balance Confidence (ABC) Scale, and the Falls Efficacy 
      Scale-International (FES-I), which participants completed before and after 
      retraining to measure their perception of their disability. They also completed 
      posturography measurements. Secondary outcomes included tolerability of the 
      intervention and rate of completion of the full protocol. RESULTS: A total of 13 
      participants (8 men [62%]; median age, 51 years [range, 18-67 years]) were 
      enrolled. All 13 participants completed the intervention and all follow-up. After 
      treatment, the median changes in scores were -16 points (95% CI, -20 to 2) for 
      the DHI, -9 (95% CI, -14 to 1) for the FES-I, and 11.9 (95% CI, 0-17.3) for the 
      ABC Scale. Eight participants (62%) improved by greater than the minimum 
      clinically important difference (MCID) for the DHI, whereas 4 (31%) exceeded the 
      MCID for the ABC Scale, and 3 (23%) exceeded the MCID for the FES-I. Participants 
      with moderate to severe disability at baseline (n = 7) had a larger magnitude of 
      improvement in DHI scores than those with mild disability (n = 6) (-18 [95% CI, 
      -78 to 2] vs -1 [95% CI, -8 to 16]). Six of the 7 patients (86%) with moderate to 
      severe disability improved by greater than the MCID for DHI, wherease 4 of 7 
      patients (57%) improved by greater than the MCID for the ABC Scale, and 3 of 7 
      patients (43%) improved by greater than the MCID for the FES-I. CONCLUSIONS AND 
      RELEVANCE: This cohort study suggests that computerized, dynamic 
      posturography-assisted retraining was associated with clinically meaningful 
      improvements in participant-reported disability among those with stable 
      unilateral vestibular deficit and moderate to severe disability. Further studies 
      should compare posturography-assisted vestibular retraining with conventional 
      physical therapy rehabilitation techniques. TRIAL REGISTRATION: 
      ClinicalTrials.gov Identifier: NCT04875013.
FAU - David, Eytan A
AU  - David EA
AD  - Otology, Neurotology, Skull Base Surgery, Department of Surgery, University of 
      British Columbia, Vancouver, British Columbia, Canada.
FAU - Shahnaz, Navid
AU  - Shahnaz N
AD  - Audiology and Speech Sciences, University of British Columbia, Vancouver, British 
      Columbia, Canada.
LA  - eng
SI  - ClinicalTrials.gov/NCT04875013
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - United States
TA  - JAMA Otolaryngol Head Neck Surg
JT  - JAMA otolaryngology-- head & neck surgery
JID - 101589542
SB  - IM
CIN - JAMA Otolaryngol Head Neck Surg. 2022 May 1;148(5):434-435. PMID: 35357407
MH  - Cohort Studies
MH  - Dizziness/complications/therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Patient Reported Outcome Measures
MH  - Physical Therapy Modalities/adverse effects
MH  - Postural Balance/physiology
MH  - *Quality of Life
MH  - Vertigo
MH  - *Vestibular Diseases/therapy
PMC - PMC8972144
COIS- Conflict of Interest Disclosures: None reported.
EDAT- 2022/04/01 06:00
MHDA- 2022/05/18 06:00
PMCR- 2023/03/31
CRDT- 2022/03/31 12:05
PHST- 2022/04/01 06:00 [pubmed]
PHST- 2022/05/18 06:00 [medline]
PHST- 2022/03/31 12:05 [entrez]
PHST- 2023/03/31 00:00 [pmc-release]
AID - 2790352 [pii]
AID - ooi220005 [pii]
AID - 10.1001/jamaoto.2022.0167 [doi]
PST - ppublish
SO  - JAMA Otolaryngol Head Neck Surg. 2022 May 1;148(5):426-433. doi: 
      10.1001/jamaoto.2022.0167.