Abstract
Background
The pathophysiology of cervical-related dizziness (CD) is unclear. Manual therapy has been shown to be a possibility for treating the symptoms of CD. The proposed manual therapy treatments may target the upper cervical spine or take a more comprehensive approach. However, it is still unclear which of these approaches produces better results. Therefore, the aim of this review and meta-analysis was to evaluate the effectiveness of manual therapy targeting the upper cervical spine and the global manual therapy interventions compared with control or sham on dizziness impact, intensity, frequency, pain intensity, and neck disability.
Methods
A comprehensive search was conducted on Cochrane Library, PubMed, PEDro, and Web of Science databases from inception to December 2, 2024. Randomized Controlled Trials (RCTs) were included. The studies had to apply manual therapy and compare it with a placebo or a control group in patients with CD. The methodological quality was evaluated using the PEDro scale, and the certainty of evidence was assessed based on GRADE guidelines.
Results
Six RCTs and three secondary analyses were included. Meta-analyses revealed statistically significant differences between manual therapy focused on the upper cervical spine and control/placebo for impact and intensity of dizziness. The certainty of evidence was downgraded to very low for pain intensity, low or very low for cervical range of motion, and disability.
Conclusion
There is low to very low certainty evidence indicating a difference in effectiveness between upper cervical spine interventions and control/placebo treatments for improving the impact and intensity of dizziness in patients with cervical-related dizziness.
PROSPERO registration ID
CRD42024615329
Supplementary Information
The online version contains supplementary material available at 10.1186/s12891-025-08899-z.
Keywords: Dizziness, Cervical, Mobilization, Manipulation, Meta-analysis
Background
Cervical-related dizziness is characterized by the aggravation of neck pain or stiffness due to neck movements and the transient imbalance and/or light-headedness and/or illusory self-motion triggered due to neck movements. Interventions targeting the neck, particularly the upper cervical spine segments, have been shown to improve neck symptoms and dizziness [1–5], but some manual therapy interventions applied not only to the upper cervical spine have also been shown to be beneficial in improving the disability caused by dizziness [6–8].
The etiology and pathophysiology of this cervicogenic dizziness is still unclear, which complicates the consistent use of terminology in both clinical and research contexts. Several studies have used the term cervicogenic dizziness to describe the association between neck pain and dizziness, but the data supporting the underlying mechanisms in humans remain inconclusive. Alternative hypotheses have been proposed to explain similar clinical presentations, including vestibular migraine, the trigeminal hypothesis, the neurovascular hypothesis, and carotid sinus syndrome [9]. Given the existence of multiple competing hypotheses regarding the pathophysiological origin of dizziness related to cervical dysfunction, a substantial degree of uncertainty remains. In this context, and to avoid implying causality in the absence of definitive evidence, the Bárány Society recommends the use of the term cervical dizziness (CD) instead of cervicogenic dizziness [9].
Several clinical tests have been developed to assist in the diagnosis of CD, including the cervical torsion test and the head-neck differentiation test [10]. In addition, certain items from the Dizziness Handicap Inventory (DHI) questionnaire have been proposed as potentially useful in identifying this condition [11]. However, due to the presence of multiple confounding factors in the diagnostic process, no gold standard test for cervical dizziness has been established to date. Therefore, the diagnosis of CD must currently be established by exclusion, requiring a thorough evaluation to rule out other neuro-otological causes by experienced specialists [9]. It has been suggested that the upper cervical spine plays a close role because of its important contribution to the proprioceptive information of the vestibular nuclei. Sung [12] explained that forward head posture places excessive stress on the upper cervical spine, causing changes in the suboccipital muscles, ligament instability, and facet joint dysfunction. These alterations might lead to abnormal proprioceptive signals to the central nervous system, which interact with vestibular and visual inputs. This mismatch of information has the potential to result in dizziness and other symptoms.
