Secondary outcome will be mental workload in each of the study arms.Positional Vertigo - An Easy Fix at Any Ageīenign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, in which the environment is seen to spin. The primary outcome of the study will be the improvement in and resolution of BPPV symptoms with VREMS use as compared to IH. For any patient with residual BPPV symptoms following Epley maneuver with VREMS or IH, the ENT specialist/vestibular physiotherapist will perform the Epley maneuver to ensure resolution of symptoms if possible prior to discharge from the clinic. They will also be given an opportunity to give free-text feedback.
All patients will also be asked to complete the NASA Task Load Index (NASA-TLX) to gauge their perceived mental workload. In both groups, once the patient has performed the Epley maneuver (whether with VREMS assistance or with the IH), they will be asked to rate their symptom severity after undergoing the Epley maneuver. Subsequently, patients will be supervised as they perform the Epley maneuver - VREMS assisted or based on reading the IH. All participants will be asked to rate the severity of their symptoms before undergoing the Epley maneuver. Patients in the VREMS cohort will be provided with the VREMS device, which will help guide them through the Epley maneuver in a virtual reality environment. Those in the control cohort will be provided an instructional handout (IH) to help them perform the Epley maneuver.
Patients who consent to participating in the study will be allocated to either the VREMS cohort or the control cohort. Those who are diagnosed with posterior canal BPPV after history and physical examination including the Dix-Hallpike test will be approached to be recruited into the study. Vertigo patients referred to the Neurovestibular Clinic will be evaluated by an Ear, Nose and Throat (ENT) specialist. PICO (Patient/Population Intervention Compare Outcome): In adult patients diagnosed with posterior canal BPPV by a specialist, does VREMS, as compared to self-performed Epley maneuver using an instructional handout (IH) result in improved or resolved symptoms? In this study we aim to apply VREMS treatment in patients who have been diagnosed with BPPV. In a previous paper we demonstrated the development and face validation of a Virtual Reality Epley Maneuver System (VREMS) for performing the Epley maneuver correctly. In-office administration of the Epley maneuver by a specialist yields a 90% success rate at treating the condition however, at-home administration is much less successful. The Epley maneuver is a particle-repositioning maneuver that is used to treat posterior semicircular canal BPPV, the most common type of BPPV, after a diagnosis has been made on physical examination.
Additionally, at least half of those with initial symptoms of BPPV will have ongoing symptoms if not treated. It can be dangerous as repetitive symptoms can lead to falls and depression, particularly in the elderly. The main symptom is the perceived sensation of movement of the surrounding or self, without actual such movement, triggered by changes in position (positional vertigo). Why Should I Register and Submit Results?īenign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, affecting 2.4% of the general population and 30% of those over 70 years old.