Lystad Reidar P, Bell Gregory, Bonnevie-Svendsen Martin, Carter Catherine V
Department of Chiropractic, Macquarie University, Sydney, Australia.
Chiropr Man Therap. 2011 Sep 18;19(1):21. doi: 10.1186/2045-709X-19-21.
Manual therapy is an intervention commonly advocated in the management of dizziness of a suspected cervical origin. Vestibular rehabilitation exercises have been shown to be effective in the treatment of unilateral peripheral vestibular disorders, and have also been suggested in the literature as an adjunct in the treatment of cervicogenic dizziness. The purpose of this systematic review is to evaluate the evidence for manual therapy, in conjunction with or without vestibular rehabilitation, in the management of cervicogenic dizziness.
A comprehensive search was conducted in the databases Scopus, Mantis, CINHAL and the Cochrane Library for terms related to manual therapy, vestibular rehabilitation and cervicogenic dizziness. Included studies were assessed using the Maastricht-Amsterdam criteria.
A total of fifteen articles reporting findings from thirteen unique investigations, including five randomised controlled trials and eight prospective, non-controlled cohort studies were included in this review. The methodological quality of the included studies was generally poor to moderate. All but one study reported improvement in dizziness following either unimodal or multimodal manual therapy interventions. Some studies reported improvements in postural stability, joint positioning, range of motion, muscle tenderness, neck pain and vertebrobasilar artery blood flow velocity.
Although it has been argued that manual therapy combined with vestibular rehabilitation may be superior in the treatment of cervicogenic dizziness, there are currently no observational and experimental studies demonstrating such effects. A rationale for combining manual therapy and vestibular rehabilitation in the management of cervicogenic dizziness is presented.
There is moderate evidence to support the use of manual therapy, in particular spinal mobilisation and manipulation, for cervicogenic dizziness. The evidence for combining manual therapy and vestibular rehabilitation in the management of cervicogenic dizziness is lacking. Further research to elucidate potential synergistic effects of manual therapy and vestibular rehabilitation is strongly recommended.
手法治疗是一种常用于疑似颈椎源性头晕管理的干预措施。前庭康复训练已被证明对单侧外周前庭疾病的治疗有效，并且文献中也建议将其作为颈源性头晕治疗的辅助手段。本系统评价的目的是评估手法治疗联合或不联合前庭康复训练在颈源性头晕管理中的证据。
在Scopus、Mantis、CINHAL和Cochrane图书馆数据库中进行了全面检索，以查找与手法治疗、前庭康复训练和颈源性头晕相关的术语。纳入的研究使用马斯特里赫特-阿姆斯特丹标准进行评估。
本评价纳入了15篇文章，报告了13项独特研究的结果，包括5项随机对照试验和8项前瞻性非对照队列研究。纳入研究的方法学质量总体较差至中等。除一项研究外，所有研究均报告了单峰或多峰手法治疗干预后头晕有所改善。一些研究报告了姿势稳定性、关节定位、活动范围、肌肉压痛、颈部疼痛和椎基底动脉血流速度的改善。
尽管有人认为手法治疗联合前庭康复训练在颈源性头晕治疗中可能更具优势，但目前尚无观察性和实验性研究证明这种效果。本文提出了在颈源性头晕管理中联合手法治疗和前庭康复训练的理论依据。
有中等证据支持使用手法治疗，特别是脊柱松动术和整复术，来治疗颈源性头晕。缺乏手法治疗联合前庭康复训练用于颈源性头晕管理的证据。强烈建议进一步开展研究，以阐明手法治疗和前庭康复训练的潜在协同效应。
