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[移动互联网远程指导平台在前庭康复中的临床应用]

[The clinical application of mobile internet remote guidance platform for vestibular rehabilitation].

作者信息

Zheng G L, Zhang Q, Chen J Y, Jin Y L, Liu L F, Yang J

机构信息

Department of Otorhinolaryngology Head and Neck Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Institute of Otology, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Ear and Nose Disease Transformation, Shanghai 200092, China.

Suzhou Hearing Technology Research Institute of Tinnitus,Suzhou 425000, China.

出版信息

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Mar 7;57(3):276-281. doi: 10.3760/cma.j.cn115330-20210528-00302.

Abstract

To guide the patients with vertigo who are suitable for vestibular rehabilitation therapy (VRT), and to evaluate the curative effect through a remote guidance platform based on mobile internet. Adult outpatients, who were diagnosed as vestibular disorders and required VRT, were selected and conducted baseline evaluation and formulated vestibular rehabilitation plan according to their symptoms, diagnosis and vestibular function examination results. These patients downloaded and installed the mobile internet remote guidance platform app for VRT, and then registered and uploaded medical records. According to the VRT plan formulated by clinicians for patients, the platform launched corresponding exercise guidance videos to guide them to complete 4-week VRT exercise at home. Before and after VRT, the patients were scored with Visual Analogue Scale (VAS), Activities-specific Balance Confidence (ABC), Dizziness Handicap Inventory (DHI) and Self-rating Anxiety Scale (SAS). The rehabilitation effects were statistically analyzed by SigmaStat 4.0 software. From October 2019 to October 2021, 233 patients with vertigo completed the registration of vestibular rehabilitation guidance platform, of whom 187 patients insisted on 4-week rehabilitation training and completed the scale evaluation. Among 187 patients, 65 were male and 122 were female; Age was (49.8±16.0) years; The medical history ranged from one to 192 months, with a median of eight months. Compared with that before rehabilitation exercise, the subjective feeling of vertigo in 170 patients was improved, and the overall effective rate was 90.9% (170/187). The subjective symptoms of vertigo were basically improved after rehabilitation training in patients with unilateral vestibular dysfunction, vestibular neuritis, sudden deafness with vertigo, Hunt syndrome and acoustic neuroma. There were significant differences in ABC, DHI and SAS scores before and after VRT (<0.05). Of those patients with Meniere's disease in the intermittent period and the patients with Meniere's disease who underwent surgical treatment, more than 90% of their subjective symptoms of vertigo or dizziness improved after VRT, and there were significant differences in the scores of ABC, DHI and SAS before and after VRT exercise (<0.05). In patients with vestibular migraine, 36.7% (11/30) had no improvement or even aggravation of subjective symptoms of vertigo after VRT, however, the DHI score after rehabilitation exercise was lower than that before exercise, and the difference was statistically significant (<0.05). In patients with bilateral vestibular dysfunction, although most (6/8) subjective symptom scores were improved compared with those before exercise, there was no significant difference in ABC, DHI and SAS scores before and after rehabilitation (>0.05). VRT with the help of vestibular rehabilitation mobile internet remote guidance platform can effectively improve the subjective symptoms of vertigo, balance ability and anxiety in patients with unilateral vestibular lesions.

摘要

为指导适合前庭康复治疗(VRT)的眩晕患者,并通过基于移动互联网的远程指导平台评估疗效。选取诊断为前庭疾病且需要VRT的成年门诊患者,根据其症状、诊断及前庭功能检查结果进行基线评估并制定前庭康复计划。这些患者下载并安装用于VRT的移动互联网远程指导平台应用程序,然后注册并上传病历。根据临床医生为患者制定的VRT计划,平台推送相应的运动指导视频,指导他们在家中完成为期4周的VRT训练。在VRT前后,采用视觉模拟评分法(VAS)、活动特定平衡信心量表(ABC)、眩晕障碍量表(DHI)和自评焦虑量表(SAS)对患者进行评分。使用SigmaStat 4.0软件对康复效果进行统计学分析。2019年10月至2021年10月,233例眩晕患者完成前庭康复指导平台注册,其中187例患者坚持进行了4周的康复训练并完成量表评估。187例患者中,男性65例,女性122例;年龄为(49.8±16.0)岁;病史1至192个月,中位数为8个月。与康复训练前相比,170例患者的眩晕主观感受得到改善,总有效率为90.9%(170/187)。单侧前庭功能障碍、前庭神经炎、突发性聋伴眩晕、亨特综合征及听神经瘤患者康复训练后眩晕主观症状基本改善。VRT前后ABC、DHI和SAS评分差异有统计学意义(<0.05)。梅尼埃病间歇期患者及接受手术治疗的梅尼埃病患者中,超过90%的患者VRT后眩晕或头晕主观症状改善,VRT前后ABC、DHI和SAS评分差异有统计学意义(<0.05)。前庭性偏头痛患者中,36.7%(11/30)VRT后眩晕主观症状无改善甚至加重,但其康复训练后的DHI评分低于训练前,差异有统计学意义(<0.05)。双侧前庭功能障碍患者中,虽多数(6/8)主观症状评分较训练前改善,但康复前后ABC、DHI和SAS评分差异无统计学意义(>0.05)。借助前庭康复移动互联网远程指导平台进行VRT可有效改善单侧前庭病变患者的眩晕主观症状、平衡能力及焦虑状态。

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