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: 10661483
• 负责人: COURTNEY HALL
• 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/10661483
• 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; Engineering; Equilibrium; Error Sources; Eye Movements; Face; Feedback; Functional disorder; General Population; Goals; Head; Head Movements; Health Care Costs; Health Personnel; Health Services Accessibility; Improve Access; Instruction; Interruption; Labyrinth; Measures; 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 medical 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， 其特点是与特定头部位置（例如，向上看或滚动）相关的短暂但致残性眩晕 BPPV 可以通过 Canalith 重新定位治疗 (CRT) 进行有效治疗，该治疗使用 一系列头部位置将颗粒（从耳石器官转移到半规管中）移出 然而，许多 BPPV 患者获得护理的机会很差，因为 未受过识别和治疗培训的一线医疗保健提供者未充分利用或滥用治疗 BPPV 的成功诊断和治疗需要准确识别眼球运动。 （眼球震颤）在测试过程中以及在测试和测试期间准确定位患者头部 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 我们提出了四个具体目标：（1）开发移动医疗。 用于 BPPV 自动诊断和指导治疗的应用程序 (app)，(2) 确定 BPPV 的准确性 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，以及 BPPV 的指导治疗，(4) 确定应用程序指导 BPPV 治疗的有效性。 对于目标 1，提出了三项任务：（1）开发记录和分析眼睛和头部的软件 BPPV诊断和治疗指南的动作，(2)开发连接智能手机的头盔 到面部进行准确的眼睛和头部运动记录，以及（3）开发教程视频来指导 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，工程师将与专家密切合作，专家将 在试点之前提供反馈以修改和完善软件算法、头盔装置和教程视频 应用程序的测试。 为了确定 BPPV 自动诊断应用程序的准确性（目标 2），该应用程序将在 退伍军人使用前庭专家的 BPPV 诊断来抱怨运动引起的头晕 联盟作为专家与应用程序不一致的患者眼动记录。 将检查诊断以确定错误来源，并修改应用程序/设备 相应地确定应用程序对 BPPV 自动诊断和指导治疗的可用性。 （目标 3），该应用程序将使用 10 名初级用户（临床研究生课程的一年级学生或 医学院）和十名健康志愿者（模拟患者）将使用该系统进行可用性测量。 可用性量表，用于确定产品可用性和可学习性的百分位排名，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，以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 名新手用户中进行试点测试，他们将执行 对患有运动诱发头晕的退伍军人进行诊断和治疗程序。 将使用绩效评估标准来评估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指导 BPPV 治疗的有效性，根据性能指标进行评级 就足够了，性能将被定义为 80% 的新手用户达到中值分数 此外，还将与初级用户的单次治疗成功率进行比较。 退伍军人群体中专家进行单次治疗的比率（86%；Akin 等人，2017 年） 初级保健医生的成功率（40%，Munoz 等人，2007 年）。