Effectiveness of trigger point dry needling for multiple body regions: a systematic review

Background

Trigger point dry needling (TDN) is commonly used to treat musculoskeletal pain related to myofascial trigger points (MTrPs). To date, no systematic review of high-quality randomised controlled trials (RCTs) investigating TDN to multiple body regions exists.

Purpose

The aim of this review is to determine the effectiveness of TDN based on high-quality RCTs for all body regions.

Methods

To ensure thorough reporting, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed as the methodological basis for this systematic review. PubMed, Physiotherapy Evidence Database (PEDro), Cinahl, Cochrane and reference lists were searched for the years 2000–2014 and the terms ‘TDN’, ‘dry needling NOT trigger point’, ‘functional dry needling’ and ‘intramuscular manual therapy’. Inclusion criteria: RCTs with PEDro scores 6–10 investigating TDN. Exclusion criteria: duplicates, non-human participants, non-English language, exclusive focus on acupuncture or medicinal injections. Three investigators searched databases, applied criteria, read and assigned PEDro scores to every RCT. Nineteen studies met the criteria. As compared to either baseline or control groups, significant differences were found for pain (14 studies), range of motion (ROM) (five studies) and at least one item on function and quality of life measures (six studies).

Limitations

This review was limited by inclusion criteria, timeframe, language and databases searched.

Conclusion

The majority of high-quality studies included in this review show measured benefit from TDN for MTrPs in multiple body areas, suggesting broad applicability of TDN treatment for multiple muscle groups. Further high-quality research is warranted to standardise TDN methods to determine clinical applicability.     

Dry needling: a literature review with implications for clinical practice guidelines

Background:

Wet needling uses hollow-bore needles to deliver corticosteroids, anesthetics, sclerosants, botulinum toxins, or other agents. In contrast, dry needling requires the insertion of thin monofilament needles, as used in the practice of acupuncture, without the use of injectate into muscles, ligaments, tendons, subcutaneous fascia, and scar tissue. Dry needles may also be inserted in the vicinity of peripheral nerves and/or neurovascular bundles in order to manage a variety of neuromusculoskeletal pain syndromes. Nevertheless, some position statements by several US State Boards of Physical Therapy have narrowly defined dry needling as an ‘intramuscular’ procedure involving the isolated treatment of ‘myofascial trigger points’ (MTrPs).

Objectives:

To operationalize an appropriate definition for dry needling based on the existing literature and to further investigate the optimal frequency, duration, and intensity of dry needling for both spinal and extremity neuromusculoskeletal conditions.

Major findings:

According to recent findings in the literature, the needle tip touches, taps, or pricks tiny nerve endings or neural tissue (i.e. ‘sensitive loci’ or ‘nociceptors’) when it is inserted into a MTrP. To date, there is a paucity of high-quality evidence to underpin the use of direct dry needling into MTrPs for the purpose of short and long-term pain and disability reduction in patients with musculoskeletal pain syndromes. Furthermore, there is a lack of robust evidence validating the clinical diagnostic criteria for trigger point identification or diagnosis. High-quality studies have also demonstrated that manual examination for the identification and localization of a trigger point is neither valid nor reliable between-examiners.

Conclusions:

Several studies have demonstrated immediate or short-term improvements in pain and/or disability by targeting trigger points (TrPs) using in-and-out techniques such as ‘pistoning’ or ‘sparrow pecking’; however, to date, no high-quality, long-term trials supporting in-and-out needling techniques at exclusively muscular TrPs exist, and the practice should therefore be questioned. The insertion of dry needles into asymptomatic body areas proximal and/or distal to the primary source of pain is supported by the myofascial pain syndrome literature. Physical therapists should not ignore the findings of the Western or biomedical ‘acupuncture’ literature that have used the very same ‘dry needles’ to treat patients with a variety of neuromusculoskeletal conditions in numerous, large scale randomized controlled trials. Although the optimal frequency, duration, and intensity of dry needling has yet to be determined for many neuromusculoskeletal conditions, the vast majority of dry needling randomized controlled trials have manually stimulated the needles and left them in situ for between 10 and 30 minute durations. Position statements and clinical practice guidelines for dry needling should be based on the best available literature, not a single paradigm or school of thought; therefore, physical therapy associations and state boards of physical therapy should consider broadening the definition of dry needling to encompass the stimulation of neural, muscular, and connective tissues, not just ‘TrPs’.     

The effect of whole body vibration on older people: a systematic review

Abstract

Background: The use of whole body vibration (WBV) platforms by older individuals is increasing, although the effects on this group have still to clearly be established.

Objectives: The purpose of this study was to review the effects of WBV on older individuals.

