Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Primary Care Rehabilitation Practice Kineglazenleeuw, Beveren, Belgium.
Ann Med. 2022 Dec;54(1):1787-1796. doi: 10.1080/07853890.2022.2091790.
Dizziness is a common reason for referral to physiotherapy. Additional information on clinical characteristics, treatment effect and prognostic indicators in physiotherapy practice are needed.
A retrospective observational study. Based on a standardised clinical evaluation patients were labelled as having Benign Paroxysmal Positioning Vertigo (BPPV) or not (no-BPPV). BPPV was treated with repositioning manoeuvres and exercises. In no-BPPV, treatment was based on additional clinical tests. Treatment was provided once per week and considered successful when the patient was free of symptoms confirmed by negative positional tests.
From 148 referred patients, 88 were labelled as having BPPV, 60 as no-BPPV. The symptom of a short-lasting spinning sensation provoked by head movements was highly suggestive of BPPV. On average, in BPPV treatment was completed after 2.27 ± 1.68 treatments, in no-BPPV this was after 4.91 ± 3.46 treatments. The delayed outcome was related to higher 'age' and 'concomitant neck pain' in BPPV and with higher 'age' only in no-BPPV. Favourable outcome was related to the feature 'dizziness provoked by movements in the horizontal plane' in BPPV.
Clinical evaluation and treatment in physiotherapy practice can be an effective and safe option for patients with dizziness. Several clinical variables with prognostic values were identified.Key messagesClinical evaluation and treatment in physiotherapy practice can be part of low threshold care for dizzy patients.Despite prior medical screening, one-third of patients without signs of BPPV were sent back for further evaluation, illustrating the need for interdisciplinary collaboration.Based on the description of the dizziness symptom (vertigo rather than light-headedness), provocation of the dizziness by movements, and a short duration of the dizziness attack, and positive clinical vestibular tests, BPPV treatment could be initiated.
头晕是转诊至物理治疗的常见原因。在物理治疗实践中，需要更多关于临床特征、治疗效果和预后指标的信息。
这是一项回顾性观察研究。基于标准化的临床评估，患者被标记为患有良性阵发性位置性眩晕（BPPV）或无 BPPV。BPPV 采用变位手法和运动疗法进行治疗。在无 BPPV 中，治疗基于额外的临床测试。每周进行一次治疗，当患者经位置性试验证实症状消失时，即认为治疗成功。
在 148 名转诊患者中，88 名被标记为患有 BPPV，60 名患有非 BPPV。头部运动诱发的短暂旋转性眩晕症状高度提示 BPPV。在 BPPV 中，平均治疗完成 2.27 ± 1.68 次治疗，而在非 BPPV 中，这一数字为 4.91 ± 3.46 次治疗。延迟结局与 BPPV 中的“年龄”和“并发颈部疼痛”较高以及非 BPPV 中的“年龄”较高有关。良好结局与 BPPV 中的“由水平平面运动诱发的头晕”特征有关。
在物理治疗实践中，临床评估和治疗可能是头晕患者的有效且安全的选择。确定了具有预后价值的几个临床变量。
物理治疗实践中的临床评估和治疗可以作为低门槛治疗头晕患者的一部分。尽管进行了先前的医学筛查，但三分之一无 BPPV 迹象的患者仍被送回进行进一步评估，这表明需要开展跨学科合作。基于头晕症状的描述（眩晕而非头晕）、头晕由运动诱发，以及头晕发作的持续时间较短，以及阳性的临床前庭测试，可开始 BPPV 治疗。
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