UNCORRECTED PROOF www.elsevier.com/locate/math Manual Therapy ] (]]]]) ]]]–]]] Manual therapy treatment of cervicogenic dizziness: a systematic review Susan A. Reid*, Darren A. Rivett Discipline of Physiotherapy, Faculty of Health, The University of Newcastle, Callaghan, NSW 2308, Australia Received 23 April 2003; received in revised form 11 March 2004; accepted 14 March 2004 Abstract Dizziness is a common and often disabling disorder. In some people the cause of their dizziness is pathology or dysfunction of upper cervical vertebral segments that can be treated with manual therapy. The aim of the present study was to systematically review the literature on the manual therapy treatment of patients with cervicogenic dizziness, by identifying and evaluating both randomized controlled trials (RCTs) and non-RCTs (controlled clinical trials and non-controlled studies). Seven electronic databases were searched up to July 2003, article reference lists were screened and an expert panel elicited to obtain relevant trials. Nine studies met the inclusion criteria and key data was extracted. Two reviewers assessed the validity of the studies using the Cochrane format and found that all studies had low methodological quality. However, a consistent finding was that all studies had a positive result with significant improvement in symptoms and signs of dizziness after manual therapy treatment. Therefore, Level 3 evidence for manual therapy treatment of cervicogenic dizziness was obtained indicating it should be considered in the management of patients with this disorder provided there is evidence of improvement. This review has identified the need for further RCTs of acceptable methodological quality. r 2004 Published by Elsevier Ltd. 1. Background Dizziness is a common complaint in manual therapy and practice. It can be described as light-headedness, imbalance, giddiness or unsteadiness (Oostendorp et al., 1992a). It is a symptom of non-specific pathological importance (Luxon, 1984). A subgroup of those with dizziness complains of vertigo which is an illusion of movement, usually rotation, whirling or spinning of the person or the environment (Froehling et al., 1994; Cronin, 1997; Aalto et al., 1998). Dizziness and vertigo are common presenting symp- toms, and were second to low back pain in frequency of occurrence in the adult population at an American Rehabilitation Hospital (Shumway-Cook and Horak, 1989). Dizziness accounts for eight million primary care visits to doctors in the United States each year and is the most common presenting complaint in patients over 75 years (Colledge et al., 1996). It is reported in 30% of people over 65 years and 39% of these people fall because of their dizziness (Colledge et al., 1996). It is particularly relevant to note that out of 18,263 patients presenting to The National Institute of Physical Therapy in the Netherlands for manual therapy from 1972–1992, 18% suffered from vertigo (Oostendorp et al., 1992b). In fact, 40–80% of neck traumatized patients experience vertigo, particularly following whi- plash injury (Fitz-Ritson, 1991; Oostendorp et al., 1999; Wrisley et al., 2000). The frequency of dizziness can vary from a rare episode to a constant sensation. There are many symptoms of varying severity reported by patients with dizziness. These symptoms can lead to emotional problems, disorientation, depression, anxiety, a fear of open spaces, an inability to perform activities of daily living, employment difficulties, early retirement and family problems (Yardley et al., 1992). There are a number of different causes of dizziness including those arising from disturbances of the ear, nose and throat (ENT), central nervous system (CNS), cardiovascular system and benign positional paroxysmal ARTICLE IN PRESS 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75 77 3B2v7:51c GML4:3:1 YMATH : 576 Prod:Type:COM pp:1210ðcol:fig::NILÞ ED:S:Gayathri PAGN: tnn SCAN: Nil *Corresponding author. Tel.: +61-2-4921-7904; fax: +61-2-4921- 7902. E-mail address: mdreid@nelsonbay.com (S.A. Reid). 1356-689X/$ - see front matter r 2004 Published by Elsevier Ltd. doi:10.1016/j.math.2004.03.006