Methodological considerations and novel perspectives in vestibular physiotherapy

The foundation of modern evidence-based healthcare rests upon two critical pillars: the trustworthy synthesis of global research evidence and the precise application to individual patient care. This thesis investigates a crucial disconnect between these two pillars, exploring both the systemic crisis in the reliability of synthesized evidence and the challenges in translating robust evidence into rehabilitation practices, using vestibular rehabilitation in neurology as a paradigmatic case study. First, a pervasive crisis in the trustworthiness of systematic reviews (SRs) was confirmed. Analyses revealed critically low confidence in the results of 90% of musculoskeletal physiotherapy SRs, with broader research showing low-quality rates of 73-81%. The inadequacy of existing manual solutions for selecting the best evidence among many SRs on the same topic was highlighted. In response, a strong need was identified, with 87.0% of decision-makers expressing interest in an AI-informed tool (e.g., the proposed WISEST AI) to efficiently appraise and compare SRs. Second, a significant and underestimated burden of vestibular dysfunction was objectively documented. Video head impulse test (vHIT) revealed a considerable prevalence of VOR gain dysfunctions in all the populations investigated. Crucially, reliance solely on mean VOR gain was found to mask isolated canal dysfunctions, which significantly correlated with balance and gait deficits in specific samples analyzed. Despite vHIT's proven diagnostic utility (84% sensitivity, 85% specificity) in ruling out stroke in acute vestibular syndrome, nearly half of rehabilitation professionals do not use instrumental assessment, citing a lack of skills and cost as key barriers. This thesis has shown the need for a synergistic, two-pronged approach. First, the evidence synthesis ecosystem must shift from quantity to quality, supported by AI-driven tools that empower users to efficiently identify trustworthy evidence. Second, clinical practice in neurorehabilitation must embrace a new precision paradigm, moving beyond subjective assessment to integrate objective vestibular profiling for individualized therapy.