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Table 1 Included studies

From: Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: a systematic review

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
  1. CVSFAS: cervical vertigo, symptoms and functional assessment scale; DHI: Dizziness Handicap Inventory; NDI: Neck Disability Index; HVLA: high-velocity, low amplitude; PIR: post-isometric relaxation; RCT: randomised, controlled trial; ROM: range of motion; SF-SSB: Berg Balance Scale (short form); sEMG: surface electromyography; SNAGs: sustained natural apophyseal glides; TCD: transcranial Doppler ultrasonography; TCM: traditional Chinese medicine; VAS: Visual Analogue Scale.
  2. * 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.
  3. † No inferential statistics reported