Vestibular disorders affect approximately 34% of adults over the age of 50. Vestibular rehabilitation (VR) is ideally provided by trained clinicians; however, access can be limited, particularly in rural and remote areas. Telehealth technologies offer alternative means of accessing healthcare. This scoping review aims to map use of telehealth technology in VR.
Methods
A systematic search of five databases (CINAHL, Scopus, ProQuest, PubMed and Cochrane) was conducted to identify relevant qualitative and quantitative studies from 2010 to 2025. The review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Data were analysed and reported using a convergent segregated approach, in line with the Joanna Briggs Institute's methodological guidance for the conduct of mixed methods systematic reviews.
Results
Forty-three articles were included. Telehealth modalities included smartphone applications (n = 18), telephone calls (n = 3), videoconferencing (n = 5), web applications (n = 14), and store-and-forward video technologies (n = 3). Telehealth technology was found to be accurate in recording oculomotor assessments and nystagmus, delivering canalith repositioning manoeuvres and undertaking outcome assessments. Improvements in health outcomes were demonstrated for subjective dizziness, balance, and oculomotor tests. Users reported telehealth technology to be feasible for remote VR with benefits including increased self-confidence with exercises, improved symptom awareness, and enhanced engagement and motivation for exercises.
Conclusions
Telehealth technologies for VR show potential for improved health outcomes, diagnostic accuracy and positive user experience across a range of vestibular disorders. However, evidence for some vestibular disorders and telehealth modalities is limited by small sample sizes and a lack of studies. Further high-quality research is required in these areas.
FigtreeWVMenantJCChauAT, et al.Prevalence of vestibular disorders in independent people over 50 that experience dizziness. Front Neurol2021; 12: 658053.
HallCDHerdmanSJWhitneySL, et al.Vestibular rehabilitation for peripheral vestibular hypofunction: An evidence-based clinical practice guideline. JNPT2016; 40: 124–155.
4.
BushMLDoughertyW. Assessment of vestibular rehabilitation therapy training and practice patterns. J Community Health2015; 40: 802–807.
5.
StoryLBarrCDowellR, et al.An exploration of significant others’ experience with ongoing vestibular disorders. Int J Audiol2020; 59: 179–185.
6.
BarbosaWZhouKWaddellE, et al.Improving access to care: Telemedicine across medical domains. Annu Rev Public Health2021; 42: 463–481.
7.
MoffattJJEleyDS. The reported benefits of telehealth for rural Australians. Aust Health Rev2010; 34: 276–281.
8.
ChangM-HMoonesingheRTrumanBI. Telehealth availability and usage among medicare beneficiaries during the COVID-19 pandemic, October and November 2020. JPHMP2022; 28: 77–85.
9.
ShaverJ. The state of telehealth before and after the COVID-19 pandemic. Prim Care Clin Office Pract2022; 49: 517–530.
10.
LillicrapLHunterCGoldswainP. Improving geriatric care and reducing hospitalisations in regional and remote areas: The benefits of telehealth. J Telemed Telecare2021; 27: 397–408.
11.
DrerupBEspenschiedJWiedemerJ, et al.Reduced no-show rates and sustained patient satisfaction of telehealth during the COVID-19 pandemic. Telemed J E Health2021; 27: 1409–1415.
12.
Perez-HeydrichCACreary-MillerISpannM, et al.Remote delivery of vestibular rehabilitation for vestibular dysfunction: A systematic review. Otol Neurotol2024; 45: 608–618.
13.
Vinolo-GilMJGarcía-CampanarioIEstebanez-PérezM-J, et al.Telehealth assessment of diagnostic and therapeutic efficacy in peripheral vestibular symptoms: A systematic review and meta-analysis. Telemed J E Health2025; 31: 540–554.
14.
GrilloDZittiMCieślikB, et al.Effectiveness of telerehabilitation in dizziness: A systematic review with meta-analysis. Sensors2024; 24: 3028.
15.
KapriPSharmaNKaurS, et al.Exploring the potential of telerehabilitation for advancing vestibular care: A systematically scoping review sin managing dizziness in older adults. Crit Rev Phys Rehabil Med2025; 37(3): 83–106.
16.
NodaMKurodaTNomuraA, et al.Smartphone-assisted medical care for vestibular dysfunction as a telehealth strategy for digital therapy beyond COVID-19: Scoping review. JMIR Mhealth Uhealth2023; 11: e48638.
17.
ArkseyHO'MalleyL. Scoping studies: Towards a methodological framework. Int J Soc Res Methodol2005; 8: 19–32.
18.
