# Smartphone-Supported Vestibular Rehabilitation in Individuals With Vestibular Dysfunction: Pilot Randomized Crossover Trial Assessing Functional Clinical Outcomes and Anxiety

## TL;DR

A smartphone app helped improve balance and reduce dizziness in patients with inner ear issues, but anxiety levels remained unchanged.

## Contribution

A smartphone app was developed and tested to improve adherence and outcomes in vestibular rehabilitation.

## Key findings

- Both app-supported and conventional rehabilitation improved dizziness-related disability over 6 weeks.
- App-supported rehabilitation showed early functional mobility benefits when used first.
- Dizziness and anxiety were consistently and significantly correlated across all time points.

## Abstract

Vestibular disorders impair balance, increase fall risk, and reduce quality of life due to dizziness and vertigo. They are frequently accompanied by heightened anxiety, which may further limit daily functioning and contribute to avoidance behaviors. Although vestibular rehabilitation has been extensively studied and shown to be effective in managing vestibular disorders, adherence to home-based exercises remains low for many dizzy patients. This is often attributed to uncertainty about correct performance, lack of feedback, or difficulty maintaining a structured routine. To help address these barriers, Vestibulon, a smartphone app co-designed with clinicians and patients, was developed to support rehabilitation practice by providing guided exercise, structured scheduling, progress monitoring, and clear instructions intended to promote confidence and engagement.

We aim to evaluate the potential contribution of a smartphone-based app to vestibular rehabilitation outcomes and to explore the relationship between dizziness-related disability and anxiety during the intervention.

This randomized 2-period crossover pilot trial included 20 adults with vestibular dysfunction (mean age 52, SD 12 y) who completed 6 weeks of rehabilitation. Participants were randomized to begin with either app-supported or conventional treatment before crossing over to the alternate condition after 3 weeks. This design enabled each participant to experience both modes of rehabilitation. Assessments were conducted at baseline (T0), mid-study (after 3 wk; T1), and end of study (T2). Outcome measures included the Dizziness Handicap Inventory (DHI) to assess dizziness-related disability, the State-Trait Anxiety Inventory to evaluate anxiety, and the Instrumented Timed Up and Go test to quantify functional mobility. The primary outcome was the change in DHI scores across time points.

Significant improvements in DHI were observed between T0 and T2 in both groups (median change: app first=34, IQR 6‐35 points, P=.006; conventional first=18, IQR 10‐19 points, P=.009). Improvement in Instrumented Timed Up and Go performance was observed only when the app-supported phase occurred first (Z=−2.45, P=.01), suggesting a potential early benefit of structured smartphone guidance. State-Trait Anxiety Inventory scores did not change significantly in either sequence. Across all time points, dizziness-related disability and state anxiety demonstrated a consistent and significant moderate correlation (r=0.64, P<.001), emphasizing the strong interplay between physical and psychological symptoms in individuals with vestibular disorders.

This pilot study indicates that smartphone-supported vestibular rehabilitation has the potential to enhance functional outcomes for some patients. The consistent association between dizziness and anxiety underscores the relevance of considering psychological factors in vestibular rehabilitation. Given the preliminary nature of this study and the small sample size, these findings should be interpreted cautiously, and further research is needed to determine the app’s effectiveness in larger randomized controlled trials.