Based on these findings, several Randomized Controlled Trials (RCTs) have investigated the application of manual therapy interventions to the cervical spine for managing CD. However, not all manual techniques are comparable, nor are they applied by the same types of therapists [13]. Physical therapists typically use a combination of clinical clusters and test outcomes to assess the specific involvement of the upper cervical spine in dizziness [14]. Physical therapists adhere to the guidelines recommended by the International Federation of Manual and Musculoskeletal Physical Therapists (IFOMPT) for their treatment, in which it is established that manual techniques in the cervical region should be applied in mid-ranges to avoid stress on cervical arteries and neural structures [15]. In contrast, other professionals, such as osteopaths or chiropractors, do not restrict their treatment to a specific body region [7], but rather adopt a more global therapeutic approach guided by the distribution of somatic dysfunctions or clinical findings.
Two previous systematic reviews with meta-analysis examined the use of manual therapy in patients with CD [16, 17]. However, Rehman et al., [16] considered specific interventions to the upper cervical spine and global manual therapy interventions as comparable, while De Vestel et al., [17] primarily included studies with exercise therapy and manual therapy interventions. This highlights the need to investigate whether interventions conducted following a critical examination and adhering to the international recommendations of IFOMPT yield outcomes comparable to other global manual therapy interventions. This systematic review with meta-analysis aimed to investigate the effectiveness of different manual therapy interventions on dizziness impact, dizziness intensity, dizziness frequency, neck pain intensity and neck disability in patient with CD.
Methods
Study design
The present systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane recommendations [18]. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42024615329.
Search strategy
The searches were conducted from inception to November 2024 in the following databases: the Physiotherapy Evidence Database (PEDro), PubMed (MEDLINE), the Cochrane Library, and Web of Science (WoS). Medical subject headings (MeSH) terms were used to conduct the searches, including “Physical therapy modalities,” “Musculoskeletal manipulation,” “Osteopathic manipulation,” “Chiropractic manipulation,” “neck,” “vertigo,” “dizziness,” “cervicogenic dizziness,” “cervical dizziness,” and “cervical vertigo.” Appendix A provides a detailed description of the specific search strategy used for each database. The reference lists of the selected studies and relevant previous systematic reviews were also manually reviewed.
Eligibility criteria
The selection criteria were defined using the PICOS framework. The studies must meet the following criteria to be included: Population: Patient with dizziness and neck pain. Intervention: Treatment based on manual therapy; Comparison: Control, sham, or placebo; Outcomes: Dizziness impact, dizziness and pain intensity, dizziness frequency, and neck disability; Study design: randomized controlled trials.
Studies were excluded if they were not published in English or Spanish, involved vestibular rehabilitation interventions, or reported outcome variables that were either not relevant to the research objectives or measured using invalid or unreliable instruments.
Study selection
The reference list was assessed by two independent reviewers (A.C.-U. and L.C.-L.). Both reviewers determined the reference potential by evaluating the title and abstract. The full text of those studies that met the inclusion criteria was evaluated. S.C.-B. was responsible for resolving any discrepancies between the reviewers’ decisions.
Data extraction
A.C.-U. and L.C.-L. independently carried out the data extraction. They used a predefined sheet based on the Cochrane Collaboration guidelines. The extracted data included population characteristics, intervention details, outcome variables, and results.
Methodological quality assessment
The methodological quality was assessed by two independent reviewers (A.C.-U. and L.C.-L.) using the PEDro scale. This scale is based on a list of 11 items developed from a Delphi consensus that evaluates the methodological quality of clinical trials. The methodological rigor of the clinical trials is evaluated considering the key aspects such as randomization, allocation concealment, blinding, and statistical reporting. The items were rated as either “yes” (1) or “no” (0), depending on whether the criteria were met in the study.
The total PEDro score was calculated by summing the ratings for items two through eleven, resulting in a combined score ranging from 0 to 10. A study was considered of high quality if the PEDro score was higher than seven, “fair” quality for studies whose score is five or six, and “poor” quality if the score is less than four [19].
