Reid S.A.1, Callister R.2, Katekar M.2, Rivett D.A.2, Treleaven J.M.3
1ACU, School of Physiotherapy, North Sydney, Australia, 2The University of Newcastle, Newcastle, Australia, 3University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
Background: There is evidence for manual therapy as an effective treatment for cervicogenic dizziness (CGD) but there is no diagnostic test to identify those with this condition. Dizziness described as unsteadiness brought on by neck movements, and associated with co-existing neck pain and signs of dysfunction on palpation of the cervical spine are characteristics of CGD. The Dizziness Handicap Inventory (DHI) is used to assess perceived handicap from dizziness and has 25 questions relating to physical, emotional and functional aspects of dizziness. A brief assessment tool based on the DHI may add to the identification process for CGD.
Purpose: The aim of this study was to derive and evaluate a brief assessment tool from the Dizziness Handicap Inventory (DHI) to assist in screening for CGD.
Methods: The DHIs from 86 people with a confirmed diagnosis of CGD and 86 people with general dizziness were compared to determine whether there were differences in the pattern of responses to DHI questions. Three questions were identified where the response patterns differed and these were compiled to form a brief assessment tool. Using the data from 80 of these participants (40 from each group), a receiver operating characteristic (ROC) curve was generated to establish a cut-off score for the brief assessment tool. Then the brief assessment tool was validated using the data from the remaining 92 participants (46 from each group).
Results: Three questions from the DHI, Q1 (does looking up increase your problem), Q9 (because of your problem are you afraid to leave home without having someone accompany you) and Q11 (do quick movements of the head increase your problem) were found to discriminate between participants with CGD and those with general dizziness. The ROC curve indicated an optimal threshold of 9 out of a maximum possible score of 12, where 4 points were given for a yes answer to Q1 and Q11, and a no answer for Q9. The diagnostic ability of the brief assessment tool among the remaining 46 participants from each group was: sensitivity 77% (95% CI: 67 to 84), specificity 66% (56 to 75), positive likelihood ratio 2.28 (1.66 to 3.13), and negative likelihood ratio 0.35 (0.23 to 0.53).
Conclusion(s): A brief assessment tool consisting of three questions from the DHI has been found to be helpful to screen for CGD.
Implications: If people with CGD can be easily identified, they can be referred for physiotherapy management.
Funding acknowledgements: Nil.
Topic: Musculoskeletal: spine
Ethics approval: Ethics approval was granted by the Human Research Ethics Committee at The University of Newcastle. No H-2009-0377
All authors, affiliations and abstracts have been published as submitted.
