BACKGROUND: We created a clinical virtual reality application for vestibular rehabilitation. Our app targets contextual sensory integration (C.S.I.) where patients are immersed in safe, increasingly challenging environments while practicing various tasks (eg, turning, walking). The purpose of this pilot study was to establish the feasibility of a randomized controlled trial comparing C.S.I. training to traditional vestibular rehabilitation. METHODS: Thirty patients with vestibular dysfunction completed the Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence Scale (ABC), Visual Vertigo Analog Scale (VVAS), Functional Gait Assessment (FGA), Timed-Up-and-Go (TUG), and Four-Square Step Test (FSST). Following initial assessment, the patients were randomized into 8 weeks (once per week in clinic plus home exercise program) of traditional vestibular rehabilitation or C.S.I. training. Six patients had to stop participation due to the COVID-19 pandemic, 6 dropped out for other reasons (3 from each group). Ten patients in the traditional group and 8 in the C.S.I group completed the study. We applied an intention to treat analysis. RESULTS: Following intervention, we observed a significant main effect of time with no main effect of group or group by time interaction for the DHI (mean difference 18.703, 95% CI -28.235 to -9.172, p = 0.0002), ABC (8.556, 95% CI 0.938 to 16.174, p = 0.028), VVAS, (-13.603, 95% CI -25.634 to -1.573, p = 0.027) and the FGA (6.405, 95% CI 4.474 to 8.335, p < 0.0001). No changes were observed for TUG and FSST. CONCLUSION: Patients' symptoms and function improved following either vestibular rehabilitation method. C.S.I training appeared comparable but not superior to traditional rehabilitation. TRIAL REGISTRATION: ClincalTrials.gov NCT04268745 https://clinicaltrials.gov/ct2/show/NCT04268745.

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