Data synthesis and analysis
The synthesis of the data was conducted by a qualitative synthesis of the results, and whenever it was possible, a quantitative synthesis of the results was performed.
The combination of data was performed when at least two studies were comparable using RevMan 5.4. software. The studies were considered comparable when the intervention specifically targeted the upper cervical spine, or when manual therapy was applied more globally (cervical spine and other parts of the body), provided that the comparison was made against a control, sham, or placebo group. The mean difference (MD) and standard deviation (SD) were used as intragroup measures of effect size. For studies that did not report these values but provided sufficient data, MD and SD were calculated following the Cochrane Handbook for systematic reviews with meta-analysis [20]. Between-group comparisons were reported as MD with a 95% cnfidence interval (95% C). Statistical significance was set at p < 0.05. The data were compiled in tables and categorized by intervention type, outcome variables and results. Short-term effects were defined as those observed immediately after the intervention protocol, medium-term effects as those measured between 6- and 12-weeks post-intervention, and long-term effects as those observed at 12 months post-intervention.
The random-effects model was used to develop the meta-analysis to account for the possibility that the studies were not estimating the same intervention effect [21]. Heterogeneity was assessed based on the similarity of point estimates, the overlap of confidence intervals, the study context, and the I² statistic in the forest plots [22, 23]. To assess publication bias and evaluate the impact of individual studies, we visually examined the forest plot and conducted sensitivity analyses by excluding individual studies. None of the meta-analyses included ≥ 10 trials, which is the recommended threshold for using funnel plots.
Certainty of evidence assessment
The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach by independent reviewers. Before conducting independent assessments, predefined criteria for downgrading the certainty of evidence were established across the following domains: risk of bias, inconsistency, indirectness, imprecision, and other considerations. The overall certainty of evidence was categorized as ‘high’, ‘moderate’, ‘low’, or ‘very low’ to guide researchers and clinicians in interpreting the relevance and strength of the findings [24].
Results
Of the 16 studies initially selected at the end of the screening process, three studies were excluded due to the type of treatment, two because they performed manual therapy and combined with vestibular rehabilitation, and one because the control group was prescribed therapeutic exercises to take at home [25–27]. Two because they did not present the variable of interest [3, 28], one study was excluded because the patients had a diagnosis of benign paroxysmal positional vertigo [29], and one because it was a single-group study [30]. The study selection process is illustrated in the PRISMA flowchart (Fig. 1).
Fig. 1.
Flowchart diagram
Finally, six primary studies and three secondary analyses were included in the review [2, 6, 8, 31–36], all of which were eligible for inclusion in the qualitative synthesis [2, 6, 8, 31–36]. Of these, one primary study and one secondary analysis were excluded from the quantitative analysis due to the inability to calculate the change score [31, 35]. Therefore, five primary studies and two secondary analyses were included in the quantitative analysis [2, 6, 8, 32–34, 36].
Characteristics of the included studies
Six primary RCTs were included in the present systematic review, involving 272 patients with dizziness [2, 6, 8, 31, 32, 36]. In four primary RCTs [2, 31, 32, 36] the assessment of an otoneurologist or otorhinolaryngologist was considered, which excluded dizziness/vertigo of central or peripheral origin other than cervical origin. In contrast, two primary studies did not include an otoneurologist’s or otorhinolaryngologists diagnosis in the participant selection [6, 8]. Four primary studies focused their intervention on the upper cervical spine [2, 31, 32, 36], one of which included two distinct experimental groups compared to a placebo [2]. Two primary studies applied global manual therapy interventions, focusing primarily on the cervical spine while also including treatment of other body regions, such as the thoracic spine and the knee [6, 8]. The sham or placebos included in the studies were the Activator II™ [8] and lying on one’s back and resting [32], and such as placebo a deactivated laser that appeared to operate normally [2, 35, 36]. Six studies evaluated the impact of dizziness with the DHI [2, 6, 8, 31, 32, 36], the intensity of dizziness was measured with visual analogue scale (VAS) on two studies [2, 34] and with numeric rating scale on one study [8], the intensity of pain was measured with VAS on three studies [2, 32, 36], and the disability of the neck was measured on three studies using the neck disability index (NDI) [8, 33, 36]. All of the studies in the present review measured the short-term effects [2, 6, 8, 31, 32, 36]. The mid-term effects were measured on three studies [2, 6, 31, 35] and long-term effects were only measured on one secondary study [35]. Table 1 showed the sociodemographic and clinical characteristics of the studies.
