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.

Figure 1

Flow of the article screening process for this systematic review. Flow chart was generated using Microsoft Word.

Figure 2

Post-intervention symptom index score (DHI) meta-analysis. SMD between VR/AR and control vestibular rehabilitation is listed. DHI dizziness handicap index, SMD standardized mean difference, VR virtual reality, AR augmented reality.

Figure 3

Post-intervention symptom index score (DHI) peripheral vestibular disorder subgroup analysis. SMDs between VR/AR and control vestibular rehabilitation for the group of UVH disorders studied by Micarelli et al. and Micarelli et al., MD alone and the vestibular disorders studied by Krueger are listed. AN acoustic neuroma, AR augmented reality, BPV benign positional vertigo, DHI dizziness handicap index, EH endolymphatic hydrops, LD labyrinth dysfunction, MD Meniere’s disease, MI motion intolerance, PCS previous cochlear surgery, PPS previous periosteal surgery, PVD peripheral vestibular disorder, PVNS previous vestibular nerve section, RHS Ramsay Hunt syndrome, SMD standardized mean differences, UVH unilateral vestibular hypofunction, VR virtual reality.

Figure 4

Post-intervention symptom index score (DHI) intervention type subgroup analysis. SMDs between VR/AR and control vestibular rehabilitation for AR, home based VR and in-clinic VR are listed. DHI dizziness handicap index, SMD standardized mean differences, VR virtual reality, AR augmented reality.