Effectiveness of Internet Based Treatment Methods for Symptom Management of Vestibular Disorders: A Systematic Review

Introduction: The objective of this systematic review is to investigate the effectiveness of internet-based and blended therapy for patients with peripheral, central, or mixed vestibular dysfunction based on current research. Methods: Medline, CINAHL Complete, PubMed, and The Cochrane Library were searched from September 2022 to January 2023 using the search terms “vestibular,” “internet,” “computer,” “management,” “online,” “self-efficacy,” “vestibular disorder,” “rehabilitation,” “treatment,” “dizziness,” and “phys* ther*.”Studies were included if they used internet-based interventions for patients with diagnosed vestibular dysfunction caused by pure vestibular pathology. Three independent reviewers performed the selection process based on title, abstract, and full-text reading. In total, 8 studies were selected, three reviewers independently extracted data related to intervention technique, duration of intervention, symptoms relief, and overall outcome. The PEDro and hierarchy of evidence scales were used to assess the methodological quality of selected articles. Results: Of 8 articles, seven were randomized controlled trials (RCTs), and one was a qualitative design study. Hierarchy of evidence rating scores ranged from level 2 to level 3. Six of the articles had a level 2 score, and two articles had a level 3 score. PEDro scores ranged from 2/10 to 8/10, including three 8/10, two 7/10, two 2/10, and one 3/10 scores. Primary outcome measures reviewed in this study include the Vertigo Symptom Scale-Short Form and Dizziness Handicap Inventory. Secondary outcome measures include Dynamic Gait Index, Hospital Anxiety and Depression Scale, Visual Analogue Scale, quality of life measures, and subjective reports. Discussion: Although PEDro scores ranged from poor to good, internet vestibular rehabilitation (IVR) was shown to be an effective form of improvement in reported dizziness, anxiety related to symptoms, and dynamic postural stability. IVR did not significantly improve quality of life or severity of symptoms. Conclusion: Based on present findings, IVR can be recommended to patients as a means to reduce chronic symptoms outside of the clinic.https://digitalcommons.misericordia.edu/research_posters2023/1007/thumbnail.jp

Coercion, consent and the forced marriage debate in the UK

An examination of case law on forced marriage reveals that in addition to physical force, the role of emotional pressure is now taken into consideration. However, in both legal and policy discourse, the difference between arranged and forced marriage continues to be framed in binary terms and hinges on the concept of consent: the context in which consent is constructed largely remains unexplored. By examining the socio-cultural construction of personhood, especially womanhood, and the intersecting structural inequalities that constrain particular groups of South Asian women in the UK, we argue that consent and coercion in relation to marriage can be better understood as two ends of a continuum, between which lie degrees of socio-cultural expectation, control, persuasion, pressure, threat and force. Women who face these constraints exercise their agency in complex and contradictory ways that are not always recognised by the existing exit-centred state initiatives designed to tackle this problem