Susan L Whitney, Pamela M Dunlap, Pedram Hovareshti, Lisa S Holt, Chad Zalkin, Devendra Tolani, Karen Lambert, Carlos Esquivel, Brooke N Klatt, Chelsea J Manetta
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引用次数: 0
Abstract
Background and purpose: VestAid is a tablet-based computer application designed to deliver vestibulo-ocular reflex (VOR) exercises to persons with dizziness. It was developed to provide objective data to clinicians to drive clinical decisions. VestAid allows for VOR exercise progression between face-to-face visits via telehealth. The primary aim of this study was to determine the consistency of clinical decision-making among physical therapists (PTs) using an exercise performance report (EPR) from the VestAid app and a video recording of patients performing VOR exercises. The secondary aim was to determine the effect of the clinical experience of a vestibular physical therapist on decision-making agreement about exercise choice. Lastly, an attempt was made to determine if the EPR provided adequate information to make a clinical judgment about exercise progression.
Methods: Thirty PTs with varied vestibular experience levels participated. Vestibular experience was clustered into 3 levels [< 5 years of experience (n = 10), 6-15 years of experience (n = 10), and > 15 years of experience (n = 10)]. The PTs viewed 12 videos of individuals with dizziness completing VORx1 exercises that were a priori classified as easy, moderate, or difficult. The PTs were randomly shown 12 EPRs for the same individuals, which included their percentage of gaze fixation, symptom reports, and head speed compliance. Each PT was then asked whether they would progress the exercise program, regress the program, or leave the exercise program unchanged.
Results: Physical therapist percent agreement using the video was 60% compared to 71.1% using the EPR. No differences existed in the percentage of agreement between experience levels. One hundred percent of the PTs with less than 5 years of experience reported that the EPR was sufficient for advancing the exercises, compared with 67% of those with greater experience.
Discussion: VestAid's EPR yielded comparable clinical decision-making agreement to that of the video. The EPR offers PTs insight into gaze fixation and head speed compliance-information otherwise inaccessible without the use of technology. Currently, there are no established guidelines for exercise progression. While such technology shows potential to improve consistency in clinical decision-making, further research is needed to better understand whether objective VOR exercise outcome metrics facilitate recovery.
期刊介绍：
Physiotherapy Research International is an international peer reviewed journal dedicated to the exchange of knowledge that is directly relevant to specialist areas of physiotherapy theory, practice, and research. Our aim is to promote a high level of scholarship and build on the current evidence base to inform the advancement of the physiotherapy profession. We publish original research on a wide range of topics e.g. Primary research testing new physiotherapy treatments; methodological research; measurement and outcome research and qualitative research of interest to researchers, clinicians and educators. Further, we aim to publish high quality papers that represent the range of cultures and settings where physiotherapy services are delivered. We attract a wide readership from physiotherapists and others working in diverse clinical and academic settings. We aim to promote an international debate amongst the profession about current best evidence based practice. Papers are directed primarily towards the physiotherapy profession, but can be relevant to a wide range of professional groups. The growth of interdisciplinary research is also key to our aims and scope, and we encourage relevant submissions from other professional groups. The journal actively encourages submissions which utilise a breadth of different methodologies and research designs to facilitate addressing key questions related to the physiotherapy practice. PRI seeks to encourage good quality topical debates on a range of relevant issues and promote critical reflection on decision making and implementation of physiotherapy interventions.
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