The effects of physiotherapy on neck pain with associated symptoms, ıncludıng cervicogenic dizziness and tinnitus: a systematic review

To systematically review the effectiveness of physiotherapy in people with neck pain and concurrent cervicogenic dizziness and/or tinnitus. Database searches were performed in PubMed, Embase, Web of Science, and PEDro (Physiotherapy Evidence Database). The primary outcome was pain-related factors and secondary outcomes were self-reported measures of dizziness-, tinnitus- and psychological-related factors, and objective functional status in the short(< 3 months)-, intermediate(≥ 3 to < 12 months), and long-term(≥ 12 months). The population of interest was people with neck pain and concurrent cervicogenic dizziness and/or tinnitus. The literature search was conducted in December 2022, with an update in June 2024. Risk of bias was assessed using the revised Cochrane Risk of Bias Tool for randomized controlled trials, and the strength of the conclusion was assessed using the evidence-based guideline development (EBRO) approach. A narrative approach was conducted to synthesize the data. Thirteen studies (n = 785 patients) were analyzed, of which 10 were at high risk of bias, one raised some concers, and two were at low risk of bias. In the short-term, mulligan mobilization provided a higher improvement in CROM but showed no differences in balance with moderate evidence, and pain intensity and self-perceived handicap imposed by dizzines with conflicting evidence when compared to placebo treatment. Limited or no evidence was found for remaining pain-, dizziness, tinnitus- and psychological-related factors, and objective functional status after physiotherapy compared to wait-list or placebo treatment, and between different forms of physiotherapy. The analysis of the literature revealed that most studies (10 studies; 77%) have overall poor methodologic quality and are at high risk of bias. Findings suggest that mulligan mobilization is more beneficial for CROM, but has similar effects on balance in the short term compared to placebo treatment. Further research would be needed to establish firm conclusions for intermediate- and longer‐term efficacy of physiotherapy, as well as its effect on pain-, tinnitus- and psychological-related factors, and objective functional status. PROSPERO Registration Number: CRD42023394443.