Table 1.
Characteristics of the studies
| Author | Participants | Intervention | Duration between treatment and follow-up | Outcome (tool) | Main results | ||||
|---|---|---|---|---|---|---|---|---|---|
| RCT | N (sex ratio) | Mean age (SD) | Diagnosis | IG | CG | ||||
| Carrasco-Uribarren et al. 2021a [32] | Primary | 40 (8M/32F) |
IG:55.9 (11.9) CG:52.1 (16) |
CD | Suboccipital massage+ traction manipulation (n=20) | Control (n=20) | Post-treatment |
Dizziness (VAS) DHI Pain (VAS) |
↑D VAS ↑ DHI ↑ P VAS |
| 4 weeks |
↑D VAS ↑ DHI ↑ P VAS |
||||||||
| Carrasco-Uribarren et al. 2021b [34], 2022 [33] | Secondary | 40 (8M/32F) |
IG:55.9 (11.9) CG:52.1 (16) |
CD | Suboccipital massage+ traction manipulation (n=20) | Control (n=20) | Post-treatment |
Dizziness (VAS) DHI Pain (VAS) |
↑D VAS ↑ DHI ↑ P VAS |
| 4 weeks |
↑D VAS ↑ DHI ↑ P VAS |
||||||||
| Fraix et al. 2021 [6] | Primary | 26 (7M/19F) | Total: 52.2 (11.8) | D+SD |
Osteopathic Manipulative Treatment (n=7) |
Control (n=5) | Post-treatment | DHI | No reported |
| 12 weeks | No reported | ||||||||
| Kendall et al. 2018 [8] | Primary | 24 (13M/11F) |
IG:74.2 (5.8) CG: 72.5 (4.3) |
NSD+NP | Chiropractic care (n=12) | Sham (n=10) | Post-treatment |
Dizziness (NRS) DHI Pain (NRS) NDI |
No reported |
| Micarelli et al. 2021 [36] | Primary | 80 (37M/43F) |
IG:44.3(14.8) CG:43.8(13.9) |
CD | SNAG (n=41) | Sham (n=39) | Post-treatment |
Dizziness (VAS) DHI Pain (VAS) NDI |
↑ DHI ↑ P VAS ↑ NDI |
| Reid et al. 2008 [31] | Primary | 34 (13M/21F) | IG:63.4(13.1) CG:63.6(13.7) | CD | SNAG (n=17) | Sham (n=16) | Post-treatment |
Dizziness (VAS) DHI Pain (VAS) Frequency |
↑ D VAS ↑ DHI ↑ P VAS |
| 6 weeks |
↑ D VAS ↑ DHI ↑ P VAS |
||||||||
| 12 weeks | No between-groups differences | ||||||||
| Reid et al. 2014 [2] | Primary | 86 (42M/41F) | IG:60.0(10.1) CG:65.6(11.0) | CD |
SNAG (n=29) PMJ (n=29) |
Sham (n=28) | Post-treatment |
Dizziness (VAS) DHI Pain (VAS) Frequency |
↑ D VAS ↑ DHI |
| 12 weeks |
↑ D VAS ↑ Frequency ↑ DHI (PJM) ↑ P VAS (PJM) |
||||||||
| Reid et al. 2015 [35] | Secondary | 86 (42M/41F) | Total: 62 (12.7) | CD | SNAG (n=29) | Sham (n=14) | Post-treatment |
Dizziness (VAS) DHI Pain (VAS) Frequency |
No reported |
| 12 weeks | No reported | ||||||||
| 12 months |
↑Frequency ↑ DHI |
||||||||
