荷兰阿姆斯特丹大学Vincent A van Vugt团队在研究中取得进展。他们发现，互联网为基础的前庭康复伴或不伴物理治疗支持可用于治疗50岁及以上的成人慢性前庭综合征。相关论文11月5日在线发表于《英国医学期刊》。

在这项实用、三臂、平行组、个体随机对照试验中，研究组招募了322名50岁及以上患有慢性前庭综合征的成年人。将其随机分为三组，其中单独前庭康复（VR）组包括为期6周的互联网干预，每周在线学习课程，并进行日常锻炼，每日10-20分钟。混合VR组在基于单独VR组的基础上，增加面对面的物理治疗支持，医生在第1周和第3周上门治疗。普通护理组则接受全科医生的标准护理，无任何限制。

在意向治疗分析中，单独VR组和混合VR组的参与者在治疗6个月后的眩晕症状量表（VSS-SF）得分显著低于普通护理组，随访3个月后该评分差异依旧存在。在治疗3个月和6个月时，与普通护理组相比，单独和混合VR组更少发生头晕相关损害和焦虑症，且主观前庭症状显著改善。试验期间未发生与在线VR相关的严重不良事件。

总之，单独和混合VR是治疗50岁及以上成人慢性前庭综合征的安全有效的方法，在线VR较易获得，可改善治疗不足患者的疗效。

附：英文原文

Title: Internet based vestibular rehabilitation with and without physiotherapy support for adults aged 50 and older with a chronic vestibular syndrome in general practice: three armed randomised controlled trial

Author: Vincent A van Vugt, Johannes C van der Wouden, Rosie Essery, Lucy Yardley, Jos W R Twisk, Henritte E van der Horst, Otto R Maarsingh

Issue&Volume: 2019/11/05

Abstract: 

Objective To investigate the clinical effectiveness and safety of stand alone and blended internet based vestibular rehabilitation (VR) in the management of chronic vestibular syndromes in general practice.

Design Pragmatic, three armed, parallel group, individually randomised controlled trial.

Setting 59 general practices in the Netherlands.

Participants 322 adults aged 50 and older with a chronic vestibular syndrome.

Interventions Stand alone VR comprising a six week, internet based intervention with weekly online sessions and daily exercises (10-20 minutes a day). In the blended VR group, the same internet based intervention was supplemented by face-to-face physiotherapy support (home visits in weeks 1 and 3). Participants in the usual care group received standard care from a general practitioner, without any restrictions.

Main outcome measures The primary outcome was vestibular symptoms after six months as measured by the vertigo symptom scale-short form (VSS-SF range 0-60, clinically relevant difference ≥3 points). Secondary outcomes were dizziness related impairment, anxiety, depressive symptoms, subjective improvement of vestibular symptoms after three and six months, and adverse events.

Results In the intention-to-treat analysis, participants in the stand alone and blended VR groups had lower VSS-SF scores at six months than participants in the usual care group (adjusted mean difference −4.1 points, 95% confidence interval −5.8 to −2.5; and −3.5 points, −5.1 to −1.9, respectively). Similar differences in VSS-SF scores were seen at three months follow-up. Participants in the stand alone and blended VR groups also experienced less dizziness related impairment, less anxiety, and more subjective improvement of vestibular symptoms at three and six months. No serious adverse events related to online VR occurred during the trial.

Conclusion Stand alone and blended internet based VR are clinically effective and safe interventions to treat adults aged 50 and older with a chronic vestibular syndrome. Online VR is an easily accessible form of treatment, with the potential to improve care for an undertreated group of patients in general practice.

DOI: 10.1136/bmj.l5922

Source: https://www.bmj.com/content/367/bmj.l5922