SternCLizarondoLCarrierJ, et al.Methodological guidance for the conduct of mixed methods systematic reviews. JBI Evid Synth2020; 18: 2108–2118.
19.
BashirKYousufARaufL, et al.Curing benign paroxysmal positional vertigo (BPPV) through telehealth: A case series. Cureus2021; 13: e16363.
20.
EsseryRKirbySGeraghtyAW, et al.The development of balance retraining: An online intervention for dizziness in adults aged 50 years and older. Am J Audiol2015; 24: 276–279.
21.
EsseryRKirbySGeraghtyAW, et al.Older adults’ experiences of internet-based vestibular rehabilitation for dizziness: A longitudinal study. Psychol Health Med2017; 32: 1327–1347.
22.
MullerIKirbySYardleyL. Understanding patient experiences of self-managing chronic dizziness: A qualitative study of booklet-based vestibular rehabilitation, with or without remote support. BMJ Open2015; 5: e007680.
23.
van VugtVAde KruifAJvan der WoudenJC, et al.Experiences of patients and physiotherapists with blended internet-based vestibular rehabilitation: A qualitative interview study. BJGP Open2020; 4: bjgpopen20X101092.
24.
CochraneGDChristyJBKickerET, et al.Inter-rater and test-retest reliability of computerized clinical vestibular tools. J Vestib Res2021; 31: 365–373.
25.
CraneBTSchubertMC. An adaptive vestibular rehabilitation technique. Laryngoscope2018; 128: 713–718.
26.
De VestelCDe HertoghWVan RompaeyV, et al.How do patients with chronic dizziness experience a web-based home rehabilitation programme for customised vestibular therapy (‘WeBaVeR’)? A qualitative study. Int J Med Inform2023; 170: 104927.
27.
GandorFTeschMNeuhauserH, et al.Diagnostic accuracy of a smartphone bedside test to assess the fixation suppression of the vestibulo-ocular reflex: When nothing else matters. J Neurol2020; 267: 2159–2163.
28.
GeraghtyAWEsseryRKirbyS, et al.Internet-based vestibular rehabilitation for older adults with chronic dizziness: A randomized controlled trial in primary care. Ann Fam Med2017; 15: 209–216.
29.
GulcelikGETarakciDSoyuyuceOG, et al.Research on the effects of a web-based system with oculomotor and optokinetic stimuli on vestibular rehabilitation. Am J Phys Med2021; 100: 555–562.
30.
HarrellRGSchubertMCOxboroughS, et al.Vestibular rehabilitation telehealth during the SAEA-CoV-2 (COVID-19) pandemic. Front Neurol2022; 12: 781482.
31.
HovareshtiPRoederSHoltLS, et al.VestAid: A tablet-based technology for objective exercise monitoring in vestibular rehabilitation. Sensors2021; 21: 8388. doi:https://doi.org/10.3390/s21248388
32.
KerberKACarenderWTelianSA, et al.Patient self-management of benign paroxysmal positional vertigo: Instructional video development and preliminary evaluation of behavioral outcomes. Otol Neurotol2022; 43: e105–e115.
33.
KirogluMDagkiranM. The role of mobile phone camera recordings in the diagnosis of meniere’s disease and pathophysiological implications. J Int Adv Otol2020; 16: 18–23.
34.
NgJWilsonBHeyS, et al.A balancing act: Changing the referral pathway following remote consultations for dizziness during the coronavirus disease 2019 pandemic. J Laryngol Otol2022; 136: 1284–1288.
35.
OrganBLiuHBromwichM. An iPhone-assisted particle repositioning maneuver for benign paroxysmal positional vertigo (BPPV): A prospective randomized study. J Am Board Fam Med2015; 28: 118–120.
36.
ParkerTMBadihianSHassoonA, et al.Eye and head movement recordings using smartphones for telemedicine applications: Measurements of accuracy and precision. Front Neurol2022; 13: 789581.
37.
ParkerTMFarrellNOtero-MillanJ, et al.Proof of concept for an” eyePhone” app to measure video head impulses. Digit Biomark2021; 5: 1–8.
38.
Riera-TurLCaballero-GarciaAMartin-MateosAJ, et al.Efficacy of the subjective visual vertical test performed using a mobile application to detect vestibular pathology. J Vestib Res2022; 32: 21–27.
39.
ShahMULottermanSRobertsD, et al.Smartphone telemedical emergency department consults for screening of nonacute dizziness. Laryngoscope2019; 129: 466–469.
40.
SmaerupMGrönvallELarsenSB, et al.Computer-assisted training as a complement in rehabilitation of patients with chronic vestibular dizziness—a randomized controlled trial. Arch Phys Med Rehabil2015; 96: 395–401.
