Self-Diagnosis and Treatment Tools for Benign Paroxysmal Positional Vertigo

描述(由申请人提供)：为患有常见和致残障碍的患者提供有效和高效护理的实质性机会正在被浪费。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，并接受潜在有害药物的治疗，而不是接受基于证据的、高效的、简单的治疗，称为管石重新定位手法(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是头晕的最常见原因之一，并会导致残疾症状。这种紊乱是由自由漂浮的颗粒进入内耳的半圆形管道(“通道”)引起的。BPPV的诊断是基于临床病史和简单的床边测试-Dix-Hallpike试验(DHT)，然后在床边几分钟内进行CRM治疗。随机接受CRM的BPPV患者在24小时内的治愈率为80%，而随机接受假操作的患者只有10%。这些以证据为基础的过程得到了两个独立生成的社会指南声明的支持(美国耳鼻喉科学会-头颈调查和美国神经病学学会)。尽管如此，这些进程未得到充分利用的情况在几个不同的环境中都有所体现。急诊科(ED)的一项基于人群的研究发现，在主治医生诊断为BPPV的患者中，78%没有DHT，96.1%没有CRM。事实上，其他检查(例如头部CT扫描)和治疗(例如药物)更常用于被诊断为BPPV的ED患者-这一发现突显了效率低下。最近和初步的研究表明，基于对YouTube视频和谷歌关键词搜索的系统审查，患者对在线BPPV工具的需求很大。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。在为未来的试验做准备时，我们首先需要开发干预措施，并证明其潜在价值。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特征，使用该干预措施的患者可以准确地执行姿势移动，并且具有代表性的美国人口样本获得了有利于其使用的行为意图的衡量标准。将使用严格的方法，结合定量和定性数据收集和分析，开发干预措施并展示其潜在价值。这些是朝着我们的长期目标迈出的关键的第一步，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。为了这个项目，已经组建了一支杰出的跨学科团队，包括神经学、耳鼻喉科、理疗、患者决策辅助和视频制作方面的专业知识。

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.