Virtual vestibular rehabilitation (VR) is as effective as in-person VR
Reviewed by Victor Osei-Lah

The effectiveness of vestibular rehabilitation (VR) for patients with several vestibular disorders is well established. Access for in-person clinic-based VR is however patchy and limited. To widen access, offering VR via virtual platforms is increasingly being adopted. The authors conducted this retrospective study at the beginning of the global Covid-19 pandemic, to determine the effectiveness of telehealth VR compared with the traditional in-person VR. Seventy three adult patients were divided into three groups: experimental group (24 patients) – completed entire treatment via telehealth Zoom platform (tele-VR); hybrid group (21 patients) – a mixture of clinic-based and telehealth (hy-VR); and the control group (28 patients) who completed all treatment in person. The outcome measure was the Dizziness Handicap Inventory (DHI). Therapy was provided by two accredited physical therapists who assessed all 73 participants in person before the start of therapy. Treatment consisted of gaze stability training, oculomotor exercises, habituation strategies, cervical exercises and techniques, postural stability exercises, somatosensory up-weighting, canalith repositioning manoeuvres and gait training activities. All participants were instructed to perform a set of regular daily home exercises specific to the patient’s impairments, home environment and daily routine. Each treatment session was supervised and adjustments were made when necessary. The average treatment visits for the virtual, in person and hybriVICTORd groups were 4.76 (1–10) and 3.78 (1–8) respectively. Average treatment visits for the hybrid group were 2.13 in-person and 3.57 virtual. Overall, there were more females than males. Age range was 17–93 years. The age-adjusted mean DHI scores in the telehealth group reduced from 32.27 to 18.74 points, a significant reduction of 50.3%. The DHI reduction in the in-person and hybrid groups were 47.8 to 16.05 points (66.5%) and 47 to 25 points (45.6%) respectively. These reductions were all statistically significant, leading the authors to conclude that telehealth VR and hybrid VR can be utilised effectively. They discussed limitations of the study, including the reliance of DHI as the only outcome measure. It would have been informative for the authors to show a breakdown of the vestibular diagnoses. Although in-person VR remains the best option, the other modalities should not be discounted in the right context.

Comparing in-clinic versus telehealth for vestibular physical therapy.
Kriz M, Conover S, Cameron N, et al.
J VESTIB RES
2024;34(4):215–22.