41.
SmaerupMLaessoeUGrönvallE, et al.The use of computer-assisted home exercises to preserve physical function after a vestibular rehabilitation program: A randomized controlled study. Rehabil Res Pract2016; 2016: 7026317.
42.
TabanfarRChanHHLinV, et al.Development and face validation of a virtual reality epley maneuver system (VREMS) for home epley treatment of benign paroxysmal positional vertigo: A randomized, controlled trial. Am J Otolaryngol2018; 39: 184–191.
43.
van BonnSMBehrendtSPPawarBL, et al.Smartphone-based nystagmus diagnostics: Development of an innovative app for the targeted detection of vertigo. Eur Arch Otorhinolaryngol2022; 279: 5565–5571.
44.
van VugtVAHeymansMWvan der WoudenJC, et al.Treatment success of internet-based vestibular rehabilitation in general practice: Development and internal validation of a prediction model. BMJ Open2020; 10: e038649.
45.
van VugtVANgoHTvan der WoudenJC, et al.Online vestibular rehabilitation for chronic vestibular syndrome: 36-month follow-up of a randomised controlled trial in general practice. Br J Gen Pract2023; 73: e710–e719.
46.
van VugtVAvan der WoudenJCEsseryR, et al.Internet based vestibular rehabilitation with and without physiotherapy support for adults aged 50 and older with a chronic vestibular syndrome in general practice: Three armed randomised controlled trial. Br Med J2019; 367: l5922. doi:https://doi.org/10.1136/bmj.l5922
47.
WengierAUngarOJHandzelO, et al.Subjective visual vertical evaluation by a smartphone-based test—taking the phone out of the bucket. Otol Neurotol2021; 42: 455–460.
48.
WhittakerMMathewAKananiR, et al.Assessing the unterberger test: Introduction of a novel smartphone application. J Laryngol Otol2014; 128: 958–960.
49.
XieKZGottlichHCAntezanaLA, et al.Experience with telemedicine in a tertiary academic otologic clinic during the COVID-19 pandemic. Otol Neurotol2023; 44: 72.
50.
YakushinSBZinkRClarkBC, et al.Readaptation treatment of mal de debarquement syndrome with a virtual reality app: A pilot study. Front Neurol2020; 11: 814.
51.
HayashiSKamoTOgiharaH, et al.Test-Retest reliability of dynamic subjective visual vertical and visual dependency in older adults using virtual reality methods. Percept Mot Skills2024; 131: 2069–2084.
52.
KimH-JKimJ-SChoiK-D, et al.Effect of self-treatment of recurrent benign paroxysmal positional vertigo: A randomized clinical trial. JAMA neurol2023; 80: 244–250.
53.
Riera-TurLAntúnez-EstudilloEMontesinos-GonzálezJM, et al.Test–retest of the subjective visual vertical test performed using a mobile application with the smartphone anchored to a turntable. Eur Arch Otorhinolaryngol2023; 280: 613–621.
54.
KulthaveesupABunnagK. Comparison of outcomes of the Epley and self-Epley maneuvers in PC-BPPV: A randomized controlled trial. Am J Otolaryngol2023; 44: 103995.
55.
HaciabbasoğluRAraciAGüniziH. Are telerehabilitation exercise practices effective in patients diagnosed with benign paroxysmal positional vertigo?Indian J Otolaryngol Head Neck Surg2023; 75: 557–567.
56.
BastaniPBRieiroHBadihianS, et al.Quantifying induced nystagmus using a smartphone eye tracking application (EyePhone). J Am Heart Assoc2024; 13: e030927.
57.
MeldrumDKearneyHHutchinsonS, et al.Wearable sensor and smartphone assisted vestibular physical therapy for multiple sclerosis: Usability and outcomes. Front Rehabil Sci2024; 5: 1406926.
58.
SoRJCevallosAPileM, et al.Quantitative vestibular assessment: The development and validation of a novel, remote video head impulse test against in-clinic measurements. Laryngoscope Investig Otolaryngol2023; 8: 758–762.
59.
LiliosANikitasCSkoulakisC, et al.The unveiled potential of telehealth practice in vestibular rehabilitation: A comparative randomized study. J Clin Med2024; 13: 7015.
60.
ElodenGKvalheimSEThesenT, et al.Web-based vestibular rehabilitation in persistent postural-perceptual dizziness. Brain Behav2021; 11: e2346.
61.
KlattBNHovareshtiPHoltLS, et al.A tablet-based technology for objective exercise monitoring in vestibular rehabilitation: Mixed methods study. JMIR Rehabil Assist Technol2025; 12: e58713.
62.