SD Standard deviation, IG Intervention group, CG Control group, M Male, F Female, CD Cervicogenic/cervical dizziness, VAS Visual Analogue scale, DHI Dizziness handicap inventory, D Dizziness, P Pain, ScD Somatic dysfunction, NSD+NP Non-specific dizziness + neck pain, NRS Numeric rating scale, NDI Neck disability index, SNAG Sustained Natural Apophyseal Glides, PJM Passive joint mobilization
Methodological quality
The PEDro scale was used to assess the methodological quality of the studies. Five studies were considered to be of good quality, four of them scoring 8 points [2, 31, 32, 36] on the PEDro scale, one scoring 7 points [8] and one study received a fair quality rating, scoring 6 points [6]. Table 2 showed the PEDro scale.
Table 2.
PEDro scale scores
| Autor | Items | Total | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | ||
| Carrasco-Uribarren et al. [32] | Y | Y | Y | Y | N | N | Y | Y | Y | Y | Y | 8/10 |
| Fraix et al. [6] | Y | Y | Y | N | N | N | Y | Y | Y | N | Y | 6/10 |
| Kendall et al. [8] | Y | Y | Y | Y | N | N | Y | Y | Y | Y | N | 7/10 |
| Micarelli et al. [36] | Y | Y | Y | Y | N | N | Y | Y | Y | Y | Y | 8/10 |
| Reid et al. [31] | Y | Y | Y | Y | N | N | Y | Y | Y | Y | Y | 8/10 |
| Reid et al. [2] | Y | Y | Y | Y | N | N | Y | Y | Y | Y | Y | 8/10 |
1, eligibility criteria 2, random allocation; 3, concealed allocation; 4, similarity at baseline; 5, blinding of participants; 6, blinding of therapists; 7, blinding of assessors; 8, measures of at least one key outcome from at least 85% of participants initially allocated to groups; 9, intention to treat analysis; 10, between-group comparison; 11, point measures and measures of variability. 1 = Yes (1 point), 0 = No (0 point), maximum score = 10 (criterion 1 is not included in scores)
Synthesis of results
A total of five primary studies and two secondary analyses were included in the quantitative analysis [2, 6, 8, 32–34, 36]. Participants in each study were considered only once on the meta-analysis. One of these studies included two intervention groups, both of which were eligible for inclusion in the meta-analysis.
Table 3 presents a summary of the certainty of the evidence. The certainty of the evidence for disability and neck pain intensity was downgraded to ‘very low’ due to risk of bias, indirectness, and imprecision. For dizziness intensity and neck disability, the certainty was downgraded to ‘low’ based on the same factors.
Table 3.
