Cervicogenic Dizziness
Conditions
Keywords
Dizziness, neck pain, range of motion
Brief summary
Cervicogenic Dizziness is characterized by non-rotatory dizziness and a sense of disequilibrium associated with neck pain, stiffness, and decreased range of motion. It arises from the abnormal afferent inputs from the upper cervical spine. Patients may experience lightheadedness and neck pain triggered by neck movements, leading to functional limitations. The present study aims to compare the effects of sustained natural apophyseal glides only and in combination with the facilitated positional release technique on pain intensity, severity of dizziness, range of motion, and functional status among patients with cervicogenic dizziness
Detailed description
A double-blinded randomized clinical trial will be conducted at the Government Teaching Hospital, Shahdara, Lahore. A total of 42 patients (21 in each group) will be enrolled in this study, and a non-probability, purposive sampling technique will be used for data collection. Patients will be allocated to Group A and Group B after randomization using an online randomization tool. After obtaining informed consent, Group A will receive treatment of SNAGs along with FPRT, while Group B will receive SNAGs only, three times a week for four weeks. Outcome measures will include the Numeric Pain Rating Scale (NPRS) for pain, the Dizziness Handicap Inventory Scale (DHI) for dizziness, a goniometer for range of motion, and the Neck Disability Index (NDI) for functional status. Assessment will be conducted on the first day and after four weeks of treatment. Data will be analyzed using SPSS version 27. Descriptive statistics will be presented, and the data normality will be assessed using the Shapiro-Wilk test to determine whether a parametric or non-parametric test will be used within or between-group analyses.
Interventions
OTHERSNAGs with FRT
SNAG : The therapist will place the palmar aspect of the thumb reinforced by the opposite thumb over the spinous process of C2. The other fingers will apply light pressure on both sides of the face to stabilize the head The therapist will apply anterior glide to C2. Instruct the patient to move his/her neck in the offending direction. FRT: The therapist will palpate the upper trapezius tender point. After palpation, the patient's neck will be brought into a neutral position. The therapist will apply a gentle axial facilitating force (compressive force) through the head towards the feet and will quickly turn the patient's head in side flexion towards the tender point in a position of maximum relaxation. The therapist will maintain this position for 3 to 5 seconds, and the patient's neck will be turned into a neutral position.
OTHERSNAGs
The patient will be seated. The therapist will stand behind the patient. The therapist will place the palmar aspect of the thumb reinforced by the opposite thumb over the spinous process of C2. The other fingers will apply light pressure on both sides of the face to stabilize the head The therapist will apply anterior glide to C2. Instruct the patient to move his/her neck in the offending direction.
Sponsors
Riphah International University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 35 Years
Healthy volunteers
No
Inclusion criteria
* Age group between 18 and 35 years * Both male and female participants * Non-traumatic cervicogenic dizziness with positive cervical torsion test
Exclusion criteria
* • History of cervical trauma or head/face injury * Vestibular disorder, i.e., BPPV * Vertebrobasilar Insufficiency * Positive Dix-Hallpike Maneuver, Alar Ligament Stress Test, and Vertebral Artery Test * History of cardiovascular disorders * Pregnancy * Diagnosed psychological disorders * History of cervical spine surgery * Vertebral Fractures * Spine disorders such as cervical spondylosis and disc herniation * Presence of tumor
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Numeric Pain Rating Scale (NPRS) for Pain | Upto 4 weeks | It is the most frequently used pain outcome measure. It consists of a horizontal 10 cm straight line with 2 marks that have "no pain" (score of 0) and a "worst imaginable pain" (score of 10) at either end of the line. On this scale, respondents will be asked to rate their level of pain before and after the treatment. The test-retest reliability of NPRS is (ICC = 0.72), and the construct validity is (AUC = 0.78-0.93). The Minimal Clinically Important Difference (MCID) is 2.5 points, suggesting a reduction of at least 2.5 points on the NPRS is clinically significant |
| Dizziness Handicap Inventory Scale (DHI) for dizziness | Upto 4 weeks | The DHI questionnaire consists of 25 items with physical, emotional, and functional subscales. This scale evaluates the self-perceived handicap from dizziness. Patients will be asked to answer the questions considering their condition before and after the treatment. Each item on the questionnaire ranges from 0 to 4. Scores of 16-34 indicate mild, 36-52 indicate moderate, and 54 points or more represent severe handicap. The test-retest reliability of DHI is high (r = 0.92 to 0.97) and high internal consistency (alpha = 0.72 to 0.89). The MCID for DHI is reported as ≥ 10 points |
| Universal Goniometer for ROM | Upto 4 weeks | It was used to measure the cervical range of motion. It is a less expensive and easy-to-use instrument. It has two arms, one of which is stationary and the other is a movable arm. The center of the UG is the fulcrum. The test-retest reliability of the goniometer is excellent (ICC ≥ 0.98), and the inter-rater reliability is (ICC ≥ 0.94). The Minimal Detectable Change (MDC ≤ 5.23% (≈ 2-3°) is considered a true change in ROM |
| Neck Disability Index (NDI) for disability | Upto 4 weeks | The NDI questionnaire consists of 10 items designed to measure neck-specific disability. Out of 10 items, 7 correlated with daily living activities, 2 with pain, and 1 with concentration. Each item on the questionnaire ranges from 0 to 5, with higher scores indicating greater disability. The test-retest reliability of NDI is high (r = 0.89), and the Construct validity is (r ≥ 0.70). The MCID for NDI is \>5 Points, meaning a reduction of 5 or more points is considered clinically meaningful |
Countries
Pakistan
Contacts
CONTACTSamrood Akram, PhD*
PRINCIPAL_INVESTIGATORRahat Afzal, MS-OMPT
Governement Teaching Hospital Shahdara Lahore.
Outcome results
None listed