Data_Sheet_1_Use of Stakeholder Feedback to Develop an App for Vestibular Rehabilitation–Input From Clinicians and Healthy Older Adults.docx

Close to half people over 60 years of age experience vestibular dysfunction. Although vestibular rehabilitation has been proven effective in reducing dizziness and falls in older adults, adherence to exercise programs is a major issue and reported to be below 50%. Therefore, this research aimed to develop an app with gaming elements to improve adherence to exercises that are part of vestibular rehabilitation, and to provide feedback to increase the accuracy during exercise performance. A clinician-informed design was used where five physical therapists were asked identical questions about the exercises they would like to see in the app, including their duration and frequency. Games were developed to train the vestibulo-ocular (VOR) reflex using VOR and gaze shifting exercises; and to train the vestibulo-spinal system using weight shifting and balance exercises. The games were designed to progress from simple to more complex visuals. The games were controlled by an Inertial Measurement Unit placed on the head or anterior waist. The app was tested on ten healthy females (69.1 ± 5.1 years) with no prior history of vestibular dysfunction or complaints of dizziness. Participants completed gaze stabilization and balance exercises using the app and provided feedback on the user interface, ease of use, usefulness and enjoyment using standardized questionnaires and changes they would like to see in the form of open-ended questions. In general, participants reported that they found the app easy to use, the user interface was friendly, and they enjoyed playing the games due to the graphics and colors. They reported that the feedback provided during the exercise session helped them recognize their mistakes and motivated them to do better. However, some elements of the app were frustrating due to incomplete instructions and inability to distinguish game objects due to insufficient contrast. Feedback received will be implemented in a revised version which will be trialed in older adults with dizziness due to vestibular hypofunction. We have demonstrated that the “Vestibular AppTM” created for rehabilitation with gaming elements was found to be enjoyable, useful, and easy to use by healthy older adults. In the long term, the app may increase adherence to vestibular rehabilitation.

近半数60岁以上人群存在前庭功能障碍（vestibular dysfunction）。尽管前庭康复（vestibular rehabilitation）已被证实可有效降低老年人的眩晕与跌倒风险，但运动方案的依从性是一大难题，据报道其依从率不足50%。为此，本研究旨在开发一款融入游戏化元素的应用程序，以提升前庭康复运动的依从性，并提供运动过程中的反馈以提升动作完成精度。本研究采用临床医生指导的设计模式：向5名物理治疗师询问了他们希望在应用中纳入的运动项目相关细节，包括运动时长与频率。研究开发了两类游戏：一类通过VOR训练与扫视转移训练来锻炼前庭眼反射（vestibulo-ocular reflex, VOR），另一类通过重心转移与平衡训练来锻炼前庭脊髓系统（vestibulo-spinal system）。游戏设计遵循从简单到复杂的视觉呈现递进原则。游戏通过佩戴于头部或前腰部的惯性测量单元（Inertial Measurement Unit）进行控制。本研究招募了10名无前庭功能障碍病史或眩晕主诉的健康女性受试者（年龄69.1±5.1岁）对该应用进行测试。受试者通过该应用完成扫视稳定训练与平衡训练，并通过标准化问卷及开放式问题，对应用的用户界面、易用性、实用性与趣味性反馈了评价，同时提出了希望改进的方向。总体而言，受试者认为该应用易用性良好，用户界面友好，并因精美的图形与色彩搭配而喜爱游戏环节。受试者反馈，运动过程中提供的反馈帮助他们识别自身动作失误，并激励他们提升动作质量。但由于操作说明不完善、游戏对象对比度不足导致难以区分，应用的部分功能令受试者感到困扰。收集到的反馈将用于应用的迭代优化，后续将在因前庭功能减退引发眩晕的老年人群中开展试验。本研究证实，这款融入游戏化元素的前庭康复应用（Vestibular App™）获得了健康老年人的认可，被认为趣味性强、实用且易用。从长远来看，该应用有望提升前庭康复运动的依从性。