Physical Therapy Department, University of the Sciences, Philadelphia, Pennsylvania (A.K.G.); Excel Physical Therapy, Blue Bell, Pennsylvania (A.T.); Willow Grove Physical Therapy, Willow Grove, Pennsylvania (M.F.); and WWS Physical Therapy and Vestibular Rehabilitation, Doylestown, Pennsylvania (W.W.S).
J Neurol Phys Ther. 2021 Apr 1;45(2):79-86. doi: 10.1097/NPT.0000000000000349.
Individuals with benign paroxysmal positional vertigo (BPPV) are frequently referred to physical therapy for management, but little is known on how reliable therapists are at diagnosing BPPV. The purpose of the study was to examine the agreement between physical therapists in identifying nystagmus and diagnosing BPPV.
Thirty-eight individuals with complaints of positional vertigo, 19 from each of 2 clinics (clinics 1 and 2) that specialize in vestibular rehabilitation, had eye movements recorded using video goggles during positioning tests including supine-to-sit, supine roll, and Dix-Hallpike tests. Three therapists from each of the clinics independently observed videos, documented nystagmus characteristics of each testing position, and made a diagnosis for each case. Kappa (κ) statistics were calculated between therapists within each clinic for nystagmus identification and diagnosis.
Clinic 1 therapists demonstrated substantial to almost perfect agreement in identifying nystagmus during positional tests (κ = 0.68-1, P < 0.005). Clinic 2 therapists showed moderate to almost perfect agreement for presence of nystagmus (κ = 0.57-1, P < 0.005). Therapists at both sites had almost perfect agreement of diagnosis side, canal, and mechanism (κ = 0.81-1, P < 0.005).
Therapists utilized observations from multiple positional tests to determine diagnoses. This was evident by occasional disagreement in nystagmus presence and characteristics, but agreement in diagnosis, including ruling out BPPV. The results may not be generalizable to all physical therapists or therapists' ability to diagnose central and atypical nystagmus presentations. Experienced physical therapists demonstrated strong agreement in diagnosing common forms of BPPV.Video Abstract available for more insight from the authors (see the Video Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A340).
患有良性阵发性位置性眩晕（BPPV）的患者经常被转介到物理治疗科进行治疗，但对于治疗师在诊断 BPPV 方面的可靠性知之甚少。本研究旨在检查物理治疗师在识别眼震和诊断 BPPV 方面的一致性。
38 名有位置性眩晕症状的患者（每个诊所 19 名，共 2 个诊所，分别为诊所 1 和诊所 2，均专门从事前庭康复治疗）接受视频护目镜记录的眼动，包括仰卧位至坐位、仰卧位翻滚和 Dix-Hallpike 试验。每个诊所的 3 名治疗师分别独立观察视频，记录每个测试位置的眼震特征，并对每个病例做出诊断。计算每个诊所治疗师之间的κ（κ）统计量，用于识别眼震和诊断。
诊所 1 的治疗师在识别位置性试验中的眼震方面表现出实质性到几乎完美的一致性（κ=0.68-1，P＜0.005）。诊所 2 的治疗师在存在眼震方面表现出中度到几乎完美的一致性（κ=0.57-1，P＜0.005）。两个地点的治疗师在诊断侧别、管型和机制方面几乎达成一致（κ=0.81-1，P＜0.005）。
治疗师利用多个位置测试的观察结果来确定诊断。这一点可以从眼震的存在和特征偶尔不一致，但诊断一致中看出，包括排除 BPPV。结果可能不适用于所有物理治疗师或治疗师诊断中枢性和非典型性眼震表现的能力。经验丰富的物理治疗师在诊断常见形式的 BPPV 方面表现出很强的一致性。视频摘要可供作者更深入了解（见视频补充数字内容 1，可在 http://links.lww.com/JNPT/A340 获得）。