ShaikhAGBronsteinACarmonaS, et al.Consensus on virtual management of vestibular disorders: urgent versus expedited care. The Cerebellum2021; 20: –8.
63.
WuT-CParkerSAJagolinoA, et al.Telemedicine can replace the neurologist on a mobile stroke unit. Stroke2017; 48: 493–496.
64.
GeislerFKunzAWinterB, et al.Telemedicine in prehospital acute stroke care. J Am Heart Assoc2019; 8: e011729.
65.
ShoresMMRyan-DykesPWilliamsRM, et al.Identifying undiagnosed dementia in residential care veterans: Comparing telemedicine to in-person clinical examination. Int J Geriatr Psychiatry2004; 19: 101–108.
66.
McCleeryJLavertyJQuinnTJ. Diagnostic test accuracy of telehealth assessment for dementia and mild cognitive impairment. Cochrane Database Syst Rev2021: 1–35. doi:https://doi.org/10.1002/14651858.CD013786.pub2
67.
SmithLJPykeWFowlerR, et al.Impact and experiences of vestibular disorders and psychological distress: Qualitative findings from patients, family members and healthcare professionals. Health Expect2024; 27: e13906–e13n/a.
68.
SunMTangFWenS, et al.Effects of telehealth interventions for people with Parkinson disease: Systematic review and meta-analysis of randomized controlled trials. JMIR Mhealth Uhealth2026; 14: e70994.
69.
DouJWangJGaoX, et al.Effectiveness of telemedicine interventions on motor and nonmotor outcomes in Parkinson disease: Systematic review and network meta-analysis. JMIR2025; 27: e71169.
70.
DohertyFLynchPPowellP, et al.Feasibility and effectiveness of telerehabilitation on mobility and balance function in multiple sclerosis: A systematic review and meta-analysis. J Neurol Sci2024; 466: 123214.
71.
NajafiPMotlRWMoghadasiM. Tele-exercise in multiple sclerosis: Systematic review and meta-analysis of effects on fatigue, depression, and overall health. Mult Scler Relat Disord2025; 93: 106225.
72.
SaragihIDTarihoranDETAUBatubaraSO, et al.Effects of telehealth interventions on performing activities of daily living and maintaining balance in stroke survivors: A systematic review and meta-analysis of randomised controlled studies. J Clin Nurs2022; 31: 2678–2690.
73.
SnoswellCLTaylorMLComansTA, et al.Determining if telehealth can reduce health system costs: Scoping review. J Med Internet Res2020; 22: e17298.
74.
LeffBRitchieCSRisingKL, et al.Addressing barriers to equitable telehealth for older adults. Front Med2025; 12: 1483366.
75.
PutraI. The evolution of technology acceptance model (TAM) and recent progress on technology acceptance research in ELT: State of the art article. Yavana Bhasha: Journal of English Language Education2018; 1: 25–37.
76.
LombardoCIslamMS. Stroke survivors’ acceptance and satisfaction of telerehabilitation delivery of physiotherapy services: A systematic review. Phys Ther Rev2023; 28: 261–277.
77.
SharmaRZachrisonKSViswanathanA, et al.Trends in telestroke care delivery: A 15-year experience of an academic hub and its network of spokes. Circ Cardiovasc Qual Outcomes2020; 13: e005903.
78.
LazarusGPermanaAPNugrohoSW, et al.Telestroke strategies to enhance acute stroke management in rural settings: A systematic review and meta-analysis. Brain Behav2020; 10: e01787.
79.
DavisLEHarnarJLaChey-BarbeeLA, et al.Using teleneurology to deliver chronic neurologic care to rural veterans: Analysis of the first 1,100 patient visits. Telemed J E Health2019; 25: 274–278.
80.
MaidaEBresciamorraVTriassiM, et al.Cost-analysis of telemedicine interventions compared with traditional care in the management of chronic neurological diseases: A systematic review. Telemed J E Health2024; 30: 404–414.
81.
GaoLTanEKimJ, et al.Telemedicine for stroke: Quantifying the long-term national costs and health benefits. Front Neurol2022; 12: 804355.
82.
LokkenTGBlegenRNHoffMD, et al.Overview for implementation of telemedicine services in a large integrated multispecialty health care system. Telemed J E Health2020; 26: 382–387.
83.
KempMRisingKLLaynorG, et al.Barriers to telehealth uptake and use: A scoping review. JAMIA open2025; 8: ooaf019.
84.
HaddadTCBlegenRNPriggeJE, et al.A scalable framework for telehealth: The mayo clinic center for connected care response to the COVID-19 pandemic. Telemed Rep2021; 2: tmr. 2020.0032.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
