JMIR Publications

ABSTRACT

Background:

Vestibular disorders impair postural stability, increase fall risk, reduce quality of life, and are commonly associated with elevated anxiety. While vestibular rehabilitation is effective, adherence remains low. To address this barrier, we developed “Vestibulon”—a smartphone application co-designed with clinicians and patients—to support and enhance the rehabilitation process.

Objective:

To evaluate the effectiveness of a smartphone-based application (Vestibulon) in supporting vestibular rehabilitation, and to examine the relationship between dizziness-related disability and anxiety.

Methods:

In this randomized, two-period, two-sequence crossover pilot trial, 20 participants with vestibular dysfunction (mean age 52 ± 12 years) underwent six weeks of vestibular rehabilitation. Patients were recruited between July 2023 and July 2024 through the dizziness clinic at Sheba Hospital. Participants were randomly assigned to start with either app-supported or conventional rehabilitation, then crossed over to the other condition. Each phase lasted three weeks, with no washout period. Assessments were conducted at baseline (T0), after phase one (T1), and at study end (T2), using the Dizziness Handicap Inventory (DHI), State-Trait Anxiety Inventory (STAI), and the instrumented Timed-Up-and-Go test (iTUG). The primary outcome was change in DHI scores. Outcome assessors were not blinded; no blinding of participants or therapists was possible.

Results:

All 20 participants completed both phases and were included in the within-subject analysis. Significant improvements in DHI were observed from T0 to T2 in both sequences (median change: app = 34 points; conventional = 18 points). Only the App-First group improved their iTUG (Z=-2.45, P =.012). We found no change in STAI scores in either group, and no correlation between DHI and iTUG. A significant positive-moderate correlation between the DHI and the STAI-state anxiety (r=0.64, P<.001) was consistent throughout the rehabilitation period. No adverse events were reported.

Conclusions:

The Vestibulon app may provide functional benefits in vestibular rehabilitation. The consistent association between dizziness and anxiety underscores the importance of addressing psychological aspects as part of treatment. Clinical Trial: ClinicalTrials.gov: NCT05959278 (registered 07/06/2023)