Reabilitação digital para a disfunção vestibular: uma revisão sistemática do âmbito e meta-análise sobre estratégias remotas para o tratamento de tonturas em idosos
DOI:
https://doi.org/10.17267/2238-2704rpf.2025.e6155Palavras-chave:
Tontura, Reabilitação Vestibular, Idosos, Realidade Virtual, Telerreabilitação, Meta-análise, Equilíbrio Postural, Qualidade de VidaResumo
INTRODUÇÃO: A tontura é um sintoma prevalente e incapacitante da disfunção vestibular, sobretudo nos idosos, afetando negativamente a mobilidade, a independência e a qualidade de vida (QV). A reabilitação digital, proporcionada através de tecnologias remotas, como a realidade virtual (VR), aplicações móveis e plataformas de telessaúde, emergiu como uma abordagem escalável e potencialmente eficaz para a reabilitação vestibular. Esta revisão de escopo e meta-análise teve como objetivo sintetizar as evidências atuais sobre as estratégias de reabilitação digital para a gestão da tontura em idosos com disfunção vestibular e identificar lacunas de investigação neste campo emergente. MÉTODO: Foi realizada uma pesquisa sistemática no PubMed, The Cochrane Library, PEDro, Ovid e Scopus desde o início até outubro de 2024. A estratégia de pesquisa seguiu as diretrizes PRISMA-ScR e incluiu estudos que investigam intervenções digitais direcionadas para sintomas vestibulares em adultos com idade ≥60 anos. Após remoção de duplicados e triagem de 1.585 títulos e resumos, oito estudos cumpriram os critérios de elegibilidade. Foi realizada uma síntese descritiva e, quando os dados o permitiram, foi realizada uma meta-análise para estimar o efeito combinado das intervenções digitais na gravidade da tontura e nos resultados do equilíbrio postural. RESULTADOS: As intervenções de reabilitação digital, particularmente as que envolvem treino de equilíbrio baseado em RV, plataformas móveis e monitorização remota, têm sido associadas a melhorias significativas na gravidade da tontura, no controlo postural e na qualidade de vida entre os adultos mais velhos. A meta-análise demonstrou um tamanho de efeito combinado moderado que favorece a reabilitação digital em relação aos cuidados padrão ou domiciliários (diferença média padronizada [SMD] = –0,62; IC 95%: –0,91 a –0,33) na redução da intensidade da tontura. No entanto, a heterogeneidade entre os estudos foi moderada a elevada, refletindo a variabilidade no tipo de intervenção, duração e medidas de resultados. CONCLUSÃO: A reabilitação digital oferece benefícios promissores para o tratamento da tontura em idosos com disfunção vestibular, existindo evidências que suportam a sua eficácia clínica na redução da gravidade dos sintomas e na melhoria do equilíbrio e da qualidade de vida. Apesar dos resultados encorajadores, o número limitado de ensaios de elevada qualidade e a heterogeneidade metodológica justificam uma interpretação cautelosa. São necessários mais ensaios clínicos randomizados de grande escala para confirmar a eficácia a longo prazo, avaliar a relação custo-eficácia e orientar a integração clínica da reabilitação digital para os cuidados vestibulares.
