Self-Diagnosis and Treatment Tools for Benign Paroxysmal Positional Vertigo

描述（由申请人提供）：为患有常见致残疾病的患者提供有效和高效护理的大量机会正在被浪费。目前，被诊断为良性阵发性位置性眩晕（BPPV）的患者更有可能接受不必要和昂贵的检查，并使用可能有害的药物治疗，而不是接受一种基于证据的、高效的、简单的治疗方法，即导管复位术（CRM）。在这个项目中，我们的目标是开发一种针对BPPV的以患者为导向的干预措施，并展示其潜在的未来价值。BPPV是眩晕最常见的原因之一，并导致致残症状。这种疾病是由自由漂浮的颗粒进入内耳的半圆形管道（“管道”）引起的。BPPV的诊断基于临床病史和简单的床边检查，即Dix-Hallpike试验（DHT），然后在床边几分钟内用CRM进行治疗。BPPV患者随机分到CRM组，24小时的治愈率为80%，而随机分到假手术组的患者只有10%。这些循证过程得到了两个独立生成的社会指南声明（美国耳鼻喉头颈调查学会和美国神经病学学会）的支持。尽管如此，在几个不同的情况下，这些过程的利用不足。急诊科（ED）的一项基于人群的研究发现，在治疗医师诊断为BPPV的患者中，78%没有DHT， 96.1%没有CRM。事实上，其他检查（如头部CT扫描）和治疗（如药物）更常用于诊断为BPPV的ED患者-这一发现突出了效率低下。最近和初步的研究表明，基于对YouTube视频和谷歌关键字搜索的系统回顾，人们对在线BPPV工具有着巨大的耐心需求。目前YouTube视频的重大缺陷也被发现，包括缺乏诊断信息和演示中的错误。为了准备未来的试验，我们首先需要开发干预措施并展示其潜在价值。目前的项目旨在从患者的角度开发一种诊断和治疗BPPV的干预措施，然后证明它具有适当的歧视性特征，使用该干预措施的患者可以准确地执行位置运动，并且美国人口的代表性样本对有利于其使用的行为意图进行了评分。将采用严格的方法，包括定量和定性数据收集和分析，来制定干预措施并展示其潜在价值。我们的长期目标是改善BPPV患者的预后，同时减少医疗效率低下，这些都是关键的第一步。为了这个项目，我们组建了一支优秀的跨学科团队，包括神经病学、耳鼻喉科、物理治疗、患者决策辅助和视频制作方面的专家。

DESCRIPTION (provided by applicant): A substantial opportunity to deliver effective and efficient care for patients with a common and disabling disorder is being squandered. Currently, patients diagnosed with Benign Paroxysmal Positional Vertigo (BPPV) are more likely to undergo unnecessary and expensive tests and to be treated with potentially harmful medications than they are to receive an evidence-based, highly effective, and simple treatment called the canalith repositioning maneuver (CRM). In this project we aim to develop a patient-oriented intervention regarding BPPV and to demonstrate the potential future value of it. BPPV is among the most common causes of dizziness and results in disabling symptoms. The disorder stems from free-floating particles that enter a semi-circular canal ("canaliths") of the inner ear. BPPV is diagnosed based on the clinical history and a simple bedside test, the Dix-Hallpike test (DHT), and then treated with the CRM in minutes at the bedside. BPPV patients randomized to the CRM have a cure rate of 80% at 24 hours compared with only 10% of patients randomized to a sham maneuver. These evidence-based processes are supported by two independently generated society guideline statements (American Academy of Otolaryngology-Head and Neck Survey and the American Academy of Neurology). Despite this, the underuse of these processes has been shown in several different settings. A population-based study of emergency departments (ED) found that among patients diagnosed with BPPV by the treating physician, 78% did not have the DHT and 96.1% did not have a CRM. In fact, other tests (e.g., head CT scans) and treatments (e.g., medicines) are more commonly utilized in ED patients diagnosed with BPPV - a finding that highlights inefficiencies. Recent and preliminary research demonstrates substantial patient demand for online BPPV tools based on a systematic review of YouTube videos and Google keyword searches. Significant shortcomings of the current YouTube videos have also been uncovered, including lack of diagnostic information and errors in the demonstration. In preparation for future trials, we first need to develop the intervention and demonstrate the potential value of it. The current project aims to develop an intervention for the diagnosis and treatment of BPPV from the patient's perspective and then to demonstrate that it has appropriate discriminatory characteristics, that patients using the intervention can perform the positional movements accurately, and that a representative sample of the US population scores measures of behavioral intent favorable to its use. Rigorous methods, incorporating quantitative and qualitative data collection and analysis, will be used to develop the intervention and demonstrate its potential value. These are critical first steps toward our long-term goal to improve the outcomes of patients with BPPV and simultaneously reduce healthcare inefficiencies. For this project, an outstanding trans-disciplinary team has been assembled including expertise in neurology, otolaryngology, physical therapy, patient decision aids, and video production.