Vestibular Rehabilitation Telehealth During the SAEA-CoV-2 (COVID-19) Pandemic

Abstract

During the COVID-19 pandemic, physical therapists transitioned to provide telehealth in the United States. We sought to determine the experiences of physical therapists delivering telerehabilitation for vestibular disorders including barriers, preferences, and concerns. A survey was created using the results of a focus group and previously published studies. The survey was distributed across social media sites and through email- the link was sent to the orthopedic, neurologic, and geriatric academies of the American Physical Therapy Association list serves. The email was also shared with each of the 50 state chapters of the American Physical Therapy Association. The survey was broken down into five sections: demographic information, physical therapists' general impressions of telehealth, physical therapists' comfort level treating various vestibular diagnoses, and common barriers physical therapists experienced during telehealth sessions. There were 159 completed surveys. More than 80% of physical therapists surveyed agreed that telehealth was an effective platform for vestibular physical therapy. When asked whether physical therapists felt the patient had similar health outcomes with telehealth versus clinic care 68% of physical therapists agreed. For the physical therapists who treated posterior or horizontal canal benign paroxysmal positional vertigo via telehealth, more than 50% were comfortable treating these conditions via telehealth. In analyzing common peripheral vestibular diagnoses treated via telehealth including bilateral vestibular loss, Meniere's disease, and vestibular neuritis more than 75% of the physical therapists reported comfort treating these diagnoses. Similarly, more than 75% of physical therapists who treated central vestibular diagnoses- including mild traumatic brain injury and vestibular migraine- via telehealth reported being comfortable treating these diagnoses. Physical therapists reported several barriers to tele healthcare ranging from concerns about testing balance with no caregiver present (94%) to challenges with providing a written home exercise program (33%). Physical therapists report that telehealth is a viable mechanism for providing rehabilitation for persons with balance and vestibular disorders. For common diagnoses, most physical therapists were comfortable treating vestibular disorders via telehealth. While barriers remain including maintaining patient safety and being able to complete a thorough vestibular exam, telehealth for vestibular physical therapy services holds promise for the delivery of virtual care.

Addressing Opportunities and Barriers in Telehealth Neurologic Physical Therapy: Strategies to Advance Practice

“…Individuals with other common diagnoses (including amyotrophic lateral sclerosis, spinal cord injuries, traumatic brain injuries, and vestibular disorders) report great satisfaction and engagement over telehealth, but there is a dearth of quantitative evidence demonstrating improvements in motor function. 8,[36][37][38] In contrast, providers lack confidence in the accuracy of a virtual diagnosis and share patient safety concerns when using telehealth. 38 Findings From Mobile Applications.…”

“…8,[36][37][38] In contrast, providers lack confidence in the accuracy of a virtual diagnosis and share patient safety concerns when using telehealth. 38 Findings From Mobile Applications. Due to the exponential growth in the number of commercially available PT, rehabilitation, and wellness smartphone applications "apps" (ie, software programs downloaded by a user on a mobile app) and limited information on the use and quality of these apps, it is a significant challenge to utilize or recommend them in a health care setting.…”

Toward a Digital Health Intervention for Vestibular Rehabilitation: Usability and Subjective Outcomes of a Novel Platform

“…It is therefore anticipated that digital health will be embedded in future care, will solve the problems of access, and allow a greater understanding of exercise parameters. In a recent VR specific survey, 80% of therapists agreed that telehealth was an effective mode of delivering treatment but reported challenges with providing the written exercise programme and concerns about testing balance remotely with no caregiver present ( 8 ), and in a large survey of US physical therapists, 40% reported using telehealth software for the first time in 2020 ( 9 ). A benefit of the pandemic has been the requirement to use technology for daily human interactions beyond health care, and this has likely increased acceptance and familiarity with remote interactions.…”

“…However, therapists face many considerations when transitioning to digital care, and barriers are often cited as cost, IT infrastructure, data privacy and security, and uncertainty around efficacy ( 10 , 11 ). Also, amongst therapists and patients, there remains a preference for face-to-face care, in a profession that is known for its “hands-on” approach ( 8 ).…”

Change in Diagnosis of Benign Paroxysmal Positional Vertigo During COVID-19 Pandemic

“…16,17 Due to the limited access to medical care provider during the COVID-19 pandemic, telemedicine for diagnosis and treatment of BPPV was proposed as a good alternative. [18][19][20] To our knowledge, this study is the first to examine the impact of COVID-19 on the incidence of BPPV subtypes by hospital visit (OPD vs ER), and the mean time interval between vertigo onset and primary evaluation. Our data demonstrated that the total number of BPPV patients who were diagnosed in the ER and OPD decreased by 15.9% (517 to 435) during the…”