Effectiveness of conventional versus virtual reality based vestibular rehabilitation in the treatment of dizziness, gait and balance impairment in adults with unilateral peripheral vestibular loss: a randomised controlled trial.
Dara Meldrum, Susan Herdman, Roisin Moloney, Deirdre Murray, Douglas Duffy, Kareena Malone, Helen French, Stephen Hone, Ronan Conroy, Rory McConn-Walsh
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引用次数: 77
Abstract
Background: Unilateral peripheral vestibular loss results in gait and balance impairment, dizziness and oscillopsia. Vestibular rehabilitation benefits patients but optimal treatment remains unknown. Virtual reality is an emerging tool in rehabilitation and provides opportunities to improve both outcomes and patient satisfaction with treatment. The Nintendo Wii Fit Plus® (NWFP) is a low cost virtual reality system that challenges balance and provides visual and auditory feedback. It may augment the motor learning that is required to improve balance and gait, but no trials to date have investigated efficacy.
Methods/design: In a single (assessor) blind, two centre randomised controlled superiority trial, 80 patients with unilateral peripheral vestibular loss will be randomised to either conventional or virtual reality based (NWFP) vestibular rehabilitation for 6 weeks. The primary outcome measure is gait speed (measured with three dimensional gait analysis). Secondary outcomes include computerised posturography, dynamic visual acuity, and validated questionnaires on dizziness, confidence and anxiety/depression. Outcome will be assessed post treatment (8 weeks) and at 6 months.
Discussion: Advances in the gaming industry have allowed mass production of highly sophisticated low cost virtual reality systems that incorporate technology previously not accessible to most therapists and patients. Importantly, they are not confined to rehabilitation departments, can be used at home and provide an accurate record of adherence to exercise. The benefits of providing augmented feedback, increasing intensity of exercise and accurately measuring adherence may improve conventional vestibular rehabilitation but efficacy must first be demonstrated.
背景:单侧外周前庭功能丧失可导致步态和平衡障碍、头晕和示波器丧失。前庭康复对患者有益，但最佳治疗方法尚不清楚。虚拟现实是一种新兴的康复工具，为改善治疗结果和患者满意度提供了机会。任天堂Wii Fit Plus®(NWFP)是一款低成本的虚拟现实系统，挑战平衡并提供视觉和听觉反馈。它可能会增强运动学习，这是改善平衡和步态所必需的，但迄今为止还没有研究其功效的试验。方法/设计:在一项单(评估者)盲、双中心随机对照优势试验中，80例单侧前庭周围功能丧失患者将被随机分为常规或基于虚拟现实(NWFP)的前庭功能康复组，为期6周。主要结果测量是步态速度(通过三维步态分析测量)。次要结果包括计算机体位照相、动态视力、眩晕、自信和焦虑/抑郁的有效问卷。将在治疗后(8周)和6个月时评估结果。讨论:游戏行业的进步使得大量生产高度复杂的低成本虚拟现实系统成为可能，这些系统结合了大多数治疗师和患者以前无法接触到的技术。重要的是，它们不局限于康复部门，可以在家里使用，并提供坚持锻炼的准确记录。提供增强反馈、增加运动强度和准确测量依从性的好处可能会改善传统的前庭康复，但必须首先证明其有效性。试验注册:Clinical trials.gov标识符:NCT01442623。
期刊介绍：
BMC Ear, Nose and Throat Disorders is an open access journal publishing original peer-reviewed research articles in all aspects of the prevention, diagnosis and management of ear, nose and throat disorders, as well as related molecular genetics, pathophysiology, and epidemiology. BMC Ear, Nose and Throat Disorders (ISSN 1472-6815) is indexed/tracked/covered by PubMed, CAS, EMBASE, Scopus and Google Scholar.
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