Methods: In September 2010, a systematic review was performed using ISI Web of Science, PubMed, EMBASE, CINHAL, PEDro, and the Cochrane library with the search terms ‘whole body vibration’ in combination with either ‘older’, ‘elderly’, ‘aged’, ‘post menopause’ or ‘post menopausal’. All studies in which chronic, i.e. multiple sessions over weeks or months, WBV was performed in people over 50 years with no known musculoskeletal disorders other than osteoporosis were included.

Results: Twenty-eight articles were identified and were rated for methodological quality and the vibration protocol independently by two authors. A number of moderate-high quality studies reported improvements in lower limb strength, power, balance, functional mobility, and bone strength. In many studies investigating strength, power and bone strength, the design was not robust enough to allow the effects of WBV to be separated from additional exercises being performed simultaneously, and the effects of WBV are unclear.

Conclusions: There is some evidence of improvements in balance and functional mobility after WBV in this population. Further rigorous research is required to determine, if these effects are due to WBV or additional exercises performed.     

Barriers to Compliance With Evidence-Based Clinical Practice Guidelines

Abstract

Study design: Systematic literature review and meta-analysis.

Objective: In symptomatic subjects to: (1) examine the effects of a single session of joint mobilization on pain at rest and with most painful movement, and (2) compare the effects when joint mobilization is provided to a specific or non-specific spinal level.

Background: Joint mobilization is routinely used for treating spinal pain in conjunction with other interventions, but its unique effect is not well understood. Further, there is controversy about the role of ‘specific level’ techniques in producing benefit.

Methods: Searches were performed for randomized controlled trials (RCTs) using electronic databases (MEDLINE, CINAHL, and PEDro) from 1966 through November 2010. Methodological quality was assessed using previously detailed criteria. Meta-analysis and meta-regression were conducted on eligible studies.

Results: Eight RCTs with a mean methodological score of 10/12 were included. Significant heterogeneity (P?=?0·075) was found in the overall meta-analysis estimate. When stratified by body location, no significant individual effect was found for pain at rest. However, there was a statistical mean difference [0·71 (95% confidence interval: 0·13–1·28)] between pain at rest for the cervical and lumbar individual means.

Conclusions: We found multiple studies which provided evidence that a single session of joint mobilization can lead to a reduction of pain at rest and with most painful movement. When using joint mobilization, the need for specific versus non-specific level mobilization may be influenced by anatomical region; the direction of effect in the cervical spine was toward specific mobilization and in the lumbar spine towards non-specific mobilization.     

Evidence for Dry Needling in the Management of Myofascial Trigger Points Associated With Low Back Pain: A Systematic Review and Meta-Analysis

Objective

To evaluate the current evidence of the effectiveness of dry needling of myofascial trigger points (MTrPs) associated with low back pain (LBP).

A systematic review of manual therapy techniques,dry cupping and dry needling in the reduction of myofascial pain and myofascial trigger points

IntroductionMyofascial pain with myofascial triggers are common musculoskeletal complaints. Popular treatments include manual therapy, dry needling, and dry cupping. The purpose of this systematic review was to compare the efficacy of each treatment in the short-term relief of myofascial pain and myofascial trigger points.MethodsSearch engines included Google Scholar, EBSCO Host, and PubMed. Searches were performed for each modality using the keywords myofascial pain syndrome and myofascial trigger points. The inclusion criteria included English-language, peer-reviewed journals; a diagnosis of myofascial pain syndrome or trigger points; manual therapy, dry needling, or dry cupping treatments; retrospective studies or prospective methodology; and inclusion of outcome measures.ResultsEight studies on manual therapy, twenty-three studies on dry needling, and two studies on dry cupping met the inclusion criteria. The Physiotherapy Evidence Database (PEDro) was utilized to assess the quality of all articles.DiscussionWhile there was a moderate number of randomized controlled trials supporting the use of manual therapy, the evidence for dry needling ranged from very low to moderate compared to control groups, sham interventions, or other treatments and there was a paucity of data on dry cupping. Limitations included unclear methodologies, high risk for bias, inadequate blinding, no control group, and small sample sizes.ConclusionWhile there is moderate evidence for manual therapy in myofascial pain treatment, the evidence for dry needling and cupping is not greater than placebo. Future studies should address the limitations of small sample sizes, unclear methodologies, poor blinding, and lack of control groups.     

Low reproducibility of randomized clinical trials methodology related to sampling: a systematic methodological review

Objectives: The reporting of sampling methods in Randomized Clinical Trials (RCTs) allows for research quality assessment, determination of sampling bias, and assures the presence of details necessary for reproducibility in future trials. The purpose of this study was to: (1) determine if sampling methodology was reproducible in RCTs related to musculoskeletal physical therapy (MSKPT) interventions to treat non-specific low back pain (NSLBP) and (2) establish if there was a relationship between sample reproducibility and established measures of research quality.

