Development of a mobile medical app for diagnosis and treatment of benign paroxysmal positional vertigo (BPPV)

开发用于诊断和治疗良性阵发性位置性眩晕（BPPV）的移动医疗应用程序

• 批准号: 10311103
• 负责人: Faith Wurm Akin
• 金额: --
• 依托单位: JAMES H QUILLEN VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2023-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10311103
• 关键词: Algorithmic Software; Automobile Driving; Beds; Benign paroxysmal positional vertigo; Cellular Phone; Clinical; Coupled; Data; Development; Devices; Diagnosis; Diagnostic; Diagnostic tests; Disease; Dizziness; Effectiveness; Engineering; Ensure; Equilibrium; Error Sources; Eye Movements; Face; Feedback; Functional disorder; General Population; Goals; Gold; Head; Head Movements; Health Care Costs; Health Personnel; Health Services Accessibility; Improve Access; Instruction; Interruption; Labyrinth; Learning; Measures; Medical; Motion; Nausea and Vomiting; Organ; Pathologic Nystagmus; Patients; Performance; Positioning Attribute; Primary Care Physician; Procedures; Process; Provider; Rehabilitation therapy; Sampling; Semicircular canal structure; Series; Students; Symptoms; System; Technology; Telephone; Testing; Time; Training; Vertigo; Veterans; Work; accurate diagnosis; barrier to care; brain magnetic resonance imaging; cost; effective therapy; effectiveness evaluation; healthy volunteer; improved; instrumentation; medical schools; military veteran; mobile application; otoconia; particle; pilot test; programs; smartphone Application; software development; success; usability

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vestibular dysfunction, characterized by brief but disabling vertigo associated with specific head positions (e.g., looking up or rolling over in bed). BPPV can be treated effectively with the Canalith Repositioning Treatment (CRT) which uses a series of head positions to move particles (displaced from the otolith organs into the semicircular canals) out of the semicircular canals. Nevertheless, access to care for many patients with BPPV is poor because the treatment is underused or mis-used by frontline healthcare providers who are not trained to recognize and treat BPPV. Successful diagnosis and treatment of BPPV requires accurate identification of eye movements (nystagmus) during the test procedure and accurate positioning of the patient's head during testing and treatment. The purpose of this project is to test the hypothesis that a smartphone camera and inertial technology can be used to accurately diagnose and treat BPPV. We propose four specific aims: (1) develop a mobile medical application (app) for automated diagnosis and guided treatment of BPPV, (2) determine the accuracy of the app for automated diagnosis of BPPV, (3) determine the usability of the app for automated diagnosis and guided treatment of BPPV, and (4) determine the effectiveness of the app for guided treatment of BPPV. For Aim 1, three tasks are proposed: (1) development of software to record and analyze eye and head movements to diagnose and guide treatment of BPPV, (2) development of headgear to couple the smartphone to the face for accurate eye and head movement recording, and (3) development of tutorial videos to guide the clinician in the proper execution of the Dix-Hallpike maneuver and treatment procedure. The development of the app will be an iterative process in which the engineers will work closely with the expert clinicians who will provide feedback to revise and refine the software algorithm, headgear device, and tutorial videos prior to pilot testing of the app. To determine the accuracy of the app for automated diagnosis of BPPV (Aim 2), the app will be pilot tested on Veterans with complaints of motion-provoked dizziness using the BPPV diagnoses of expert vestibular clinicians as the gold standard. Eye movement recordings of patients with discordant expert versus app diagnoses will be examined to determine the source of the errors and the app/device will be modified accordingly. To determine the usability of the app for automated diagnosis and guided treatment of BPPV (Aim 3), the app will be pilot tested using ten naïve users (first year students in clinical graduate programs or medical school) and ten healthy volunteers (mock patients). Usability will be measured using the System Usability Scale to identify the percentile rank of the product's usability and learnability, and the data will be used to improve usability of the app prior to pilot testing on patients. To determine the effectiveness of the app for guided treatment of BPPV (Aim 4), the app will be pilot tested on ten naïve users who will perform the diagnostic and treatment procedures on Veterans with motion-provoked dizziness. Expert vestibular clinicians will use a performance rubric to rate each user on the adequacy of the diagnostic and treatment procedures. To examine the effectiveness of the app for guided treatment of BPPV, the rating from the performance rubric will be calculated, and adequate performance will be defined as 80% of naïve users achieving a median score of 80%. In addition, the success rate of a single treatment by naïve users will be compared with the success rate of a single treatment by expert clinicians in the Veteran population (86%; Akin et al., 2017) and with the success rate by primary care physicians (40%, Munoz et al., 2007).

良性阵发性位置性眩晕（BPPV）是前庭功能障碍的最常见原因， 其特征在于与特定头部位置相关的短暂但致残的眩晕（例如，向上看或滚动 在床上）。BPPV可以通过使用 一系列头部位置，以将颗粒（从耳石器官移位到半规管中）移出 半规管尽管如此，许多BPPV患者的护理机会很差，因为 一线医疗保健提供者未接受过识别和治疗方面的培训， BPPV。BPPV的成功诊断和治疗需要准确识别眼球运动 （眼球震颤）和在测试过程中患者头部的准确定位， 治疗 该项目的目的是测试智能手机摄像头和惯性技术可以 用于准确诊断和治疗BPPV。我们提出了四个具体目标：（1）开发一个移动的医疗 应用程序（app）用于BPPV的自动诊断和指导治疗，（2）确定 用于BPPV自动诊断的应用程序，（3）确定用于自动诊断的应用程序的可用性， BPPV的指导治疗，以及（4）确定应用程序用于BPPV指导治疗的有效性。 针对目标1，提出了三项任务：（1）开发记录和分析眼睛和头部的软件 诊断和指导BPPV治疗的运动，（2）开发头戴式耳机， 用于精确的眼睛和头部运动记录，以及（3）开发教程视频，以指导 临床医生正确执行Dix-Hallpike操作和治疗程序。的发展 该应用程序将是一个迭代过程，工程师将与临床专家密切合作， 提供反馈，以在试点之前修改和完善软件算法、头盔设备和教程视频 测试app。 为了确定该应用程序自动诊断BPPV的准确性（目标2），该应用程序将在 使用专家前庭BPPV诊断主诉运动诱发头晕的退伍军人 临床医生作为黄金标准。专家与应用程序不一致的患者的眼动记录 将检查诊断以确定错误的来源，并修改应用程序/设备 相应地确定应用程序用于BPPV自动诊断和引导治疗的可用性 (Aim 3），该应用程序将使用10个天真的用户进行试点测试（临床研究生课程的一年级学生或 医学院）和10名健康志愿者（模拟患者）。将使用系统测量可用性 可用性量表，以确定产品的可用性和可学习性的百分比排名，数据将 用于在对患者进行试点测试之前提高应用程序的可用性。确定应用程序的有效性 对于BPPV的指导治疗（目标4），该应用程序将在10名初次使用者身上进行试点测试， 诊断和治疗程序的退伍军人与运动引起的头晕。专家前庭临床医生 将使用一个性能标准来评价每个用户的诊断和治疗程序的充分性。 为了检查该应用程序用于BPPV指导治疗的有效性， 将计算，充分性能将定义为80%的初次使用者达到中位评分 的80%。此外，将比较初次使用者单次治疗的成功率与 退伍军人群体中专家临床医生的单次治疗率（86%; Akin等人，2017年），与 初级保健医生的成功率（40%，Munoz等人，2007年）。