| PMC full text: | Published online 2011 Sep 18. doi: 10.1186/2045-709X-19-21
|
Table 1
Return to:
Manual Therapy With and Without Vestibular Rehabilitation
for Cervicogenic Dizziness
Included studies
| Study | Participants | Interventions | Outcome measures | Main findings | Quality | |
|---|---|---|---|---|---|---|
| Manual therapy | Vestibular rehabilitation | |||||
| Randomised controlled trials: | ||||||
| Karlberg et al. 1996 [26]; Malmström et al. 2007 [44] | n = 34 (88% females) Mean age: 37 Age range: 25-55 Country: Sweden Setting: primary care centers and a tertiary referral center | Mobilisation; Soft tissue therapy (relaxation techniques, stabilisation techniques); Home training program; Ergonomic changes at work | Nil | Dizziness frequency; Dizziness intensity; Posturography | - Significantly improved dizziness intensity and neck pain post-treatment (p < 0.05). - Significantly improved postural sway post-treatment (p < 0.2). - 14 patients (82%) reported improvements at 6 months post-treatment.† - 11 patients (65%) reported improvements in dizziness at 2 year post-treatment.† | Moderate |
| Reid et al. 2008 [47] | n = 34 (62% females), 1 drop-out Mean age: 63.5 Age range: not reported Country: Australia Setting: University of Newcastle | Mobilisation (SNAGs) | Nil | DHI; Dizziness severity (VAS); Dizziness frequency; Neck pain (VAS); Posturography | - Significantly reduced DHI, dizziness severity, dizziness frequency and neck pain in the treatment group at 6 and 12 weeks post-treatment (p < 0.05). - No difference in dizziness severity at 12 weeks post-treatment. - No difference in dizziness frequency at either 6 or 12 weeks post-treatment. | Good |
| Kang, Wang and Ye 2008 [48] | n = 76 (49% females) Mean age: 32.4 Age range: 18-45 Country: China Setting: hospital | Group A: Spinal manipulation Group B: Acupressure | Nil | TCD-US; TCM syndrome diagnostic criteria | - Significantly reduced VBA blood flow velocity post-treatment in both groups (p < 0.01). - Significantly larger reduction in left and right vertebral artery blood flow velocity in Group B compared with Group A (p < 0.01). - Group differences remained statistically significant at a 6-month follow-up. | Moderate |
| Fang 2010 [49] | n = 168 (73% females) Mean age: 37.5 Age range: not reported Country: China Setting: hospital | Treatment group: Spinal manipulation; Soft tissue therapy Control group: TCM medication | Nil | CVSFAS; Colour Doppler ultrasonography | - Significant improvements in dizziness (p < 0.01), shoulder/neck pain (p < 0.05), and headache (p < 0.01) post-treatment. - Significant reduction of cervical artery spasm index and atlantoaxial displacement index in the treatment group post-treatment (p < 0.05). | Moderate |
| Du et al. 2010 [50] | n = 70 (54% females) Mean age: 37.6 Age range: 21-45 Country: China Setting: hospital | Treatment group: Spinal manipulation; Soft tissue therapy Control group: Traction; Medication | Nil | CVSFAS; Radiography; TCD-US; TCM syndrome diagnostic criteria | - Significant improvements in dizziness scores, vertebral displacement post-treatment (p < 0.01). - Significantly reduced left and right vertebral artery blood flow velocity post-treatment (p < 0.01). - Significantly improved clinical outcomes six months post-treatment (p < 0.01). | Moderate |
| Prospective cohort studies: | ||||||
| Konrad and Gerencser 1990 [51] | n = 54 (74% females) Mean age: 34.7 Age range: not reported Country: Hungary Setting: hospital | Mobilisation; Manipulation | Nil | Dizziness (instrument not specifically stated); Electronystagmography | - 40 patients (74%) experienced improvement of dizziness post-treatment.† | Poor |
| Mahlstedt, Westhofen and König 1992 [52] | n = 28 (gender distribution not reported) Mean age: not reported Age range not reported Country: Germany Setting: not reported | Spinal manipulation | Nil | No information provided | - 19 patients (68%) reported reduced dizziness post-treatment.† | Poor |
| Uhlemann et al. 1993 [53] | n = 12* (gender distribution not reported) Mean age: 40.7 Age range: not reported Country: Germany Setting: not reported | Mobilisation; Spinal manipulation (traction) | Nil | Cervical turn test | - 5 out of 9 patients went from testing positive to testing negative on the cervical turn test post-treatment. | Poor |
| Bracher et al. 2000 [54] | n = 15 (80% females), 3 drop-outs Mean age: 41 Age range: 27-82 Country: Brazil Setting: chiropractic clinic | Spinal manipulation; Soft tissue therapy; Electrotherapy; Labyrinth sedation medication; sEMG biofeedback; Exercise program | Nil | Dizziness (instrument not specifically stated; "improvement of symptoms was based on patient's reports") | - 9 patients (60%) reported complete remission of dizziness, 3 patients (20%) reported consistent improvement with rare recurrence of episodes of mild intensity, and 3 patients (20%) reported no change.† | Poor |
| Hülse and Hölzl 2000 [55] | n = 67 (52% females) Mean age: 49 Age range: 18-66 Country: Germany Setting: not reported | Soft tissue therapy (traction massage, PIR, occipital-base-release technique, atlas-impulse-therapy) | Nil | Craniocorpography; Posturography | - Significant improvements in pathological vestibulospinal reactions found post-treatment (p < 0.001). | Poor |
| Chen and Zhan 2003 [56] | n = 16 (38% females) Mean age: 42.4 Age range: 38-58 Country: China Setting: hospital | Spinal manipulation; Soft tissue therapy | Nil | TCD-US; Radiography; TCM syndrome diagnostic criteria | - 14 patients (87.5%) reported marked improvement or complete remission of symptoms. - Significantly decreased vertebral artery mean blood flow velocity post-treatment (p < 0.05). - Significantly reduced vertebral displacement post-treatment (p < 0.05). | Poor |
| Wu et al. 2006 [45]; Wu et al. 2008 [46] | n = 121 (73% females) Mean age: not reported Age range: 20-71 Country: China Setting: hospital | Tuina manipulation therapy (pressing-kneading manipulation applied continuously to bilateral vertebrae for 5 minutes) | Nil | Custom-made instrument to measure skull 3D motion and head repositioning. | - Significant improvements in skull spatial offset repositioning ability post-manipulation (p < 0.01). | Poor |
| Strunk and Hawk 2009 [57] | n = 21 (63% females), 2 drop-outs Mean age: 70 Age range: 44-85 Country: USA (California) Setting: Cleveland Chiropractic College | Spinal manipulation; Soft tissue therapy (myofascial release, PIR, and heat or cold therapy) | Nil | DHI SF-BBS NDI | - Improved DHI and SF-BBS scores.† - Improved balance.† - Decreased dizziness and neck pain.† | Moderate |
* Of the 42 patients that were recruited for this study only 12 patients were included in the manual therapy group, of which only 9 patients actually tested positive on the cervical turn test pre-treatment.
† No inferential statistics reported