Methods: Data were collected through a systematic review by a professional librarian. The identified RCTs were assessed for methodological quality by two blinded individual reviewers. Data analysis was performed by a third, blinded researcher; additional comparisons were made based on Journal Impact Factor and PEDro score.

Results: Ninety-nine published peer-reviewed RCTs were identified that met inclusion criteria. Only 29% of the articles were judged to be reproducible based on the reported sampling methodology. There were meaningful correlations between two out of ten of the sampling reporting criteria and the judgement made if the sample was reported in significant detail to allow for replication. There was no relationship between sampling reporting criteria, Journal Impact Factors (JIFs), and Physiotherapy Evidence Database (PEDro) scores.

Discussion: The reporting of sampling methodology needs to be considered to ensure reproducibility and avoid sampling bias. Despite the proliferation of measures of research quality, the overall reporting quality of RCTs continues to be inadequate to allow widespread reproducibility of trials.

Level of Evidence: 1a     

The effect of whole body vibration in common neurological conditions – a systematic review

Abstract

Background: Whole body vibration (WBV) is a new therapeutic tool used to improve muscle strength, power and postural control in various healthy and pathological populations.

Aim: The aim of this systematic review was to summarise and evaluate the available literature on the effectiveness of WBV in neurological conditions.

Method: A systematic review of the literature was performed to identify randomised controlled trials (RCTs) examining the effect of WBV on common neurological conditions. The methodological quality of the studies was systematically assessed using the PEDro rating scale. Reported outcomes were assessed for differences between the experimental and control groups and effect sizes were calculated.

Results: Five RCTs and two pseudo RCTs were included. Methodological scores ranged from 1 to 9 (maximum 11) with a mean score of 5˙71 (SD 2˙69). There is weak to moderate evidence for positive effects on postural control, mobility, motor function and strength following the single application of WBV in neurological populations. A paucity of available literature into repeated WBV training prevents the drawing of firm conclusions regarding long-term treatment effectiveness.

Conclusion: Despite being a new technique, there is early evidence that WBV applied to neurological populations has positive effects on postural control, mobility, motor function and strength. Further studies into the effectiveness of WBV in neurological populations are warranted.     

Systematic reviews and meta-analyses for more profitable strategies in peripheral artery disease

Abstract

Clearly defined processes exist for developing evidence-based guidelines in clinical medicine. Approaches such as the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) where recommendations are made on the basis of quality of evidence gathered in a systematic literature review are also appropriate for recommendations relating to nutritional management of disease. Strong recommendations are based on high-quality evidence derived from randomized controlled trials (RCTs). In nutritional studies, RCTs often examine risk factors and occasionally other surrogates of disease rather than clinical end-points. Criteria are suggested as to when such surrogates may be used. GRADE and similar approaches are less appropriate when considering recommendations regarding chronic disease prevention. Cancer develops over many years, and RCTs exploring nutritional measures to reduce risk are inappropriate. The World Cancer Research Fund (WCRF) has developed an approach in which recommendations are based on clearly defined ‘convincing’ or ‘probable’ relationships between nutritional variables and disease outcomes.

The WCRF criteria have been adapted for developing a wide range of policy recommendations which provide opportunities for those responsible for implementing policy to select options best suited to their purpose. Recommendations related to nutrition policy tend to evolve as a delicate balance between political wisdom and judgement of the scientific evidence. However, policy recommendations are important since they have the potential to create environments which are conducive to the behavioural changes required for improved nutrition.     

The effectiveness of low-level laser therapy on pain,self-reported hand function,and grip strength compared to placebo or “sham” treatment for adults with carpal tunnel syndrome: A systematic review

Background: Carpal tunnel syndrome (CTS) is one of the most common peripheral neuropathies in the upper extremity. Objective: The aim of this review was to systematically and critically appraise the available literature for the effectiveness of Low-Level Laser Therapy (LLLT) on pain, self-reported hand function, and grip strength compared to placebo treatment in adults with CTS. Methodology: Seven databases were searched from 2000 to March 2015 namely: Cinahl, Cochrane Library, EBSCOhost, PEDro, PubMed, Science Direct, and Scopus. Key search terms were: CTS, LLLT, and physiotherapy. Specific inclusion and exclusion criteria were applied. The methodological quality was appraised with the PEDro scale. Data were extracted and captured on an Excel spreadsheet. Results: The nine included randomized control trials (RCTs) had an average score of 8.2/11 according to the PEDro scale. The heterogeneity of the LLLT regimes used made statistical pooling inappropriate for this review and results were described narratively. Conclusion: No strong evidence exists concerning the effects of LLLT on CTS in adults. Studies that used 780–860 nm Lasers and energy dosages of 9–11 J/cm² or 10.8 J reported a more favorable outcome for pain, symptom severity, and functional ability as well as grip strength at the end of treatment and short-term follow up.     

