Developing Tools and a Care Path for Somatosensory Tinnitus

开发体感耳鸣的工具和护理路径

• 批准号: 10538961
• 负责人: Sarah Theodoroff
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-10-01 至 2026-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10538961
• 关键词: Address; American Physical Therapy Association; Area; Articular Range of Motion; Attention; Audiology; Auditory Perception; Awareness; Belief; Biomechanics; Caring; Cervical; Cervical spine; Characteristics; Clinic; Clinical; Clinical Practice Guideline; Clinical Trials; Communication; Data; Development; Diagnosis; Diagnostic tests; Discipline; Disease; Distress; Effectiveness; Evaluation; Eye Movements; Financial compensation; Flexor; Future; Goals; Gold; Guidelines; Head and neck structure; Health Personnel; Healthcare Systems; Hearing; Injury; Jaw; Knowledge; Location; Loudness; Movement; Muscle; Muscle Contraction; Musculoskeletal; Neck; Outcomes Research; Pathway interactions; Patient Care; Patient Self-Report; Patients; Perception; Phase; Physical therapy; Pilot Projects; Prevalence; Primary Health Care; Procedures; Protocols documentation; Randomized Clinical Trials; Recording of previous events; Rehabilitation therapy; Reporting; Research; Screening procedure; Sensitivity and Specificity; Sensorineural Hearing Loss; Series; Services; Standardization; Stimulus; Suggestion; Techniques; Temporomandibular Joint Dysfunction Syndrome; Testing; Tinnitus; Traction; Treatment Effectiveness; Uncertainty; Veterans; Work; arm; associated symptom; base; clinical care; clinical decision-making; clinical examination; clinical practice; comorbidity; diagnostic accuracy; diagnostic screening; disability; efficacy evaluation; evidence base; individualized medicine; instrument; jaw movement; military veteran; patient oriented; physical therapist; programs; response; screening; somatosensory; standard of care; tool; trial comparing

Somatosensory tinnitus is suspected when perceptual characteristics (e.g., pitch and loudness) change immediately following head and neck maneuvers, forceful muscle contractions, or eye or jaw movements. Prevalence estimates vary, with reports as high as 80% of tinnitus patients being able to modulate their tinnitus by manipulating somatic regions of the head, neck, and jaw (Ralli et al, 2017), suggesting somatosensory tinnitus to be common, yet research related to this type of tinnitus in Veterans has received minimal attention. Veterans whose tinnitus is influenced by somatic movements suggests the possibility of an underlying biomechanical deficit that is being overlooked, which if treated, has the potential to alleviate the tinnitus symptoms associated with the musculoskeletal problem and help them regain normal functioning. The proposed research is taking the next step in achieving our long-term goal to develop a framework that can diagnose, assess, and treat Veterans with somatosensory tinnitus. The plan for this avenue of research is to build-on the important knowledge gained from the pilot phase of this work and accomplish the following objectives: (1) create a diagnostic screening test with good sensitivity and specificity to identify ST; (2) develop evidence-based clinical procedures for physical therapists to assess and treat ST; and (3) perform a randomized clinical trial comparing the newly developed treatment for ST with audiology-based standard of care. The first year of the project will focus on creating two “short forms” (i.e., diagnostic tests) that will be compared with the clinical exam currently used to diagnose somatosensory tinnitus to develop a test instrument with good sensitivity and specificity, i.e., good diagnostic accuracy, to identify somatosensory tinnitus. Additionally, work to be done during Year 1 involves adapting the standardized biomechanical physical evaluation consistent with the American Physical Therapy Association clinical practice guidelines to include procedures that capture changes in tinnitus perception and develop an 8-week individualized physiotherapy program that will be used in the clinical trial portion of this research. In Years 2-4, we will conduct a longitudinal three-parallel arm randomized clinical trial on 72 subjects to evaluate the relative efficacy of individualized physiotherapy and audiology-based standard of care, alone, or in combination, for reducing tinnitus loudness and distress. This avenue of research is taking the necessary steps to provide an evidence-based approach to direct clinical decision-making for Veterans with tinnitus. Knowledge learned will be disseminated to healthcare providers in multiple disciplines (e.g., audiology, physical therapy, primary care, etc.) to dispel the belief that “nothing can be done” and raise awareness regarding how best to assess and treat Veterans with tinnitus, ultimately enhancing the delivery and effectiveness of patient care. The long-term goal of this avenue of research is to apply principles of individualized medicine to develop a Veteran-centric care pathway integrating audiology and physical therapy in the assessment and treatment of somatosensory tinnitus. Outcomes of this research will guide the development of a clinical care pathway to meet the rehabilitative needs of Veterans in a way that currently is unmet and provide clinicians patient-centered tools along with a viable treatment option for somatosensory tinnitus.

当知觉特征(如音调和响度)改变时，可怀疑有躯体感觉耳鸣 紧接着头部和颈部动作，肌肉剧烈收缩，或眼睛或下巴运动。 患病率估计各不相同，据报道，高达80%的耳鸣患者能够调整他们的耳鸣 通过操纵头部、颈部和下巴的躯体区域(Ralli等人，2017)，暗示了躯体感觉 耳鸣很常见，但退伍军人中与这种类型的耳鸣相关的研究很少受到关注。 退伍军人的耳鸣受躯体运动的影响表明潜在的耳鸣 被忽视的生物力学缺陷，如果得到治疗，有可能缓解耳鸣 与肌肉骨骼问题相关的症状，并帮助他们恢复正常功能。 拟议的研究正在采取下一步行动，以实现我们的长期目标，即开发一个能够 诊断、评估和治疗患有体感耳鸣的退伍军人。这一研究途径的计划是 以从这项工作的试点阶段获得的重要知识为基础，并完成以下工作 目的：(1)建立具有良好敏感性和特异性的诊断筛查试验以识别ST段；(2)开发 物理治疗师评估和治疗ST的循证临床程序；以及(3)执行 新开发的ST治疗方法与听力学标准的随机临床试验比较 关心。 该项目的第一年将专注于创建两个将进行比较的“简短表格”(即诊断测试 结合目前临床上用于诊断体感耳鸣的检查手段，研制出一种具有较好检测效果的测试仪器 敏感度和特异度，即良好的诊断准确性，以识别体感耳鸣。此外，工作 在第一年完成的工作包括调整符合以下标准的生物力学物理评估 美国物理治疗协会临床实践指南将包括捕获 耳鸣感觉的改变，并开发一个为期8周的个性化物理治疗计划，将使用 在这项研究的临床试验部分。在第二年到第四年，我们将进行纵向三平行手臂 72例随机临床试验评价个体化理疗与常规理疗的相对疗效 以听力学为基础的护理标准，单独或联合使用，以减少耳鸣的响度和痛苦。 这一研究途径正在采取必要的步骤，提供一种循证的方法来指导临床 患有耳鸣的退伍军人的决策。学到的知识将传播给医疗保健提供者 多学科(如听力学、理疗、初级保健等)为了驱散“没有什么可以 并最终提高对如何最好地评估和治疗患有耳鸣的退伍军人的认识 加强病人护理的交付和有效性。这一研究途径的长期目标是 应用个体化医学原则，建立以退伍军人为中心、听力学与医学相结合的护理路径 物理疗法在体感耳鸣评估和治疗中的作用。这项研究的结果将 指导临床护理路径的发展，以满足退伍军人的康复需求 目前尚未得到满足，并为临床医生提供以患者为中心的工具以及可行的治疗方案 体感耳鸣。