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Treatment success of internet-based vestibular rehabilitation in general practice: development and internal validation of a prediction model

OBJECTIVES: To develop and internally validate prediction models to assess treatment success of both stand-alone and blended online vestibular rehabilitation (VR) in patients with chronic vestibular syndrome. DESIGN: Secondary analysis of a randomised controlled trial. SETTING: 59 general practices...

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Autores principales: van Vugt, Vincent A, Heymans, Martijn W, van der Wouden, Johannes C, van der Horst, Henriëtte E, Maarsingh, Otto R
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569931/
https://www.ncbi.nlm.nih.gov/pubmed/33067287
http://dx.doi.org/10.1136/bmjopen-2020-038649
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author van Vugt, Vincent A
Heymans, Martijn W
van der Wouden, Johannes C
van der Horst, Henriëtte E
Maarsingh, Otto R
author_facet van Vugt, Vincent A
Heymans, Martijn W
van der Wouden, Johannes C
van der Horst, Henriëtte E
Maarsingh, Otto R
author_sort van Vugt, Vincent A
collection PubMed
description OBJECTIVES: To develop and internally validate prediction models to assess treatment success of both stand-alone and blended online vestibular rehabilitation (VR) in patients with chronic vestibular syndrome. DESIGN: Secondary analysis of a randomised controlled trial. SETTING: 59 general practices in The Netherlands. PARTICIPANTS: 202 adults, aged 50 years and older with a chronic vestibular syndrome who received either stand-alone VR (98) or blended VR (104). Stand-alone VR consisted of a 6-week, internet-based intervention with weekly online sessions and daily exercises. In blended VR, the same intervention was supplemented with physiotherapy support. MAIN OUTCOME MEASURES: Successful treatment was defined as: clinically relevant improvement of (1) vestibular symptoms (≥3 points improvement Vertigo Symptom Scale—Short Form); (2) vestibular-related disability (>11 points improvement Dizziness Handicap Inventory); and (3) both vestibular symptoms and vestibular-related disability. We assessed performance of the predictive models by applying calibration plots, Hosmer-Lemeshow statistics, area under the receiver operating characteristic curves (AUC) and applied internal validation. RESULTS: Improvement of vestibular symptoms, vestibular-related disability or both was seen in 121, 81 and 64 participants, respectively. We generated predictive models for each outcome, resulting in different predictors in the final models. Calibration for all models was adequate with non-significant Hosmer-Lemeshow statistics, but the discriminative ability of the final predictive models was poor (AUC 0.54 to 0.61). None of the identified models are therefore suitable for use in daily general practice to predict treatment success of online VR. CONCLUSION: It is difficult to predict treatment success of internet-based VR and it remains unclear who should be treated with stand-alone VR or blended VR. Because we were unable to develop a useful prediction model, the decision to offer stand-alone or blended VR should for now be based on availability, cost effectiveness and patient preference. TRIAL REGISTRATION NUMBER: The Netherlands Trial Register NTR5712.
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spelling pubmed-75699312020-10-21 Treatment success of internet-based vestibular rehabilitation in general practice: development and internal validation of a prediction model van Vugt, Vincent A Heymans, Martijn W van der Wouden, Johannes C van der Horst, Henriëtte E Maarsingh, Otto R BMJ Open General practice / Family practice OBJECTIVES: To develop and internally validate prediction models to assess treatment success of both stand-alone and blended online vestibular rehabilitation (VR) in patients with chronic vestibular syndrome. DESIGN: Secondary analysis of a randomised controlled trial. SETTING: 59 general practices in The Netherlands. PARTICIPANTS: 202 adults, aged 50 years and older with a chronic vestibular syndrome who received either stand-alone VR (98) or blended VR (104). Stand-alone VR consisted of a 6-week, internet-based intervention with weekly online sessions and daily exercises. In blended VR, the same intervention was supplemented with physiotherapy support. MAIN OUTCOME MEASURES: Successful treatment was defined as: clinically relevant improvement of (1) vestibular symptoms (≥3 points improvement Vertigo Symptom Scale—Short Form); (2) vestibular-related disability (>11 points improvement Dizziness Handicap Inventory); and (3) both vestibular symptoms and vestibular-related disability. We assessed performance of the predictive models by applying calibration plots, Hosmer-Lemeshow statistics, area under the receiver operating characteristic curves (AUC) and applied internal validation. RESULTS: Improvement of vestibular symptoms, vestibular-related disability or both was seen in 121, 81 and 64 participants, respectively. We generated predictive models for each outcome, resulting in different predictors in the final models. Calibration for all models was adequate with non-significant Hosmer-Lemeshow statistics, but the discriminative ability of the final predictive models was poor (AUC 0.54 to 0.61). None of the identified models are therefore suitable for use in daily general practice to predict treatment success of online VR. CONCLUSION: It is difficult to predict treatment success of internet-based VR and it remains unclear who should be treated with stand-alone VR or blended VR. Because we were unable to develop a useful prediction model, the decision to offer stand-alone or blended VR should for now be based on availability, cost effectiveness and patient preference. TRIAL REGISTRATION NUMBER: The Netherlands Trial Register NTR5712. BMJ Publishing Group 2020-10-16 /pmc/articles/PMC7569931/ /pubmed/33067287 http://dx.doi.org/10.1136/bmjopen-2020-038649 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle General practice / Family practice
van Vugt, Vincent A
Heymans, Martijn W
van der Wouden, Johannes C
van der Horst, Henriëtte E
Maarsingh, Otto R
Treatment success of internet-based vestibular rehabilitation in general practice: development and internal validation of a prediction model
title Treatment success of internet-based vestibular rehabilitation in general practice: development and internal validation of a prediction model
title_full Treatment success of internet-based vestibular rehabilitation in general practice: development and internal validation of a prediction model
title_fullStr Treatment success of internet-based vestibular rehabilitation in general practice: development and internal validation of a prediction model
title_full_unstemmed Treatment success of internet-based vestibular rehabilitation in general practice: development and internal validation of a prediction model
title_short Treatment success of internet-based vestibular rehabilitation in general practice: development and internal validation of a prediction model
title_sort treatment success of internet-based vestibular rehabilitation in general practice: development and internal validation of a prediction model
topic General practice / Family practice
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569931/
https://www.ncbi.nlm.nih.gov/pubmed/33067287
http://dx.doi.org/10.1136/bmjopen-2020-038649
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