Comparison of outcomes in neck pain patients with and without dizziness undergoing chiropractic treatment: a prospective cohort study with 6 month follow-up

Abstract

BackgroundThe symptom ‘dizziness’ is common in patients with chronic whiplash related disorders. However, little is known about dizziness in neck pain patients who have not suffered whiplash. Therefore, the purposes of this study are to compare baseline factors and clinical outcomes of neck pain patients with and without dizziness undergoing chiropractic treatment and to compare outcomes based on gender.MethodsThis prospective cohort study compares adult neck pain patients with dizziness (n = 177) to neck pain patients without dizziness (n = 228) who presented for chiropractic treatment, (no chiropractic or manual therapy in the previous 3 months). Patients completed the numerical pain rating scale (NRS) and Bournemouth questionnaire (BQN) at baseline. At 1, 3 and 6 months after start of treatment the NRS and BQN were completed along with the Patient Global Impression of Change (PGIC) scale. Demographic information was also collected. Improvement at each follow-up data collection point was categorized using the PGIC as ‘improved’ or ‘not improved’. Differences between the two groups for NRS and BQN subscale and total scores were calculated using the unpaired Student’s t-test. Gender differences between the patients with dizziness were also calculated using the unpaired t-test.ResultsFemales accounted for 75% of patients with dizziness. The majority of patients with and without dizziness reported clinically relevant improvement at 1, 3 and 6 months with 80% of patients with dizziness and 78% of patients without dizziness being improved at 6 months. Patients with dizziness reported significantly higher baseline NRS and BQN scores, but at 6 months there were no significant differences between patients with and without dizziness for any of the outcome measures. Females with dizziness reported higher levels of depression compared to males at 1, 3 and 6 months (p = 0.007, 0.005, 0.022).ConclusionsNeck pain patients with dizziness reported significantly higher pain and disability scores at baseline compared to patients without dizziness. A high proportion of patients in both groups reported clinically relevant improvement on the PGIC scale. At 6 months after start of chiropractic treatment there were no differences in any outcome measures between the two groups.

Cervicogenic causes of vertigo

“…Humphreys et al [15] also noted that neck pain patients with dizziness reported significantly higher pain and disability scores at baseline than patients without dizziness. This observation is consistent with the older literature.…”

“…Regarding treatment, Humphreys et al [15] and associates reported that 78-80% of patients were improved after 6 months of chiropractic treatment. Regarding treatment, Humphreys et al [15] and associates reported that 78-80% of patients were improved after 6 months of chiropractic treatment.…”

The development and implementation of an outcomes database for imaging-guided therapeutic musculoskeletal injections

“…The NRS for pain is a frequently used outcome measure and the advantages of the PGIC are becoming well recognized. The PGIC has been shown to be a valid and reliable outcome measure in several studies [16][17][18][19][20][21]. It has also been shown to be a "gold standard" for measuring clinically relevant "improvement" compared with longer outcome measures, including the Oswestry questionnaire [16].…”

“…The PGIC scale is a seven-point scale and incorporates factors such as disability and over-all well-being. It has been validated as a "gold standard" for "improvement" [16] and has been used as the primary outcome measure in several recent studies [17][18][19][20][21]. Only patients responding "much better" or "better" (scores of 1 or 2) were categorized as "improved."…”

“Cervical Vertigo-Pathophysiology and Management: An Update”

“…As to RVAO, treatment options, introduced by acase report, range from lifestyle modification (avoid-ance of head turning), anticoagulation, endovascular, and stenting to surgical treatments (95). On the basis of their safety, effectiveness, and good long-term out-come, surgical treatments, including cervical decompression and/or cervical spine fusion, have been recommended as the first line treatment option of RVAO.…”