Objectives: To evaluate the efficacy of manual therapy treatment compared to non-manual therapy intervention (detuned laser) or no intervention, on dizziness intensity, dizziness frequency, neck pain and disability among people with cervicogenic dizziness (CD). To compare the effectiveness of different types of manual therapy techniques used in the treatment of people with cervicogenic dizziness.
Methods: PRISMA guidelines were followed and protocol registered. An electronic search was conducted of databases in December 2016: Academic Search Complete, AMED, Pubmed, CINAHL, EMBASE, Medline, SPORT
Discus, Web of Science and the Cochrane library. Randomized Controlled Trials published in English, involving adults diagnosed with dizziness originating in the cervical spine and undergoing manual therapy or a multi-modal treatment containing manual therapy were included. Manual therapy is a clinical approach utilising specific hands-on manual mobilisation techniques. Multi-modal physiotherapy treatments include manual therapy in conjunction with other physiotherapy interventions. The control group received detuned laser or a delayed treatment intervention. Outcome measures assessed were dizziness severity and intensity, cervical spine pain intensity and disability using the Dizziness Handicap Inventory. Each study was evaluated using the Cochrane Risk of Bias Tool.
Results: Five studies met the inclusion criteria. This review demonstrated level II evidence that manual therapy may be effective for the treatment of CD and has a positive impact on many of the symptoms associated with this condition. People receiving intervention improved in scores for intensity and frequency of dizziness, intensity of neck pain and disability in the short immediately post treatment and long term at up to 2 years follow up compared to the control group. There was no difference found between the SNAGS and Maitland passive mobilisation groups for the outcome measures investigated.
Conclusions: CD as a disorder experiences a lack of uniformity regarding its definition and no specific test to diagnose its presence. Research into interventions aimed at resolving CD is still in its infancy. Dizziness, neck pain and disability are reported as symptoms that can be reduced with manual therapy. This reflects the long term positive outcomes following manual therapy intervention. Further high quality RCT’s are required determining the benefits of manual therapy in specific subgroups with this disorder. This review highlights the importance of diagnosis and treatment in this cohort of patients in order to prevent long term disability resulting from dizziness and neck pain.
Keywords: Systematic Review, Cervicogenic dizziness, Manual Therapy, Dizziness intensity and frequency, cervical spine pain and Disability.
References:
Reid, S.A. and Rivett, D.A. (2005) 'Manual therapy treatment of cervicogenic dizziness: a systematic review', Manual Therapy, 10(1), 4-13.
Lystad, R.P., Bell, G., Bonnevie-Svendsen, M. and Carter, C.V. (2011) 'Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: a systematic review', Chiropractic & Manual Therapies, 19(1), 21-21, available: http://dx.doi.org/10.1186/2045.
