Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.
Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium.
J Med Internet Res. 2023 Feb 9;25:e39076. doi: 10.2196/39076.
Tinnitus is a highly prevalent symptom affecting 10%-20% of the adult population. Most patients with tinnitus have chronic tinnitus, which can directly or indirectly disrupt their daily life and negatively affect the health-related quality of life. Therefore, patients with tinnitus are frequently in need of costly and time-consuming treatments. As an answer, telerehabilitation interventions are on a rise to promote self-management in patients with tinnitus and reduce their dependency on in-person care.
This systematic review aimed to provide an overview of the research concerning the effectiveness of telerehabilitation interventions for self-management of tinnitus.
This systematic review adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were eligible for inclusion if study participants were adult patients with complaints of primary subjective tinnitus and the study intervention comprised any possible telerehabilitation form for the self-management of tinnitus complaints. A search for eligible studies was conducted on PubMed, ScienceDirect, Scopus, Web of Science, and Cochrane Library. The Cochrane Risk of Bias 2 tool was used to the assess risk of bias.
In total, 29 articles were found eligible, and of these, 5 (17%) studied multiple telerehabilitation forms. Internet-based cognitive behavioral treatment with guidance by a psychologist or audiologist was examined in 17 studies (n=1767), internet-based cognitive behavioral treatment without guidance was examined in 4 studies (n=940), self-help manuals were examined in 1 study (n=72), technological self-help devices were examined in 2 studies (n=82), smartphone apps were examined in 8 studies (n=284), and other internet-based interventions were examined in 2 studies (n=130). These rehabilitation categories were proven to be effective in decreasing tinnitus severity and relieving tinnitus distress as measured by tinnitus questionnaires such as Tinnitus Functional Index, Tinnitus Handicap Inventory, or Tinnitus Reactions Questionnaire. However, dropout rates were often high (range 4%-71.4%). All studies reported between some concerns and high concerns of risk of bias, resulting in low to moderate certainty levels.
Overall, there is low to moderate quality evidence that telerehabilitation interventions effectively reduce tinnitus severity and distress. These interventions form a possible tool to improve the self-management capacities of the patient and the accessibility of tinnitus care as a replacement or an addition to in-person care. Nevertheless, barriers such as lack of time, engagement, motivation, and openness of the patient causing high dropout should be considered.
PROSPERO International Prospective Register of Systematic Reviews CRD42021285450; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=285450.
耳鸣是一种高发病率的症状，影响 10%-20%的成年人。大多数耳鸣患者为慢性耳鸣，这可能直接或间接扰乱他们的日常生活，并对健康相关的生活质量产生负面影响。因此，耳鸣患者经常需要昂贵且耗时的治疗。作为一种解决方案，远程康复干预措施应运而生，以促进耳鸣患者的自我管理，并减少他们对面对面护理的依赖。
本系统综述旨在概述关于耳鸣自我管理的远程康复干预措施的研究。
本系统综述遵循 PRISMA（系统评价和荟萃分析的首选报告项目）指南。如果研究参与者为患有原发性主观耳鸣的成年患者，且研究干预措施包括任何可能的用于耳鸣投诉自我管理的远程康复形式，则研究符合纳入标准。在 PubMed、ScienceDirect、Scopus、Web of Science 和 Cochrane Library 上进行了合格研究的搜索。使用 Cochrane 风险偏倚 2 工具评估风险偏倚。
共发现 29 篇符合条件的文章，其中 5 篇（17%）研究了多种远程康复形式。共检查了 17 项基于互联网的认知行为治疗，由心理学家或听力学家指导（n=1767），4 项研究检查了没有指导的基于互联网的认知行为治疗（n=940），1 项研究检查了自我帮助手册（n=72），2 项研究检查了技术自我帮助设备（n=82），8 项研究检查了智能手机应用程序（n=284），2 项研究检查了其他基于互联网的干预措施（n=130）。这些康复类别在降低耳鸣严重程度和缓解耳鸣困扰方面被证明是有效的，如耳鸣问卷（如耳鸣功能指数、耳鸣残疾量表或耳鸣反应问卷）所测量的。然而，辍学率往往很高（范围为 4%-71.4%）。所有研究报告了不同程度的风险偏倚关切和高风险偏倚关切，导致证据质量为低到中等。
总体而言，有低到中等质量的证据表明远程康复干预措施可有效降低耳鸣严重程度和困扰程度。这些干预措施可能成为改善患者自我管理能力和增加耳鸣护理可及性的工具，作为面对面护理的替代或补充。然而，应该考虑到一些障碍，例如患者缺乏时间、参与度、动机和开放性，这可能导致高辍学率。
PROSPERO 国际前瞻性系统评价注册中心 CRD42021285450；https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=285450.
