Clinical Decision Making in the Management of Patients With Cervicogenic Dizziness: A Case Series

• Published in: The journal of orthopaedic and sports physical therapy Vol. 47; no. 11; pp. 874 - 884
• Main Authors: Jung, Francis C, Mathew, Sherin, Littmann, Andrew E, MacDonald, Cameron W
• Format: Journal Article
• Language: English
• Published: United States 01-11-2017
• Subjects: Adult; Aged; Aged, 80 and over; Clinical Decision-Making; Diagnosis, Differential; Dizziness - diagnosis; Dizziness - etiology; Dizziness - physiopathology; Dizziness - therapy; Female; Humans; Middle Aged; Neck Pain - etiology; Physical Examination - methods; Physical Therapy Modalities; Treatment Outcome; manual physical therapy; case report; sensorimotor retraining; dizziness; clinical reasoning; cervical vertigo
• ISSN: 0190-6011; 1938-1344
• DOI: 10.2519/jospt.2017.7425

Study Design Case series. Background Although growing recognition of cervicogenic dizziness (CGD) is emerging, there is still no gold standard for the diagnosis of CGD. The purpose of this case series is to describe the clinical decision making utilized in the management of 7 patients presenting with CGD. Case Description Patients presenting with neck pain and accompanying subjective symptoms, including dizziness, unsteadiness, light-headedness, and visual disturbance, were selected. Clinical evidence of a temporal relationship between neck pain and dizziness, with or without sensorimotor disturbances, was assessed. Clinical decision making followed a 4-step process, informed by the current available best evidence. Outcome measures included the numeric rating scale for dizziness and neck pain, the Dizziness Handicap Inventory, Patient-Specific Functional Scale, and global rating of change. Outcomes Seven patients (mean age, 57 years; range, 31-86 years; 7 female) completed physical therapy management at an average of 13 sessions (range, 8-30 sessions) over a mean of 7 weeks. Clinically meaningful improvements were observed in the numeric rating scale for dizziness (mean difference, 5.7; 95% confidence interval [CI]: 4.0, 7.5), neck pain (mean difference, 5.4; 95% CI: 3.8, 7.1), and the Dizziness Handicap Inventory (mean difference, 32.6; 95% CI: 12.9, 52.2) at discontinuation. Patients also demonstrated overall satisfaction via the Patient-Specific Functional Scale (mean difference, 9) and global rating of change (mean, +6). Discussion This case series describes the physical therapist decision making, management, and outcomes in patients with CGD. Further investigation is warranted to develop a valid clinical decision-making guideline to inform management of patients with CGD. Level of Evidence Diagnosis, therapy, level 4. J Orthop Sports Phys Ther 2017;47(11):874-884. Epub 9 Oct 2017. doi:10.2519/jospt.2017.7425.