Author Names

Reaid, S.A., Callister, R., Katekar, M.G., Rivett, D.A.

Reviewer Name

Paula Stonehouse Salinas

Reviewer Affiliations

Duke University School of Medicine, Doctor of Physical Therapy Division

 

Paper Abstract

Objective: To evaluate and compare the effects of 2 manual therapy interventions on cervical spine range of motion (ROM), head repositioning accuracy, and balance in patients with chronic cervicogenic dizziness.

Design: Randomized controlled trial with 12-week follow-up using blinded outcome assessment.

Setting: University School of Health Sciences.

Participants: Participants (NZ86; mean age   SD, 62.0 12.7y; 50% women) with chronic cervicogenic dizziness.

Interventions: Participants were randomly assigned to 1 of 3 groups: sustained natural apophyseal glides (SNAGs) with self-SNAG exercises, passive joint mobilization (PJM) with ROM exercises, or a placebo. Participants each received 2 to 6 treatments over 6 weeks.

Main Outcome Measures: Cervical ROM, head repositioning accuracy, and balance.

Results: SNAG therapy resulted in improved (P.05) cervical spine ROM in all 6 physiological cervical spine movement directions immediately posttreatment and at 12 weeks. Treatment with PJM resulted in improvement in 1 of the 6 cervical movement directions posttreatment and 1 movement direction at 12 weeks. There was a greater improvement (P<.01) after SNAGs than PJM in extension (mean difference, -7.5º; 95% confidence interval [CI], -13º to -2.0º) and right rotation (mean difference, -6.8º; 95% CI, -11.5º to -2.1º) posttreatment. Manual therapy had no effect on balance or head repositioning accuracy

Conclusions: SNAG treatment improved cervical ROM, and the effects were maintained for 12 weeks after treatment. PJM had very limited impact on cervical ROM. There was no conclusive effect of SNAGs or PJMs on joint repositioning accuracy or balance in people with cervicogenic dizziness.

 

NIH Risk of Bias Tool

Quality Assessment of Controlled Intervention Studies

Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT

  • Yes

Was the method of randomization adequate (i.e., use of randomly generated assignment)?

  • Yes

Was the treatment allocation concealed (so that assignments could not be predicted)?

  • Yes

Were study participants and providers blinded to treatment group assignment?

  • Yes

Were the people assessing the outcomes blinded to the participants’ group assignments?

  • Yes

Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?

  • Yes

Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?

  • Yes

Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?

  • Yes

Was there high adherence to the intervention protocols for each treatment group?

  • Yes

Were other interventions avoided or similar in the groups (e.g., similar background treatments)?

  • Yes

Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?

  • Yes

Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?

  • Yes

Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?

  • Yes

Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?

  • Yes

Were the included studies listed along with important characteristics and results of each study?

  • Yes

 

Key Finding #1

Among patients with chronic cervicogenic dizziness, SNAG exercises resulted in significant improvement in cervical spine ROM in all directions.

Key Finding #2

Comparing SNAG and PJM, the SNAG group had significantly greater changes in extension and right rotation posttreatment, but no differences at 12 weeks.

Key Finding #3

Manual therapy had no conclusive effect on head repositioning accuracy or balance.

 

Please provide your summary of the paper

This article studied the effects of 2 manual therapy interventions, passive joint mobilization (PJM) and sustained natural apophyseal glide (SNAG), on cervical ROM, head repositioning accuracy, and balance in people with cervicogenic dizziness. The participants in the SNAGs group received an anterior glide to the C1 or C2 vertebra and sustained the glide through head movement in the direction that produced dizziness. The participants were advised on how to self-SNAG using a strap placed on the cervical spine, as a home exercise to be performed as 6 repetitions once daily. The PJM group received mobilization to hypomobile or painful joints in the upper cervical spine. The participants were advised to perform cervical ROM exercises once a day. The placebo group received an intervention consisting of a deactivated laser. The study lasted 12 weeks.  The outcome measures were cervical ROM, head repositioning accuracy, and balance. The SNAG group had greater ROM in all 6 cervical spine movement directions both after treatments and at 12 weeks (when participants performed self-SNAG at home). The PJM group had significant difference from placebo in left cervical rotation after treatment and right cervical rotation at 12 weeks. Comparing SNAG and PJM, the SNAG group had significantly greater changes in extension and right rotation posttreatment, but no differences at 12 weeks. There were no conclusive effect for SNAGs and PJMs on head repositioning accuracy nor balance in people with cervicogenic dizziness.

Please provide your clinical interpretation of this paper.  Include how this study may impact clinical practice and how the results can be implemented.

Based on the results, it can be concluded that treatment with SNAGs resulted in a greater improvement in cervical ROM than treatment with PJM. The article concludes that it is recommended to treat with SNAGs and ongoing self-SNAG exercises to improve cervical spine ROM in people with cervicogenic dizziness. Self-SNAGs is a simple technique that can be used outside the clinical setting to create significant changes in everyday activity and quality of life of people with cervicogenic dizziness. Clinicians can consider implementing this into their manual therapy techniques and home exercise programs as a functional approach to treatment.