Virtual Reality in People With Persistent Postural-Perceptual Dizziness

The Effect of Using Virtual Reality on Balance in People With Persistent Postural-Perceptual Dizziness

This study aimed to compare the effectiveness of virtual reality (VR) and vestibular rehabilitation therapy (VRT) in enhancing balance in individuals with Persistent Postural-Perceptual Dizziness (PPPD). The experimental group received VR combined with VRT and optokinetic stimulation, while the control group received VRT and optokinetic stimulation. The study involved 42 individuals diagnosed with PPPD and administered ten intervention sessions over six weeks. The study also examined the impact of VR on various aspects of PPPD, including dizziness, visual vertigo, mental well-being, sleep quality, fall risk, and overall quality of life.

Study Overview

• Status: Completed
• Conditions: Vestibular Dizziness
• Intervention / Treatment: Other: Optokinetic Stimulation exercises; Other: Virtual reality exercises; Other: Vestibular Rehabilitation Therapy (VRT)

Detailed Description

Persistent Postural-Perceptual Dizziness (PPPD) represents a relatively new vestibular diagnosis that has garnered recent attention within the medical community. Consequently, there exists a pressing demand for efficacious and innovative management strategies. The primary purpose of this study was to assess the comparative effectiveness of virtual reality (VR) versus vestibular rehabilitation therapy (VRT) in enhancing balance among individuals afflicted with PPPD. A secondary purpose encompassed an investigation of VR's impact on various dimensions of PPPD, including dizziness, visual vertigo, mental well-being, sleep quality, fall risk, and overall quality of life. Materials and Methods: A cohort comprising forty-two individuals conclusively diagnosed with PPPD was randomly assigned to two distinct groups. The experimental cohort comprised twenty-one participants subjected to a combination of VR with optokinetic stimulation alongside VRT, whereas the control group, also consisting of twenty-one individuals, underwent solely optokinetic stimulation paired with VRT. The intervention sessions were administered twice weekly over a span of six weeks, resulting in a total of ten intervention sessions. Additionally, baseline and post-intervention assessments were conducted to gauge the efficacy of the interventions.

• Study Type: Interventional
• Enrollment (Actual): 42
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Jordan
  • Amman, Jordan
    • Royal Medical Services

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients with a confirmed diagnosis of the PPPD from a specialized physician, based on the diagnostic criteria published by the Barany Society.
• Patients who scored more than 27 on the Niigata PPPD Questionnaire (NPQ)

Exclusion Criteria:

• If they suffered from other neurological or orthopedic deficits that affected their balance and prevented them from moving independently.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Vestibular Rehabilitation Therapy (VRT); Participants went through conventional VRT in addition to optokinetic exercise training. The VRT exercises were composed of gaze stabilization, head motion, and postural stability exercises with static and dynamic balance exercises. Ten repetitions of each VRT exercise were practiced in the same session for three sets. Moreover, participants were instructed to watch optokinetic stimulation videos. The optokinetic stimulation training was conducted using the following displays (a mobile and TV screen).	Other: Optokinetic Stimulation exercises; Optokinetic Stimulation is a type of visual stimulation used to improve visual function and balance in patients with vestibular disorders.; Other: Vestibular Rehabilitation Therapy (VRT); The VRT exercises were composed of gaze stabilization, head motion and postural stability exercises with static and dynamic balance exercises.; Other Names: VRT
Experimental: Virtual Reality; The same intervention program for the control group was implemented for participants in the experimental group, with the addition of using the VR split screen in Samsung Gear VR goggles in the last 4 sessions. Using the VR goggles, participants started watching the videos for 30 seconds to 1 minute in the sitting position in the first two sessions, followed by 1-2 minutes in the standing position for the last 2 sessions.	Other: Optokinetic Stimulation exercises; Optokinetic Stimulation is a type of visual stimulation used to improve visual function and balance in patients with vestibular disorders.; Other: Virtual reality exercises; The VR exercises included watching theraputic videos using the virtual reality goggles with static and dynamic balance exercises.; Other Names: VR; Other: Vestibular Rehabilitation Therapy (VRT); The VRT exercises were composed of gaze stabilization, head motion and postural stability exercises with static and dynamic balance exercises.; Other Names: VRT

