JMIR Publications

ABSTRACT

Background:

Vestibular hypofunction results in dizziness, gaze instability, imbalance, and an increased risk of falls. Vestibular exercises are effective in reducing symptoms of dizziness and improving gaze stability, balance, and mobility. Unfortunately, adherence to vestibular exercises is low, resulting in persisting symptoms that can have devastating outcomes.

Objective:

To determine the feasibility, acceptability, and preliminary efficacy of at-home vestibular rehabilitation exercises delivered via an interactive tablet-based app, and to identify predictors of adherence to the app intervention.

Methods:

Four individuals (mean age 64.5 ± 4.01 years; 2 males and 2 females) with a diagnosed vestibular hypofunction participated in the intervention. Vestibular exercises for gaze stability and balance were performed using the VestRx™ App; additional exercises included habituation and functional mobility training. Exercises were prescribed 5 times a day for 6 weeks following the clinical practice guidelines for vestibular hypofunction. Participants attended weekly in-lab sessions to progress the exercises based on individual recovery patterns and symptom intensity. A combination of quantitative (e.g., dynamic balance, gait speed, gaze stability, symptoms, and survey-based measures of usability) and qualitative (e.g., semi-structured interviews) measures was employed at baseline, 3 weeks, and after 6 weeks of training to evaluate the feasibility, acceptability, and early signal of app-based intervention efficacy.

Results:

Participants were motivated, and they achieved high adherence to the exercises (between 53% to 92% completion rates). Participants highly endorsed the intervention and said they would be likely to use the app and complete a program like this in the future. They made significant improvements in dynamic balance, gait speed, and confidence with daily activity. Individual factors that promoted adherence to exercises included the engaging nature of the app exercises, the ability to get feedback from the app during exercises, inherent motivation to improve, and comfort with technology. Family support with technology and reminders by family members to do the exercises were identified as facilitators for adherence. Barriers to consistent exercise performance included illness, flaring symptoms, and family events. From a structural and environmental perspective, the responsiveness of the program during exercises, and technical issues with the web portal (unrelated to patient access to the internet) were barriers that influenced adherence; while the ability to exercise based on individual schedules, ability to take the tablet on vacation, and having ample space in the home to leave the tablet undisturbed were identified as facilitators for adherence to exercises.

Conclusions:

In this early pilot study, the app-intervention was easy to use in the home setting, feasibly implemented, and shows promise for improving vestibular outcomes. Future work should focus on addressing study limitations, including sample size, showing the efficacy of the intervention in a controlled experimental trial, and focus on understanding barriers and facilitators to implementing tablet-based interventions for vestibular hypofunction at larger scale in clinical settings. Clinical Trial: No.