OBJECTIVE: This study aimed to assess the outcomes of 2 treatments for patients with dizziness after mild traumatic brain injury (mTBI) who demonstrate abnormal cervical spine proprioception (CSP).
METHODS: A retrospective records review was conducted on the medical charts of patients treated for dizziness after mTBI who received either standard care (vestibular rehabilitation therapy [VRT]) or cervical spine proprioceptive retraining (CSPR) from 2009 to 2013. All patients included in the analysis were active-duty military with recurring dizziness after mTBI who had at least 1 abnormal CSP test. Patients were excluded for dizziness with a clear peripheral vestibular or central symptom origin, incomplete data, or no CSP assessment, or if both treatments were administered. Forty-eight total patients were included in the final dataset (22 VRT; 26 CSPR). Traditional VRT was compared with CSPR when abnormal CSP tests were present, regardless of the presence or absence of neck pain. A clinician review of records was used to determine improvement of dizziness based on patient reports of symptoms at discharge evaluation (ie, no symptoms for at least 2 weeks).
RESULTS: Patients who received CSPR were 30 times more likely to report improvement in dizziness symptoms compared with those who received VRT (adjusted odds ratio: 30.12; 95% confidence interval 4.44-204.26, P < .001) when abnormal CSP tests were present. Patients with dizziness over 1 year were significantly less likely to improve.
CONCLUSION: These results suggest that patients with dizziness after mTBI and who had abnormal CSP assessments responded better to CSPR compared with those who received VRT.
Author keywords: Dizziness, Brain Concussion, Neck Pain, Cervicalgia, Vertigo, Postural Balance, Kinesthesis
Author affiliations: MH: Brooke Army Medical Center, Fort Sam Houston, Texas. AAS: South Texas Veterans Health Care System, Audie L. Murphy VA Hospital, San Antonio, Texas. JTN: Department of Defense Hearing Center of Excellence, JBSA Lackland, San Antonio, Texas. JMT: CCRE Spine, Division of Physiotherapy, SHRS, University of Queensland, Queensland, Australia
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