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The Niigata Persistent Postural-Perceptual Dizziness Questionnaire (NPQ)	self-reported questionnaire that was generated to screen for and assess the severity of Persistent Postural-Perceptual Dizziness. Higher score is worse severity of Persistent Postural-Perceptual Dizziness. Minimum score is 0 and maximum score is 72.	Before intervention.
The Niigata Persistent Postural-Perceptual Dizziness Questionnaire (NPQ)	self-reported questionnaire that was generated to screen for and assess the severity of Persistent Postural-Perceptual Dizziness. Higher score is worse severity of Persistent Postural-Perceptual Dizziness. Minimum score is 0 and maximum score is 72.	After 6 weeks
The Niigata Persistent Postural-Perceptual Dizziness Questionnaire (NPQ)	self-reported questionnaire that was generated to screen for and assess the severity of Persistent Postural-Perceptual Dizziness. Higher score is worse severity of Persistent Postural-Perceptual Dizziness. Minimum score is 0 and maximum score is 72.	After one year follow up.
Dizziness Handicap Inventory (DHI)	self- reported questionnaire that assesses the perceived disability from dizziness. Higher score indicates worse disability from dizziness. Minimum score is 0 and maximum score is 100.	Before intervention.
Dizziness Handicap Inventory (DHI)	self- reported questionnaire that assesses the perceived disability from dizziness. Higher score indicates worse disability from dizziness. Minimum score is 0 and maximum score is 100.	After 6 weeks
Falls Efficacy Scale International (FES-I)	self-reported questionnaire that assesses fear of falling. A higher score means worse concerns from falling. Minimum score is 16 and maximum score is 64.	Before intervention.
Falls Efficacy Scale International (FES-I)	self-reported questionnaire that assesses fear of falling. A higher score means worse concerns from falling. Minimum score is 16 and maximum score is 64.	After 6 weeks
Dynamic Gait Index (DGI)	A clinical performance-based tool that is used to evaluate dynamic postural stability. A higher score indicates better dynamic balance and gait. Minimum score is 0 and maximum score is 24.	Before intervention.
Dynamic Gait Index (DGI)	A clinical performance-based tool that is used to evaluate dynamic postural stability. A higher score indicates better dynamic balance and gait. Minimum score is 0 and maximum score is 24.	After 6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pittsburgh Sleep Quality Index (PSQI)	A self-reported questionnaire that assesses quality of sleep. A higher score indicates worse sleep quality. Minimum score is 0 and maximum score is 21.	Before intervention.
Pittsburgh Sleep Quality Index (PSQI)	A self-reported questionnaire that assesses quality of sleep. A higher score indicates worse sleep quality. Minimum score is 0 and maximum score is 21.	After 6 weeks
Hospital Anxiety and Depression Scale (HADS)	a self-assessment scale that was developed to assess the severity of mood disturbances including depression and anxiety. Higher scores mean worse severity in depression and anxiety. Minimum score is 0 and maximum score is 21 for each subscale (depression and anxiety).	Before intervention.
Hospital Anxiety and Depression Scale (HADS)	a self-assessment scale that was developed to assess the severity of mood disturbances including depression and anxiety. Higher scores mean worse severity in depression and anxiety. Minimum score is 0 and maximum score is 21 for each subscale (depression and anxiety).	After 6 weeks
Medical Outcomes Study Short Form 12 (SF-12)	A self-reported questionnaire that assesses the impact of any health condition on the quality of life. Higher scores indicate better quality of life. Minimum score is 0 and maximum score is 100.	Before intervention.
Medical Outcomes Study Short Form 12 (SF-12)	A self-reported questionnaire that assesses the impact of any health condition on the quality of life. Higher scores indicate better quality of life. Minimum score is 0 and maximum score is 100.	After 6 weeks

Collaborators and Investigators

• Sponsor: University of Jordan
• Investigators: Principal Investigator: Alia A Alghwiri, PhD, The University of Jordan

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2022
• Primary Completion (Actual): December 31, 2023
• Study Completion (Actual): March 1, 2024

Study Registration Dates

• First Submitted: March 25, 2024
• First Submitted That Met QC Criteria: April 13, 2024
• First Posted (Actual): April 16, 2024

Study Record Updates

• Last Update Posted (Actual): July 3, 2024
• Last Update Submitted That Met QC Criteria: July 1, 2024
• Last Verified: July 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Nervous System Diseases; Neurologic Manifestations; Otorhinolaryngologic Diseases; Labyrinth Diseases; Ear Diseases; Vestibular Diseases; Sensation Disorders; Vertigo; Dizziness
• Other Study ID Numbers: 2/2024

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: The data that support the findings of this study are available from the corresponding author upon reasonable request.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No