Downloads
Referências
1. Chawla N, Olshaker JS. Diagnosis and management of dizziness and vertigo. Med Clin North Am. 2006 Mar;90(2):291-304. https://doi.org/10.1016/j.mcna.2005.11.003
2. Yardley L, Donovan-Hall M, Smith HE, Walsh BM, Mullee M, Bronstein AM. Effectiveness of primary care-based vestibular rehabilitation for chronic dizziness. Ann Intern Med. 2004 Oct 19;141(8):598-605. https://doi.org/10.7326/0003-4819-141-8-200410190-00007
3. Shaikh AG, Bronstein A, Carmona S, Cha YH, Cho C, Ghasia FF, et al. Consensus on Virtual Management of Vestibular Disorders: Urgent Versus Expedited Care. Cerebellum. 2021 Feb;20(1):4-8. https://doi.org/10.1007/s12311-020-01178-8
4. Koo JW, Chang MY, Woo SY, Kim S, Cho YS. Prevalence of vestibular dysfunction and associated factors in South Korea. BMJ Open. 2015 Oct 26;5(10):e008224. https://doi.org/10.1136/bmjopen-2015-008224
5. Al-Asadi JN, Al-Lami QA. Prevalence and Risk Factors of Benign Paroxysmal Positional Vertigo among Patients with Dizziness in Basrah, Iraq. BJMMR. 2015;7(9):754-761. https://doi.org/10.9734/BJMMR/2015/16542
6. Tahtis V, Male A, Kaski D. Positional Manoeuvres for BPPV: Theoretical Approach to Remote Training for Non-specialists. Front Neurol. 2021 Oct 5;12:738785. https://doi.org/10.3389/fneur.2021.738785
7. Hall CD, Herdman SJ, Whitney SL, Anson ER, Carender WJ, Hoppes CW, et al. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. J Neurol Phys Ther. 2022 Apr 1;46(2):118-177. https://doi.org/10.1097/NPT.0000000000000382
8. Yerlikaya T, Öniz A, Özgùren M. The Effect of an Interactive Tele Rehabilitation Program on Balance in Older Individuals. Neurol Sci Neurophysiol. 2021;38(3):180–186. https://doi.org/10.4103/nsn.nsn_91_21
9. Stamou M, Nikolaou C, Chοiras S. Telerehabilitation in Physiotherapy Science: A Scoping Review. Cureus. 2024 Feb 18;16(2):e54396. https://doi.org/10.7759/cureus.54396
10. Velayati F, Ayatollahi H, Hemmat M. A Systematic Review of the Effectiveness of Telerehabilitation Interventions for Therapeutic Purposes in the Elderly. Methods Inf Med. 2020 May;59(2-03):104-109. https://doi.org/10.1055/s-0040-1713398
11. Cox NS, Dal Corso S, Hansen H, McDonald CF, Hill CJ, Zanaboni P, et al. Telerehabilitation for chronic respiratory disease. Cochrane Database Syst Rev. 2021 Jan 29;1(1):CD013040. https://doi.org/10.1002/14651858.CD013040.pub2
12. Burge AT, Cox NS, Abramson MJ, Holland AE. Interventions for promoting physical activity in people with chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev. 2020 Apr 16;4(4):CD012626. https://doi.org/10.1002/14651858.CD012626.pub2
13. Laver KE, Adey-Wakeling Z, Crotty M, Lannin NA, George S, Sherrington C. Telerehabilitation services for stroke. Cochrane Database Syst Rev. 2020 Jan 31;1(1):CD010255. https://doi.org/10.1002/14651858.CD010255.pub3
14. Grillo D, Zitti M, Cieślik B, Vania S, Zangarini S, Bargellesi S, et al. Effectiveness of Telerehabilitation in Dizziness: A Systematic Review with Meta-Analysis. Sensors (Basel). 2024 May 10;24(10):3028. https://doi.org/10.3390/s24103028
15. Perez-Heydrich CA, Creary-Miller I, Spann M, Agrawal Y. Remote Delivery of Vestibular Rehabilitation for Vestibular Dysfunction: A Systematic Review. Otol Neurotol. 2024 Jul 1;45(6):608-618. https://doi.org/10.1097/MAO.0000000000004218