Summary of manual therapy treatment and evidence certainty for upper cervical spine interventions and global manual therapy interventions compared to sham, placebo or control
| Number of the studies and population | Certainty of evidence |
|---|---|
| Upper cervical spine interventions vs. sham, placebo or control | |
| Outcome variable: Disability | |
| 3 RCTs (206 patients) | Very low, due to risk of bias, indirectness#, imprecision‡ |
| Outcome variable: Dizziness intensity | |
| 2 RCTs (126 patients) | Low, due to risk of bias, indirectness#, imprecision‡ |
| Outcome variable: Neck pain intensity | |
| 3 RCTs (206 patients) | Very low, due to risk of bias, indirectness#, imprecision‡ |
| Outcome variable: Neck disability | |
| 2 RCTs (119 patients) | Low, due to risk of bias, indirectness#, imprecision‡ |
| Global manual therapy interventions vs. sham, placebo or control | |
| Outcome variable: Disability | |
| 2 RCTs (33 patients) | Very low, due to risk of bias*, indirectness#,†, imprecision‡,∫ |
*two studies presented high risk of bias
#patient received uncontrolled treatment
†two studies included patients with nonspecific diagnosis
‡confidence intervals are wide
∫small sample size
Disability
The very low certainty of the evidence suggested that manual therapy applied at upper cervical spine showed a statistically significant change compared with a placebo or a control (MD = −7.30; 95%CI −11.34, −3.26; 3 studies, 206 patients) [2, 32, 36]. The very low certainty of the evidence (downgraded for risk of bias, inconsistency and imprecision) suggested that global intervention showed no statistically significant change compared with a placebo or control (MD = −5.37, 95%CI −21.31, 10.56; 2 studies, 33 patients) [6, 8] (Fig. 2).
Fig. 2.
A Forest plot of the impact of dizziness. B Forest plot of the intensity of dizziness. C Forest plot of the intensity of pain. D Forest plot of neck disability
Dizziness intensity
The low certainty of the evidence suggested that manual therapy applied to the upper cervical spine showed a statistically significant change compared with a placebo or control (MD = −19.34; 95%CI −26.81, −11.87; 2 studies, 126 patients) [2, 32]. (Fig. 2B).
Neck pain intensity
The very low certainty of the evidence suggested that manual therapy applied to the upper cervical spine provides no statistically significant change compared with a placebo or control (MD = −8.80; 95%CI −17,66, 0.05; 3 studies, 206 patients) [2, 34, 36] (Fig. 2C).
Neck disability
The low certainty of the evidence suggested that manual therapy applied to the upper cervical spine provides no statistically significant change compared with a placebo or control [33, 36] (MD = −2.01; 95%CI −4.50, 0.47; 2 studies, 119 patients) (Fig. 2D).
Discussion
Manual therapy has been a treatment modality proposed for CD. The aim of this study is to compare whether the manual therapy interventions were superior to sham or control or vice versa for the improvement of dizziness impact, dizziness intensity and neck pain intensity in patients with CD. According to the eligibility criteria six studies and three secondary analyses were included in the present systematic review and meta-analysis.
The impact and intensity of dizziness, neck disability, and neck pain intensity were meta-analyzed. The four outcome measures were meta-analyzed for interventions focused on the upper cervical spine [2, 32–34, 36]. The results showed a statistically significant effect in favor of manual therapy applied to the upper cervical spine, compared to sham or control interventions, in reducing the impact of dizziness and dizziness intensity. A meta-analysis comparing global intervention to sham for the dizziness impact could only be performed [6, 8], and the results did not achieve statistically significant differences.
The methodological assessment of the clinical trials reveals that neither participants nor therapists were blinded. Due to the nature of the interventions analyzed in this study, therapist blinding was not feasible. Although this limitation may introduce potential bias and affect the methodological quality of the study, it is important to note that therapist blinding is not commonly implemented in routine clinical practice [37]. The study by Fraix et al. [6] showed fair methodological quality, while the studies by Carrasco-Uribarren et al. [32–34], Kendall et al. [8], Micarelli et al. [36], and Reid et al. [2, 35] showed high methodological quality. The eligibility criteria of the PEDro scale did not influence the results of the methodological assessment, and although all studies explained the eligibility criteria, In the studies by Kendall et al. [8] and Fraix et al. [6], the assessment of an otoneurologist was not taken into account in the diagnosis of CD. There are numerous confounding factors that make the diagnosis of CD challenging. As a result, CD is currently diagnosed by exclusion, requiring careful evaluation to rule out central nervous system disorders and other peripheral causes of dizziness [14, 38]. The certainty of the evidence was downgrade.
