针对慢性头晕老年患者的基于互联网的前庭康复：一项初级保健中的随机对照试验
Internet-Based Vestibular Rehabilitation for Older Adults With Chronic Dizziness: A Randomized Controlled Trial in Primary Care.
作者信息
Geraghty Adam W A, Essery Rosie, Kirby Sarah, Stuart Beth, Turner David, Little Paul, Bronstein Adolfo, Andersson Gerhard, Carlbring Per, Yardley Lucy
机构信息
Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
Academic Unit of Psychology, University of Southampton, Southampton, United Kingdom.
出版信息
Ann Fam Med. 2017 May;15(3):209-216. doi: 10.1370/afm.2070.
PURPOSE
Vestibular rehabilitation is an effective intervention for dizziness due to vestibular dysfunction, but is seldom provided. We aimed to determine the effectiveness of an Internet-based vestibular rehabilitation program for older adults experiencing dizziness in primary care.
METHODS
We undertook a single-center, single-blind randomized controlled trial comparing an Internet-based vestibular rehabilitation intervention (Balance Retraining, freely available from https://balance.lifeguidehealth.org) with usual primary care in patients from 54 primary care practices in southern England. Patients aged 50 years and older with current dizziness exacerbated by head movements were enrolled. Those in the intervention group accessed an automated Internet-based program that taught vestibular rehabilitation exercises and suggested cognitive behavioral management strategies. Dizziness was measured by the Vertigo Symptom Scale-Short Form (VSS-SF) at baseline, 3 months, and 6 months. The primary outcome was VSS-SF score at 6 months.
RESULTS
A total of 296 patients were randomized in the trial; 66% were female, and the median age was 67 years. The VSS-SF was completed by 250 patients (84%) at 3 months and 230 patients (78%) at 6 months. Compared with the usual care group, the Internet-based vestibular rehabilitation group had less dizziness on the VSS-SF at 3 months (difference, 2.75 points; 95% CI, 1.39-4.12; <.001) and at 6 months (difference, 2.26 points; 95% CI, 0.39-4.12; = .02, respectively). Dizziness-related disability was also lower in the Internet-based vestibular rehabilitation group at 3 months (difference, 6.15 points; 95% CI, 2.81-9.49; <.001) and 6 months (difference, 5.58 points; 95% CI, 1.19-10.0; = .01).
CONCLUSIONS
Internet-based vestibular rehabilitation reduces dizziness and dizziness-related disability in older primary care patients without requiring clinical support. This intervention has potential for wide application in community settings.
目的
前庭康复是治疗前庭功能障碍所致头晕的有效干预措施，但很少得到应用。我们旨在确定一项基于互联网的前庭康复计划对基层医疗中出现头晕的老年人的有效性。
方法
我们进行了一项单中心、单盲随机对照试验，将一项基于互联网的前庭康复干预措施（平衡再训练，可从https://balance.lifeguidehealth.org免费获取）与英格兰南部54家基层医疗机构的患者接受的常规基层医疗进行比较。纳入年龄在50岁及以上、当前因头部运动而加重头晕的患者。干预组患者访问一个基于互联网的自动化程序，该程序教授前庭康复锻炼并建议认知行为管理策略。在基线、3个月和6个月时通过眩晕症状量表简表（VSS-SF）测量头晕情况。主要结局是6个月时的VSS-SF评分。
结果
共有296例患者参与试验随机分组；66%为女性，中位年龄为67岁。250例患者（84%）在3个月时完成了VSS-SF评估，230例患者（78%）在6个月时完成了评估。与常规治疗组相比，基于互联网的前庭康复组在3个月时VSS-SF上的头晕程度较轻（差异为2.75分；95%CI，1.39 - 4.12；P<.001），在6个月时也是如此（差异为2.26分；95%CI，0.39 - 4.12；P = .02）。基于互联网的前庭康复组在3个月时（差异为6.15分；95%CI，2.81 - 9.49；P<.001）和6个月时（差异为5.58分；95%CI，1.19 - 10.0；P = .01）与头晕相关的残疾程度也较低。
结论
基于互联网的前庭康复可减轻基层医疗中老年患者的头晕及与头晕相关的残疾，且无需临床支持。这种干预措施在社区环境中有广泛应用的潜力。
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