Validation of the Cervical Torsion Test and Head-Neck Differentiation Test in Patients With Peripheral Vestibular Hypofunction.
Andrea Nüesch, Julia Treleaven, Markus J Ernst
PMID 38590288WHAT IT FOUND
The Head-Neck Differentiation Test en bloc provoked symptoms in 78.9% of 19 patients with vestibular hypofunction, and none of 19 controls.
It distinguished patients from controls in this small study, but it cannot identify the affected side.
Key findings
01The dynamic Head-Neck Differentiation Test en bloc provoked dizziness symptoms in 78.9% of patients with vestibular hypofunction and none of the healthy controls. In that test, the odds of symptom provocation in a patient were 21.21 times higher than in a control.
02In patients with vestibular hypofunction, higher Neck Disability Index scores were associated with more positive Cervical Torsion Tests and Head-Neck Differentiation Tests. For every additional point on the Neck Disability Index, the odds of a positive Cervical Torsion Test in torsion were 1.33 times higher, and the number of symptoms during that test were 1.13 times higher.
03The Cervical Torsion Test and Head-Neck Differentiation Test cannot identify the side of a peripheral vestibular lesion because eye movements were not observed.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 19 patients with vestibular hypofunction and 19 controls were studied, and the authors reported wide confidence intervals, so the accuracy estimates are uncertain. The design created an artificial 50% prevalence of vestibular hypofunction, which does not match the likely prevalence in people with dizziness seen in clinic. Patients with head or neck trauma and people over 65 years were excluded, so the results may not apply to those groups. Neck problems were assessed only with the Neck Disability Index, not with objective cervical range of motion or motor control tests. The examiner knew the diagnosis, and test positivity depended on patient-reported symptoms, which can affect interpretation. The tests and coding chart were not tested for reliability or validity in patients with vestibular hypofunction. The study did not include patients with dizziness and neck pain but no vestibular hypofunction, so it cannot confirm that a positive torsion test means cervical dizziness.
Declared interests
The paper states that funders played no role in the design, conduct, or reporting of the study. No other conflict-of-interest statement is provided in the supplied text.
The easy way to misread this
Do not conclude that a positive torsion test proves cervical dizziness. This study compared patients with known vestibular hypofunction to healthy controls, not patients with dizziness and neck pain but normal vestibular function, so it cannot separate neck-related dizziness from vestibular symptoms.