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Response to “Osteopathic manipulative techniques in the treatment of vestibular dizziness not related to the cervical spine”

  • Yasir Rehman EMAIL logo , Jonathon Kirsch and Karen T. Snider ORCID logo
Published/Copyright: March 20, 2023
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 123 Issue 5

To the Editor,

We read with interest the letter by Álvarez et al. [1], and we thank and appreciate them for the supportive feedback. Their feedback and comments were very cogent and insightful. However, there were a few issues on which we would like to share our thoughts.

Regarding the consensus on the definition of cervicogenic dizziness, we found inconsistent definitions within the reviewed articles. All studies that specifically defined cervicogenic dizziness as a form of vertigo caused by vascular impingement within the cervical spine were excluded from the study. We stated this in our published protocol as an exclusion criterion [2]. Consistent with our inclusion of neuro-otological disorders, studies that defined cervicogenic dizziness as an impaired or altered interaction between cervical proprioceptive input and vestibular function met our inclusion criteria.

In our published protocol [2], we stated that we would perform sensitivity analysis specific to the neuro-otological condition, provided that the intervention is reported in two or more studies. We did not have enough studies to perform sensitivity analysis based on the specific condition type and OMT. In our review, we critically appraised the published literature that explored the effectiveness of OMT in various neuro-otological disorders and reported them narratively, because we could not do the pooling for those disorders. We provided our conclusion based on the overall published literature and not only on the three pooled analyses. The quality of evidence in our pooled analysis was moderate [3]. According to the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria [4], with moderate quality evidence, further research is likely to impact confidence in the estimate of effect and may change the estimate.

We agree with Alvarez et al.’s feedback that OMT and analogous techniques should be part of a comprehensive therapeutic approach to neuro-otological disorders. As we performed a systematic review and meta-analysis, our focus was on providing evidence about the effectiveness of OMT and analogous techniques in the management of dizziness due to the neuro-otological causes. Recommendations about the treatment protocols are informed by the guidelines, which was beyond the scope of this review. Our study provided a moderate quality of evidence for the inclusion of OMT in the management of neuro-otological conditions. Future studies will be needed to define condition-specific recommendations.

Corresponding author: Yasir Rehman, MD, MSc, Health Research Methodology and Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada; and Medical Sciences for the Canadian Academy of Osteopathy, 66 Ottawa Street North, Hamilton, ON, L8H 3Z1, Canada, E-mail:

  1. Research funding: None reported.

  2. Author contributions: All authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; all authors drafted the article or revised it critically for important intellectual content; all authors gave final approval of the version of the article to be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  3. Competing interests: None reported.

References

1. Alvarez, G, Lucas, S, Roura, S. Osteopathic manipulative techniques in the treatment of vestibular dizziness not related to the cervical spine. J Osteopath Med 2023;123:273–6. https://doi.org/10.1515/jom-2022-0224.Search in Google Scholar PubMed

2. Rehman, Y, Kirsch, J, Bhatia, S, Johnston, R, Bingham, J, Senger, B, et al.. Impact of osteopathic manipulative techniques on the management of dizziness caused by neuro-otologic disorders: protocol for systematic review and meta-analysis. Int J Osteopath Med 2021;42:76–82. https://doi.org/10.1016/j.ijosm.2021.11.002.Search in Google Scholar

3. Rehman, Y, Kirsch, J, Wang, MY, Ferguson, H, Bingham, J, Senger, B, et al.. Impact of osteopathic manipulative techniques on the management of dizziness caused by neuro-otologic disorders: systematic review and meta-analysis. J Osteopath Med 2023;123:91–101. https://doi.org/10.1515/jom-2022-0119.Search in Google Scholar PubMed

4. Atkins, D, Best, D, Briss, PA, Eccles, M, Falck-Ytter, Y, Flottorp, S, et al.. Grading quality of evidence and strength of recommendations. BMJ 2004;328:1490. https://doi.org/10.1136/bmj.328.7454.1490.Search in Google Scholar PubMed PubMed Central

Received: 2023-01-09
Accepted: 2023-01-29
Published Online: 2023-03-20

© 2023 the author(s), published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.

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https://doi.org/10.1515/jom-2023-0010
Creative Commons
BY 4.0

Articles in the same Issue

  1. Frontmatter
  2. Behavioral Health
  3. Original Article
  4. Beyond burnout: a four-year survey of osteopathic medical student mental health and the implications for the development of wellness and mental health programs
  5. General
  6. Original Article
  7. The presence of person-centered language in orthopedic-related amputation research: a cross-sectional analysis
  8. Medical Education
  9. Original Article
  10. Establishing a baseline for multilingual capabilities of medical students at the Michigan State University College of Osteopathic Medicine
  11. Musculoskeletal Medicine and Pain
  12. Original Article
  13. Retrospective analysis of whole-body cryotherapy adverse effects in Division I collegiate athletes
  14. Neuromusculoskeletal Medicine (OMT)
  15. Original Article
  16. Osteopathic manipulative treatment of patients with chronic low back pain in the United States: a retrospective cohort study
  17. Public Health and Primary Care
  18. Clinical Practice
  19. Anatomy-based approach to the thyroid examination
  20. Letters to the Editor
  21. Osteopathic manipulative techniques in the treatment of vestibular dizziness not related to the cervical spine
  22. Response to “Osteopathic manipulative techniques in the treatment of vestibular dizziness not related to the cervical spine”
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