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Use of Technology for Exercise Prescription Among Persons With Dizziness: A Mixed-Methods Study
Susan L Whitney1, Pamela M Dunlap2, Pedram Hovareshti3
1University of Pittsburgh Department of Physical Therapy and Otolaryngology, Pittsburgh, Pennsylvania, USA.
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.
