CERVICAL FLEXION ROTATION TEST AND VESTIBULAR/OCULAR MOTOR SCREENING IN PATIENTS WITH CERVICOGENIC DIZZINESS: A FEASIBILITY STUDY

V. Scheuber¹, G. Mantokoudis², A. Korda², M.L. Verra³, S. Reid⁴, B.R. Winteler^3,1

¹Bern University of Applied Sciences, School of Health Professions, Physiotherapy, Bern, Switzerland, ²Bern University Hospital, Inselspital, Department of Otolaryngology, Head and Neck Surgery, Bern, Switzerland, ³Bern University Hospital, Inselspital, Department of Physiotherapy, Insel Gruppe, Bern, Switzerland, ⁴Australian Catholic University, Faculty of Health Sciences Department, School of Allied Health, Sydney, Australia

Background: Although Cervicogenic Dizziness has been the subject of research in recent years, the diagnosis remains controversial, and often Cervicogenic Dizziness is a diagnosis of exclusion. Assessment is difficult as there is no single conclusive test for the diagnosis. In the field of physiotherapy, there are two tests for patients with neck pain that may be helpful in identifying Cervicogenic Dizziness: the Cervical Flexion Rotation Test and the Vestibular/Ocular Motor Screening.

Purpose: The primary aim of this study was to evaluate feasibility in terms of recruitment and measurement. The secondary aim was to assess potential differences in the Cervical Flexion Rotation Test and Vestibular/Ocular Motor Screening between patients with Cervicogenic Dizziness and healthy controls.

Methods: A cross-sectional design was chosen for this feasibility study. Mixed methods were used for the evaluation, focusing on quantitative analysis and using a qualitative method only for one feasibility objective. The Cervical Flexion Rotation Test and Vestibular/Ocular Motor Screening were investigated in six participants with Cervicogenic Dizziness and six healthy controls. The following outcomes were quantitatively assessed (rates and percentages) to evaluate feasibility: eligibility-, screen failure- and recruitment rate, willingness to participate, acceptability/tolerance of the measurement procedure and resources. Feasibility of process was interpreted qualitatively through a thematic analysis of the records in the study logbook. To assess potential differences, the Cervical Flexion Rotattion Test and Vestibular/Ocular Motor Screening were compared between groups (tables, Mann-Whitney U test).

Results: Three criteria for success were achieved: screen failure rate at measurement (0%), willingness to participate (75%) and acceptability/tolerance of measurement procedure. Eligibility rate (21%), screen failure rate at phone calls (73%) and recruitment rate (21%) were below expected levels. In Vestibular/Ocular Motor Screening, participants with Cervicogenic Dizziness had considerably higher total symptom provocation (median 9.5) compared to healthy controls (0). No clear differences between the groups were measured in the Cervical Flexion Rotation Test.

Conclusions: The overall feasibility of the measurement procedure was good, while there were problems with recruitment. A future study is feasible with modifications in recruitment, and the Cervical Flexion Rotation Test and Vestibular/Ocular Motor Screening should be investigated in patients with Cervicogenic Dizziness compared to healthy controls.

Implications: The results of the Cervical Flexion Rotation Test remain unclear and it is recommended that this test be studied in a larger population to clarify conflicting results from different studies. However, the results of the Vestibular/Ocular Motor Screening tool showed clear differences between groups, especially for items involving head movements. Therefore, both tests should be investigated (and further validated) with sufficient power in a future study including both patients with Cervicogenic Dizziness and healthy controls.

Funding acknowledgements: This work was supported by the Swiss Association of Physiotherapy. The EasyAngle device was sponsored byMeloq AB, Stockholm, Sweden.

Keywords:
Dizziness
Cervical Spine
Neck Pain

Topics:
Musculoskeletal
Musculoskeletal: spine
Disability & rehabilitation

Did this work require ethics approval? Yes

Institution: Bern University Hospital, Switzerland

Committee: Ethics Review Board Bern, Switzerland

Ethics number: 2020-00444