Dizziness In Orthopaedic Physical Therapy Practice: History And Physical Examination Page 27
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30of these pathologies amenable to sole PT management.
fit with a diagnosis amenable to sole PT management,
The greatest danger for patients complaining of diz-
the patient’s failure to respond to seemingly appropri-
ziness (and for the therapist managing such patients)
ate conservative measures also indicates the need for
is that the therapist may fail to recognize signs and
a medical second opinion
.
4
symptoms that are indicative of a pathology requiring
urgent medical-surgical management but that resemble
Conclusion
pathology amenable to sole PT management
. A delayed
2
medical diagnosis and delayed subsequent appropriate
Dizziness is a frequent complaint in primary care
medical-surgical management may prove harmful in
orthopaedic physical therapy practice. A PT differential
these cases
.
diagnosis of previously undiagnosed patients centers on
2
In this article, we have provided a template for the
distinguishing patients with BPPV, cervicogenic dizziness,
history (Tables 1-2) and physical examination (Table 4)
and musculoskeletal impairments leading to dysequilib-
relevant to previously undiagnosed patients presenting
rium from those patients who require referral for medi-
to the orthopaedic physical therapist with a main com-
cal-surgical differential diagnosis and (co)management.
plaint of dizziness. In these tables and in the text, we
This article provides information on history items and
have provided indications for when to refer the patient
physical tests within the PT scope of practice that can
for medical-surgical evaluation. The data provided on
enable the orthopaedic physical therapist to distinguish
test reliability and validity, where available, should serve
between these two categories of patients. The decision
as a guideline by which to establish the confidence we
to refer the patient for a medical-surgical evaluation is
have in our findings. However, this research data on
based on our findings, the interpretation of such find-
the history items and physical tests described in this
ings in light of data on reliability and validity of history
article is often absent, contradictory, or insufficient for
items and physical tests, an analysis of the risk of harm
confident diagnostic decision-making.
to the patient, and the response to seemingly appropriate
Our recommendations for referral throughout
intervention. The literature search for data on reliability
the text are based to the maximum extent possible on
and validity of history items and physical tests revealed
psychometric properties of the tests and measures, but
a general paucity of data especially with regards to the
they are also guided by an analysis of possible harm
history and indicates a clear avenue for future research.
to the patient should we decide not to refer. At times,
We also hope that the classification system discussed
it is better to refer the patient and have the patient
in our earlier article
and the template for history and
1
found normal than to not refer and do potential harm.
examination introduced in this article may serve as a
Considering the pathologies possibly responsible for
template for future diagnostic and outcomes research
complaints of dizziness
, the potential for harm is real
in this patient population.
1
and present when working with this population. Clearly
documenting the reason for a medical-surgical referral
Acknowledgement
based on the information presented in this article will
clarify the need for referral and allow for better com-
The authors would like to thank Maureen McKenna
munication with our medical colleagues. Any uncer-
PT, MS, OCS, for her willingness to serve as a model,
tainty regarding the proper diagnosis should result in
as well as Paul Mensack, PTA, for their assistance with
referral. But even if the signs and symptoms appear to
the figures presented.
REFERENCES
of Systematic Reviews 2004, Issue 2. Art. No.: CD003162.pub2.
1. Huijbregts P, Vidal P. Dizziness in orthopaedic physical therapy
practice: Classification and pathophysiology. J Manual Manipula-
DOI: 10.1002/14651858.CD003162.pub2.
4. Herdman SJ, Blatt PJ, Schubert MC. Vestibular rehabilitation of
tive Ther 2004;12:196-211.
patients with vestibular hypofunction or with benign paroxysmal
2. Van der Velde GM. Benign paroxysmal positional vertigo. Part II:
positional vertigo. Curr Opin Neurol 2000;13:39-43.
A qualitative review of non-pharmacological, conservative treat-
ments and a case report presenting Epley’s “canalith repositioning
5. Pollak L, Davies RA, Luxon LL. Effectiveness of the particle
repositioning maneuver in benign paroxysmal positional vertigo
procedure,” a non-invasive bedside manoeuvre for treating BPPV.
with and without additional vestibular pathology. Otol Neurotol
J Can Chiropr Assoc 1999;43:41-49.
2002;23:79-83.
3. Hilton M, Pinder D. The Epley (canalith repositioning) manoeuvre
for benign paroxysmal positional vertigo. The Cochrane Database
6. Kim YK, Shin JE, Chung JW. The effect of canalith repositioning
248 / The Journal of Manual & Manipulative Therapy, 2005
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Medical