Manual therapy interventions have been shown to be effective in improving symptoms associated with CD [16, 17]. Although the pathophysiology of CD is not fully understood, the high density of mechanoreceptors in the upper cervical spine, the role of this region in proprioceptive input, and its contribution to movement perception are well established [12, 14]. Manual therapy appears to produce immediate analgesic effects through neurophysiological mechanisms [39–41]. Given the high density of mechanoreceptors in the upper cervical spine, applying manual therapy interventions in this area may have a greater effect compared to more global techniques, as shown by the results of the present systematic review and meta-analysis. Previous studies have shown that combining localized cervical interventions with sensorimotor training—such as balance exercises, joint position error correction, and oculomotor training—can significantly improve cervical proprioception [42]. These exercises are similar to those used in vestibular rehabilitation for individuals with other types of peripheral dizziness and have been shown to yield positive results [43–45]. Therefore, combining both treatments— upper cervical spine manual therapy interventions, balance training exercises and joint position error exercises —could potentially offer greater benefits.
Neck pain intensity and neck disability showed no statistically significant differences between groups. Although patients with CD often report neck pain or stiffness, these symptoms are typically secondary, with dizziness being the primary and most disabling complaint [38]. In this population, baseline levels of neck pain and disability are generally low, which may limit the potential for detecting significant between-group differences in these variables. Furthermore, given that cervical-related symptoms may not be the main therapeutic target in interventions for CD, the limited change observed in these outcomes is consistent with the clinical presentation of the condition.
This systematic review has some limitations. Only six randomized controlled trials and three secondary analyses were included, leading to a small sample size. Furthermore, the sample size of the meta-analysis was smaller because not all studies could be included, and the analysis had to be divided into two separate subgroups. These factors may influence the results found. Finally, the search strategy was restricted by the exclusion of other databases, and studies published in languages other than English.
Conclusion
In conclusion, the local manual therapy has better results to improve the impact, and the intensity of dizziness compared with global manual therapy treatment. The level of evidence was downgraded to very low due to the biases found in the studies included. Given the results and current evidence, it would be advisable to future research combine vestibular rehabilitation with local manual therapy treatment to investigate if the combination of both could achieve results above the minimal clinical important difference.
Supplementary Information
Acknowledgements
Not applicable.
Abbreviations
- CD
Cervicogenic/cervical dizziness
- RCT
randomized controlled trials
- PRISMA
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- PEDro
Physiotherapy Evidence Database
- WOS
Web of Science
- MeSH
Medical subject headings
- PICOS
Population, Intervention, Comparison, Outcome, and Study Design
- SD
Standard Deviation
- CI
Confidence Interval
- MD
Mean Difference
- SNAG
Sustained Natural Apophyseal Glides
- PJM
Passive Join Mobilization
Authors’ contributions
A.C.-U.: Conceptualization, Methodology, Data curation, Formal analysis, Software, Writing– original draft, Writing– review & editing. L.C.-L.: Conceptualization, Methodology, Supervision, Writing– original draft, Writing– review & editing, Investigation. S.P.-G.: Conceptualization, Investigation, Supervision, Writing– original draft, Writing– review & editing. S.J.-d.B.: Data curation, Formal analysis, Investigation, Writing– original draft, Writing– review & editing. P.R.R.-R.: Data curation, Formal analysis, Software, Writing– original draft, Writing– review & editing. D.P.-H.: Data curation, Formal analysis, Software, Writing– original draft, Writing– review & editing. S.C.-B.: Conceptualization, Methodology, Supervision, Writing– original draft, Writing– review & editing, Investigation.
Funding
This research did not receive any specific funding.
Data availability
All data relevant to the study are included in the manuscript or uploaded as supplementary information.
Declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Note applicable. All authors have read and agreed to the published version of the manuscript.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Contributor Information
Andoni Carrasco-Uribarren, Email: acarrasco@uic.es.
Luis Ceballos-Laita, Email: luis.ceballos@uva.es.
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