16. Horsley S, Schock G, Grona SL, Montieth K, Mowat B, Stasiuk K, et al. Use of real-time videoconferencing to deliver physical therapy services: A scoping review of published and emerging evidence. J Telemed Telecare. 2020 Dec;26(10):581-589. https://doi.org/10.1177/1357633X19854647
17. Iacono T, Stagg K, Pearce N, Chambers AH. A scoping review of Australian allied health research in ehealth. BMC Health Serv Res. 2016;16:543. https://doi.org/10.1186/s12913-016-1791-x
18. Wong B, Ward D, Gemmell K, Bright R. How is telehealth being utilized in the context of rehabilitation for lower limb musculoskeletal disorders: a scoping review. Phys Ther Rev. 2020;25(5-6):350–360. https://doi.org/10.1080/10833196.2020.1832712
19. World Confederation for Physical Therapy & International Network of Physiotherapy Regulatory Authorities. Report of the WCPT/INPTRA Digital Physical Therapy Practice Task Force [Internet]. WCPT/INPTRA; 2020. Available from: https://world.physio/sites/default/files/2020-06/WCPT-INPTRA-Digital-Physical-Therapy-Practice-Task-force-March2020.pdf
20. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32. https://doi.org/10.1080/1364557032000119616
21. Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010 Sep 20;5:69. https://doi.org/10.1186/1748-5908-5-69
22. Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z. JBI Manual for Evidence Synthesis. JBI; 2024. https://doi.org/10.46658/JBIMES-24-01
23. Maldonado-Díaz M, Vargas P, Vasquez R, Gonzalez-Seguel F, Rivero B, Hidalgo-Cabalín V, et al. Teleneurorehabilitation program (virtual reality) for patients with balance disorders: descriptive study. BMC Sports Sci Med Rehabil. 2021 Aug 2;13(1):83. https://doi.org/10.1186/s13102-021-00314-z
24. Geraghty AWA, Essery R, Kirby S, Stuart B, Turner D, Little P, et al. Internet-Based Vestibular Rehabilitation for Older Adults With Chronic Dizziness: A Randomized Controlled Trial in Primary Care. Ann Fam Med. 2017 May;15(3):209-216. https://doi.org/10.1370/afm.2070
25. van Vugt VA, van der Wouden JC, Essery R, Yardley L, Twisk JWR, van der Horst HE, et al. 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. BMJ. 2019 Nov 5;367:l5922. https://doi.org/10.1136/bmj.l5922
26. Smaerup M, Grönvall E, Larsen SB, Laessoe U, Henriksen JJ, Damsgaard EM. Computer-assisted training as a complement in rehabilitation of patients with chronic vestibular dizziness--a randomized controlled trial. Arch Phys Med Rehabil. 2015 Mar;96(3):395-401. https://doi.org/10.1016/j.apmr.2014.10.005
27. Haciabbasoğlu R, Araci A, Günizi H. Are Telerehabilitation Exercise Practices Effective in Patients Diagnosed with Benign Paroxysmal Positional Vertigo? Indian J Otolaryngol Head Neck Surg. 2023 Apr;75(Suppl 1):557-567. https://doi.org/10.1007/s12070-023-03631-6
28. Aldawsary N, Almarwani M. The combined effect of gaze stability and balance exercises using telerehabilitation in individuals with vestibular disorders during the COVID-19 pandemic: A pilot study. PLoS One. 2023 May 5;18(5):e0282189. https://doi.org/10.1371/journal.pone.0282189
29. Smaerup M, Laessoe U, Grönvall E, Henriksen JJ, Damsgaard EM. The Use of Computer-Assisted Home Exercises to Preserve Physical Function after a Vestibular Rehabilitation Program: A Randomized Controlled Study. Rehabil Res Pract. 2016;2016:7026317. https://doi.org/10.1155/2016/7026317
30. Yardley L, Barker F, Muller I, Turner D, Kirby S, Mullee M, et al. Clinical and cost effectiveness of booklet based vestibular rehabilitation for chronic dizziness in primary care: single blind, parallel group, pragmatic, randomised controlled trial. BMJ. 2012 Jun 6;344:e2237. https://doi.org/10.1136/bmj.e2237
