Therapeutic patient education and exercise therapy in patients with cervicogenic dizziness: a prospective case series clinical study

Abstract

The purpose of this study was to evaluate the effectiveness of a treatment for patients with cervicogenic dizziness that consisted of therapeutic education and exercises. The Dizziness Handicap Inventory and Neck Disability Index were used. Secondary outcomes included range of motion, postural control, and psychological variables. Seven patients (two males and five females) aged 38.43±14.10 with cervicogenic dizziness were included. All the participants received eight treatment sessions. The treatment was performed twice a week during a four weeks period. Outcome measures included a questionnaire (demographic data, body chart, and questions about pain) and self-reported disability, pain, and psychological variables. Subjects were examined for cervical range of motion and postural control. All of these variables were assessed pre- and postintervention. Participants received eight sessions of therapeutic education patient and therapeutic exercise. The majority of participants showed an improvement in catastrophism (mean change, 11.57±7.13; 95% confidence interval [CI], 4.96–18.17; d=1.60), neck disability (mean change, 5.14±2.27.28; 95% CI, 3.04–7.24; d=1.32), and dizziness disability (mean change, 9.71±6.96; 95% CI, 3.26–16.15; d=1.01). Patients also showed improved range of motion in the right and left side. Therapeutic patient education in combination with therapeutic exercise was an effective treatment. Future research should investigate the efficacy of therapeutic patient education and exercise with larger sample sizes of patients with cervicogenic dizziness.

Peer Review #1 of "Patient-reported outcomes measured with and without dizziness associated with non-specific chronic neck pain: implications for primary care (v0.1)"

“…Therefore, patients who suffered from dizziness associated to NSCNP 301 showed greater fear of movement than patients with isolated NSCNP, which seemed to be in line 302 with prior studies (Dickin, 2010;Alahmari et al, 2014;Minguez-Zuazo et al, 2016;Grande-303 Alonso et al, 2018a). This fact may be due to dizziness may produce a non-specific anomalous 304 spatial sensation secondary to anomalous spine afferences which may alter visual, vestibular or 305 somatosensory inputs (Minguez-Zuazo et al, 2016).…”

“…Manuscript to be reviewed 247 248 Discussion 249 To the authors´ knowledge, this is the first study that has addressed the effects of dizziness and 250 NSCNP together in primary care patients who presented an impairment in patient-reported 251 outcome measurements such as the HRQoL, disability levels, and kinesiophobia. According to 252 the mentioned neurophysiological model (Minguez-Zuazo et al, 2016;Devaraja, 2018), the 253 hypothesis of this model resides in the fact that the alteration of a sensory input, specially 254 provided by the neurophysiological pathways between the upper cervical region and the 255 subsystems that form the postural control, could cause sensations of dizziness secondary to an 256 integration incongruity between the aberrant cervical somatosensory input and the expected 257 physiological sensory patterns (Kristjansson & Treleaven, 2009). Indeed, vestibular and 258 somatosensory systems could compensate for alterations in balance by increasing the rigidity of 259 the body, mainly in the cervical region, thus explaining the hyperactivity of the cervical 260 musculature in patients with cervicogenic dizziness (Minguez-Zuazo et al, 2016;Devaraja, 261 2018).…”

“…According to 252 the mentioned neurophysiological model (Minguez-Zuazo et al, 2016;Devaraja, 2018), the 253 hypothesis of this model resides in the fact that the alteration of a sensory input, specially 254 provided by the neurophysiological pathways between the upper cervical region and the 255 subsystems that form the postural control, could cause sensations of dizziness secondary to an 256 integration incongruity between the aberrant cervical somatosensory input and the expected 257 physiological sensory patterns (Kristjansson & Treleaven, 2009). Indeed, vestibular and 258 somatosensory systems could compensate for alterations in balance by increasing the rigidity of 259 the body, mainly in the cervical region, thus explaining the hyperactivity of the cervical 260 musculature in patients with cervicogenic dizziness (Minguez-Zuazo et al, 2016;Devaraja, 261 2018). Nevertheless, patients with NSCNP presented an alteration in cervical neuro-sensorimotor 262 control and, conversely, these patients did not present dizziness (Falla, Bilenkij & Jull, 2004).…”

“…Dizziness may predispose an individual with NSCNP to development of instability 296 and misbalance in addition to an increase in disability levels (Wrisley et al, 2000;Reid & Rivett, 297 2005;Dickin, 2010;Alahmari et al, 2014;Weidt et al, 2014;Minguez-Zuazo et al, 2016;298 Grande-Alonso et al, 2018a), which may lead to a higher rate of falls, disability-related 299 problems, and economic burden in primary care patients (Sun et al, 2014;Mueller et al, 2014;300 Weidt et al, 2014). Therefore, patients who suffered from dizziness associated to NSCNP 301 showed greater fear of movement than patients with isolated NSCNP, which seemed to be in line 302 with prior studies (Dickin, 2010;Alahmari et al, 2014;Minguez-Zuazo et al, 2016;Grande-303 Alonso et al, 2018a). This fact may be due to dizziness may produce a non-specific anomalous 304 spatial sensation secondary to anomalous spine afferences which may alter visual, vestibular or 305 somatosensory inputs (Minguez-Zuazo et al, 2016).…”

Physical therapy management in patients with cervicogenic dizziness- A case series

“…Cervical spondylosis is extremely common in adults. It has been estimated that 75% of persons over the age of 50 years have narrowing of spinal canal and intervertebral foramina and 50% of these cases are symptomatic 1,2 .…”