Efficacy of manual therapy treatments for people with cervicogenic dizziness and pain: Protocol of a randomised controlled trial

BMC Musculoskeletal Disorders (Impact Factor: 1.72). 10/2012; 13(1):201. DOI: 10.1186/1471-2474-13-201
Source: PubMed


Cervicogenic dizziness is a disabling condition characterised by postural unsteadiness that is aggravated by cervical spine movements and associated with a painful and/or stiff neck. Two manual therapy treatments (Mulligan’s Sustained Natural Apophyseal Glides (SNAGs) and Maitland’s passive joint mobilisations) are used by physiotherapists to treat this condition but there is little evidence from randomised controlled trials to support their use. The aim of this study is to conduct a randomised controlled trial to compare these two forms of manual therapy (Mulligan glides and Maitland mobilisations) to each other and to a placebo in reducing symptoms of cervicogenic dizziness in the longer term and to conduct an economic evaluation of the interventions.

Participants with symptoms of dizziness described as imbalance, together with a painful and/or stiff neck will be recruited via media releases, advertisements and mail-outs to medical practitioners in the Hunter region of NSW, Australia. Potential participants will be screened by a physiotherapist and a neurologist to rule out other causes of their dizziness. Once diagnosed with cervciogenic dizziness, 90 participants will be randomly allocated to one of three groups: Maitland mobilisations plus range-of-motion exercises, Mulligan SNAGs plus self-SNAG exercises or placebo. Participants will receive two to six treatments over six weeks. The trial will have unblinded treatment but blinded outcome assessments. Assessments will occur at baseline, post-treatment, six weeks, 12 weeks, six months and 12 months post treatment. The primary outcome will be intensity of dizziness. Other outcome measures will be frequency of dizziness, disability, intensity of cervical pain, cervical range of motion, balance, head repositioning, adverse effects and treatment satisfaction. Economic outcomes will also be collected.

This paper describes the methods for a randomised controlled trial to evaluate the effectiveness of two manual therapy techniques in the treatment of people with cervicogenic dizziness for which there is limited established evidence-based treatment.

Trial registration

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    • "A randomised controlled trial (RCT) was conducted in a physiotherapy research laboratory at an Australian university. A detailed protocol has been published elsewhere (Reid et al., 2012). Briefly, participants with chronic cervicogenic dizziness were randomised using concealed allocation to one of three groups: Mulligan's SNAGs together with self-SNAGs, Maitland's PJMs with ROM exercises , or a placebo intervention of detuned laser. "
    Physiotherapy 05/2015; 101:e1270-e1271. DOI:10.1016/ · 1.91 Impact Factor
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    ABSTRACT: Unlabelled: Sympathetic symptoms associated with cervical disorders, such as vertigo, headache, dizziness, etc., are common clinical disorders bewildering both clinicians and patients. In our clinical practice we observed that sympathetic symptoms associated with cervical disorders were apparently relieved in some patients after undergoing routine anterior cervical decompression and fusion plus posterior longitudinal ligament (PLL) resection. This study was designed to investigate the sympathetic nerve innervations in the cervical PLL and its potential correlation with cervical sympathetic symptoms such as vertigo. Method: In animal research, cervical PLLs of 9 adult rabbits were harvested and stained with sucrose-phosphate-glyoxylic acid (SPG), which is a specific fluorescence staining method for sympathetic postganglionic fibers. In human research, cervical PLL of 8 patients of cervical spondylosis with sympathetic symptoms were harvested during surgery and stained with SPG. All sections were observed under fluorescence microscope. Sympathetic symptoms were evaluated using the sympathetic symptom 20-point score preoperatively and at 1 week, 2-month, and 6-month postoperatively. Results: In rabbit specimens, a large number of sympathetic postganglionic fibers were distributed in the cervical PLL of every segment. The density of sympathetic fibers distributed in the intervertebral portion of PLL was more than that in the vertebral portion. Compared with deep layer section, the nerve fibers in the superficial PLL layer section were thicker and more densely populated. Existence of sympathetic postganglionic fibers was also confirmed in human specimens. Those nerve fibers were mostly short and isolated in areatus form, with non-interwoven branches. The mean sympathetic symptoms score decreased significantly from 6.6 ± 2.6 before surgery to 2.0 ± 1.9 at 6 months postoperatively after anterior cervical decompression and fusion with PLL removed. Conclusion: According to the experimental result and clinical practice, we hypothesized that sympathetic nerve fibers distributed in PLL may represent a pathologic basis of stimulation induced by cervical vertebral degenerative changes and thus are susceptible to being a potential causative factor in cervical spondylosis with sympathetic symptoms.
    Medical Hypotheses 03/2014; 82(5). DOI:10.1016/j.mehy.2014.02.029 · 1.07 Impact Factor
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    ABSTRACT: This systematic review updated and extended the "UK evidence report" by Bronfort et al. (Chiropr Osteopath 18:3, 2010) with respect to conditions / interventions that received an 'inconclusive' or 'negative' evidence rating or were not covered in the report. A literature search of more than 10 general medical and specialised databases was conducted in August 2011 and updated in March 2013. Systematic reviews, primary comparative studies and qualitative studies of patients with musculoskeletal or non-musculoskeletal conditions treated with manual therapy and reporting clinical outcomes were included. Study quality was assessed using standardised instruments, studies were summarised, and the results were compared against the evidence ratings of Bronfort. These were either confirmed, updated, or new categories not assessed by Bronfort were added. 25,539 records were found; 178 new and additional studies were identified, of which 72 were systematic reviews, 96 were RCTs, and 10 were non-randomised primary studies. Most 'inconclusive' or 'moderate' evidence ratings of the UK evidence report were confirmed. Evidence ratings changed in a positive direction from inconclusive to moderate evidence ratings in only three cases (manipulation / mobilisation [with exercise] for rotator cuff disorder; spinal mobilisation for cervicogenic headache; and mobilisation for miscellaneous headache). In addition, evidence was identified on a large number of non-musculoskeletal conditions not previously considered; most of this evidence was rated as inconclusive. Overall, there was limited high quality evidence for the effectiveness of manual therapy. Most reviewed evidence was of low to moderate quality and inconsistent due to substantial methodological and clinical diversity. Areas requiring further research are highlighted.
    Chiropractic and Manual Therapies 03/2014; 22(1):12. DOI:10.1186/2045-709X-22-12
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