Virtual and augmented reality in the vestibular rehabilitation of peripheral vestibular disorders: systematic review and meta-analysis

Abstract

Vestibular rehabilitation therapy is an established treatment for patients with vestibular dysfunction. Virtual reality (VR) and augmented reality (AR) can be utilised in vestibular rehabilitation. Evidence of the efficacy of VR and AR delivered rehabilitation in patients with peripheral vestibular disorders is reviewed. MEDLINE, EMBASE, CENTRAL, CINAHL, PsychInfo, PsychBITE, OTSeeker, Ei Compendex, IEE, Clinical trials.gov and WebofScience databases were searched. Reduction in vestibular dysfunction symptoms 0–3 months post-intervention was the primary outcome. Secondary outcomes included long-term symptom improvement and side effects. Risk of bias assessment and meta analyses were planned. Five studies meeting eligibility criteria were included. Dizziness Handicap Inventory (DHI) scores 0–3 months post-intervention were reported by four studies. Meta-analysis identified a 1.13 (95% CI, − 1.74, − 0.52) standardized mean difference reduction in DHI in VR and AR treated patients compared to controls. Side effects reported by two studies were reduced by week four of VR intervention. Bias assessment identified DHI scores and side effects to be at high risk or of some concern. Adjunct VR interventions reduced patient DHI significantly more than vestibular rehabilitation alone 0–3 months post-intervention in adult patients diagnosed with unilateral vestibular disease. High quality studies are needed.

Perception, knowledge, and attitude of medical doctors in Saudi Arabia about the role of physiotherapists in vestibular rehabilitation: a cross-sectional survey

“…A number of research studies have examined the potential for modern physical therapy technology for the assessment and treatment of patients with vestibular rehabilitation such as virtual reality to improve gaze stability during head movements ( Xie et al, 2021 ), smartphone application for guiding and monitoring exercises ( Moral-Munoz et al, 2021 ), force plateform to measure postural sway ( Song, 2019 ). Moreover, studies report that the management of patients with vestibular dysfunction with evidence-based medicine augmented by advanced therapeutic exercise led to better patient outcomes ( Heffernan, Abdelmalek & Nunez, 2021 ; Xie et al, 2021 ).…”

Vestibular Rehabilitation: Conventional and Virtual Reality-Based Methods

“…Virtual reality (VR) is an important contribution of computer technology to the vestibular field in recent years. VR is a computer-generated simulation of a visual environment or an activity [16] and is defined as the user entering an interactive environment that mimics reality [17]. At the same time, VR can be defined as using computer technology to create simulations of objects, space, and events.…”

“…Head-mounted VE systems are very effective in improving vestibulo-ocular reflex, oculomotor movements, eye tracking, and head-eye coordination. Systems that cannot be integrated with any platform, requiring only eye or head movements or staying still, can be called "passive VR rehabilitation systems," systems that require providing or maintaining postural balance on a moving floor, stepping on a stable floor, walking on a treadmill or doing yoga can be called "active VR rehabilitation systems" [11,15,17,19].…”

“…VR sessions were applied in the clinic for 30-40 minutes five days a week or 35-45 minutes two days a week. In some protocols, home exercises are included in the program [17].…”

Systematic Review and Meta-Analysis of the Application of Virtual Reality in Hearing Disorders

“…The technologies are being applied only to certain diseases in hearing loss, tinnitus, and vestibular disease. Although some studies have reported the efficacy and/or effectiveness of recent technologies especially for VR in otology by using the systematic review [18][19][20] and meta-analysis [3,6], most have been either inconclusive or lack enough topic diversity and/or subjective evidence and do not report any statistical significance. By using a systematic review and a meta-analysis approach, we sought to identify the VR technology applied to hearing loss, vestibular dysfunction, and tinnitus, indeed the representative diseases in the fields of otology and audiology.…”