31. Peretti A, Amenta F, Tayebati SK, Nittari G, Mahdi SS. Telerehabilitation: Review of the State-of-the-Art and Areas of Application. JMIR Rehabil Assist Technol. 2017 Jul 21;4(2):e7. https://doi.org/10.2196/rehab.7511
32. Bashshur R, Shannon G, Krupinski E, Grigsby J. The taxonomy of telemedicine. Telemed J E Health. 2011 Jul-Aug;17(6):484-94. https://doi.org/10.1089/tmj.2011.0103
33. Cottrell MA, Russell TG. Telehealth for musculoskeletal physiotherapy. Musculoskelet Sci Pract. 2020 Aug;48:102193. https://doi.org/10.1016/j.msksp.2020.102193
34. Doraiswamy S, Abraham A, Mamtani R, Cheema S. Use of Telehealth During the COVID-19 Pandemic: Scoping Review. J Med Internet Res. 2020 Dec 1;22(12):e24087. https://doi.org/10.2196/24087
35. Strupp M, Dlugaiczyk J, Ertl-Wagner BB, Rujescu D, Westhofen M, Dieterich M. Vestibular Disorders. Dtsch Arztebl Int. 2020 Apr 24;117(17):300-310. https://doi.org/10.3238/arztebl.2020.0300
36. Velayati F, Ayatollahi H, Hemmat M. A Systematic Review of the Effectiveness of Telerehabilitation Interventions for Therapeutic Purposes in the Elderly. Methods Inf Med. 2020 May;59(2-03):104-109. https://doi.org/10.1055/s-0040-1713398
37. Saito T, Izawa KP. Effectiveness and feasibility of home-based telerehabilitation for community-dwelling elderly people in Southeast Asian countries and regions: a systematic review. Aging Clin Exp Res. 2021 Oct;33(10):2657-2669. https://doi.org/10.1007/s40520-021-01820-3
38. McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev. 2015 Jan 13;1(1):CD005397. https://doi.org/10.1002/14651858.CD005397.pub4
39. Czaja SJ, Boot WR, Charness N, Rogers WA, Sharit J. Improving Social Support for Older Adults Through Technology: Findings From the PRISM Randomized Controlled Trial. Gerontologist. 2018 May 8;58(3):467-477. https://doi.org/10.1093/geront/gnw249
40. Hjelm NM. Benefits and drawbacks of telemedicine. J Telemed Telecare. 2005;11(2):60-70. https://doi.org/10.1258/1357633053499886
41. Seron P, Oliveros MJ, Gutierrez-Arias R, Fuentes-Aspe R, Torres-Castro RC, Merino-Osorio C, et al. Effectiveness of Telerehabilitation in Physical Therapy: A Rapid Overview. Phys Ther. 2021 Jun 1;101(6):pzab053. https://doi.org/10.1093/ptj/pzab053
42. Dalfrà MG, Nicolucci A, Lapolla A; TISG. The effect of telemedicine on outcome and quality of life in pregnant women with diabetes. J Telemed Telecare. 2009;15(5):238-42. https://doi.org/10.1258/jtt.2009.081213
43. Szturm T, Hochman J, Wu C, Lisa L, Reimer K, Wonneck B, et al. Games and Telerehabilitation for Balance Impairments and Gaze Dysfunction: Protocol of a Randomized Controlled Trial. JMIR Res Protoc. 2015 Oct 21;4(4):e118. https://doi.org/10.2196/resprot.4743
44. Gaikwada SB, Mukherjeeb T, Shahb PV, Ambodeb OI, Johnsonb EG, Dahera NS. Home exercise program adherence strategies in vestibular rehabilitation: a systematic review. Phys Ther Rehabil Sci. 2016;5(2):53–62. https://doi.org/10.14474/ptrs.2016.5.2.53
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2025 Preeti Kapri, Nidhi Sharma, Simranjeet Kaur, Priyanka Negi, Parveen Kumar, Gurjant Singh, Anshu Sharma
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Esta obra está licenciada com uma Licença Creative Commons Atribuição 4.0 Internacional.
