Elsevier

Manual Therapy

Volume 10, Issue 1, February 2005, Pages 4-13
Manual Therapy

Review article
Manual therapy treatment of cervicogenic dizziness: a systematic review

https://doi.org/10.1016/j.math.2004.03.006Get rights and content

Abstract

Dizziness is a common and often disabling disorder. In some people the cause of their dizziness is pathology or dysfunction of upper cervical vertebral segments that can be treated with manual therapy. The aim of the present study was to systematically review the literature on the manual therapy treatment of patients with cervicogenic dizziness, by identifying and evaluating both randomized controlled trials (RCTs) and non-RCTs (controlled clinical trials and non-controlled studies). Seven electronic databases were searched up to July 2003, article reference lists were screened and an expert panel elicited to obtain relevant trials. Nine studies met the inclusion criteria and key data was extracted. Two reviewers assessed the validity of the studies using the Cochrane format and found that all studies had low methodological quality. However, a consistent finding was that all studies had a positive result with significant improvement in symptoms and signs of dizziness after manual therapy treatment. Therefore, Level 3 evidence for manual therapy treatment of cervicogenic dizziness was obtained indicating it should be considered in the management of patients with this disorder provided there is evidence of improvement. This review has identified the need for further RCTs of acceptable methodological quality.

Section snippets

Background

Dizziness is a common complaint in manual therapy and practice. It can be described as light-headedness, imbalance, giddiness or unsteadiness (Oostendorp et al., 1992a). It is a symptom of non-specific pathological importance (Luxon, 1984). A subgroup of those with dizziness complains of vertigo which is an illusion of movement, usually rotation, whirling or spinning of the person or the environment (Froehling et al., 1994; Cronin, 1997; Aalto et al., 1998).

Dizziness and vertigo are common

Objective

The purpose of this study was to systematically review the literature to evaluate the evidence for the efficacy of manual therapy treatment in the management of cervicogenic dizziness. The review examines the evidence in order to inform practitioners.

Literature search

Several bibliographic databases were searched in July 2003. The following electronic databases were searched: MEDLINE using OVID (January 1, 1966 onwards), EMBASE (1988 onwards), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (from 1983 onwards), Physiotherapy Evidence Database (PEDro), the Cochrane Controlled Trials Register in the Cochrane Library (latest edition), Manual Alternative and Natural Therapy Index System (MANTIS) (1880 onwards) and the Allied and Complementary

Selection of studies

Twenty-six trials were identified using MEDLINE. These were scanned and three trials were identified that met the criteria for inclusion (Karlberg et al., 1996; Bracher et al., 2000; Heikkila et al., 2000). The search of EMBASE identified three German studies (Konrad and Gereneser, 1990; Uhlemann et al., 1993; Biesinger, 1997). The search of AMED identified a further study accepted for the review (Zhou et al., 1999). PEDro, MANTIS, CINAHL and the Cochrane Controlled Trials Register did not

Discussion

Results from the studies examined in this systematic review showed that there is limited evidence that manual therapy is beneficial in the treatment of cervicogenic dizziness.

Due to the lack of RCTs on this topic non-RCTs were included. It has been acknowledged that RCTs are not the only or necessarily the best means of evaluating health care, and the Cochrane Collaboration has considered changing to include other research methodologies (Newman and Jacobsen 1993; Mulrow and Oxman, 1997).

Conclusions

This systematic review has found that there is limited evidence at present to support the use of manual therapy in treating cervicogenic dizziness. Insufficient clinical research of satisfactory quality has been performed on this topic. Further RCTs, with high-methodological quality, are needed to clearly determine the role of manual therapy for this disorder. Future research should examine the efficacy of individual types of manual therapy as well as a multimodal approach.

References (52)

  • N.R. Colledge et al.

    Evaluation of investigations to diagnose the cause of dizziness in elderly peoplea community based controlled study

    British Medical Journal

    (1996)
  • P. Cote et al.

    Cervicogenic vertigoa report of three cases

    The Journal of the Canadian Chiropractic Association

    (1991)
  • P.C. Cronin

    Cervicogenic vertigo

    European Journal of Chiropractic

    (1997)
  • P.T.V.M. De Jong et al.

    Ataxia and nystagmus induced by injection of local anaestetics in the neck

    Annales of Neurology

    (1977)
  • D. Fitz-Ritson

    Assessment of cervicogenic vertigo

    Journal of Manipulative and Physiological Therapies

    (1991)
  • D. Froehling et al.

    Does this dizzy patient have a serious form of vertigo?

    Journal of the American Medical Association

    (1994)
  • Furman J, Cass S. Balance disorders: a case-study approach. Philadelphia: F.A. Davis Co;...
  • J. Furman et al.

    Central causes of dizziness

    Physical Therapy

    (2000)
  • R. Galm et al.

    Vertigo in patients with cervical spine dysfunction

    European Spine Journal

    (1998)
  • Gargano F. Treatment of cervicogenic dizziness. Unpublished raw data. Personal communication,...
  • Grieve GP. Common vertebral joint problems. Edinburgh: Churchill Livingstone;...
  • S. Haldeman

    Modern developments in the principles and practice of chiropractic

    (1980)
  • M. Hinoki

    Vertigo due to whiplash injurya neurotological approach

    Acta Oto-laryngology (Stockholm)

    (1985)
  • M. Hulse

    Disequilibrium caused by a functional disturbance of the upper cervical spine, clinical aspects and differential diagnosis

    Manual Medicine

    (1983)
  • A. Jadad et al.

    Guides for reading and interpreting systematic reviews

    Archives of Pediatrics & Adolescent Medicine

    (1998)
  • K. Konrad et al.

    Manual treatment in patients with vertigo

    Manual Medicine

    (1990)
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