Spinal manipulative therapy for low back pain: A systematic review

Abstract

Objectives: Gather and analyse relevant literature on spinal manipulative therapy for low back pain through systematic review to present a balanced and impartial summary of the findings. The aim of this systematic review was to investigate the efficacy of spinal manipulative therapy in patients with low back pain.

Methods: Databases searched included COCHRANE, MEDLINE, EMBASE, PEDro, PUBMED, WEB OF KNOWLEDGE, INGENTA CONNECT and GOOGLE SCHOLAR between January 2000 and January 2008. Sixteen articles were retrieved. Standardised inclusion and exclusion criteria were applied to select articles relevant to the review question. Seven studies were excluded and nine studies were included. In the next step, the methodological quality of the included studies was assessed with the PEDro scale, which rated the studies from 0 to 10.

Results: Methodological quality scores ranged from 4 to 8 out of a possible 10. Spinal manipulative therapy can be preferred for short-term relief of low back pain when compared with general exercise and dynamic strengthening exercises, which is revealed by a high quality study, moderate quality studies and a low quality study. Spinal manipulative therapy combined with exercise is more effective than exercise alone, which is revealed by a high quality study.

Conclusions: Further studies are needed to improve the quality of the evidence. There is evidence that spinal manipulative therapy combined with exercise is more effective than other procedures like spinal manipulative therapy, exercise or physician consultation alone.     

Liquid biopsy in germ cell tumors: biology and clinical management

ABSTRACT

Introduction: Liquid biopsy is an increasingly studied approach for optimal and minimally invasive diagnostics of malignant tumors. The aim of this review is to provide evidence and discuss the utility of liquid biopsy in the management of germ cell tumors (GCTs).

Areas covered: Herein, we summarize the evidence on liquid biopsy in GCTs including serum tumor markers, circulating tumor cells, microRNA and cell-free DNA. The search of literature was conducted from Pubmed/Medline, ASCO-meeting library searching for terms ‘liquid biopsy’, ‘germ cell tumors’, ‘circulating tumor cells’, ‘microRNA’, ‘cell-free DNA’. Obtained original studies were included. Reference lists of review articles and key original articles were searched for additional original studies. We included articles published between1990 and 2019.

Expert opinion: Liquid biopsy is a minimally invasive tool using body fluids for diagnostic purposes in cancer. The established value of serum tumor markers may be already considered a liquid biopsy technique in diagnosis of GCTs. Possible near-future refinements in diagnosis of GCTs are emerging. Further information on diagnosis, prognosis and resistance is added with recently described microRNAs, circulating tumor cells and cell-free DNA. While great promise is shown, further large-scale validation is needed to incorporate these novel liquid biopsies into clinical practice.     

DRY NEEDLING IN SUBJECTS WITH MUSCULAR TRIGGER POINTS IN THE LOWER QUARTER: A SYSTEMATIC REVIEW

Background

Trigger points, which have been defined as highly localized, hyperirritable locations in a palpable taut band of skeletal muscle fibers, have been identified with a variety of musculoskeletal conditions. The incidence of trigger point pain is high, with studies showing them as the primary source of pain in 30-85% of patients presenting in a primary care setting or pain clinic. Dry needling has emerged as a possible intervention for trigger points, but its effectiveness has not yet fully been determined.

Purpose

To assess and provide a summary on the current literature for the use of dry needling as an intervention for lower quarter trigger points in patients with various orthopedic conditions.

Study Design

Systematic review

Methods

CINAHL, NCBI-PubMed, PEDro, SPORTDiscus, Cochrane Library, and APTA''s PTNow were searched to identify relevant randomized controlled trials. Six studies meeting the inclusion criteria were analyzed using the PEDro scale.

Results

Four of the studies assessed by the PEDro scale were deemed ‘high’ quality and two were ‘fair’ quality. Each of the six included studies reported statistically significant improvements with dry needling for the reduction of pain intensity in the short-term. Only one study reported a statistically significant improvement in short-term functional outcomes; however, there was no maintenance of improved function at long-term follow-up. Furthermore, none of the studies reported statistically significant changes regarding the effect of dry needling on quality of life, depression, range of motion, or strength.

Conclusion

A review of current literature suggests that dry needling is effective in reducing pain associated with lower quarter trigger points in the short-term. However, the findings suggest that dry needling does not have a positive effect on function, quality of life, depression, range of motion, or strength. Further high quality research with long-term follow-up investigating the effect of dry needling in comparison to and in conjunction with other interventions is needed to determine the optimal use of dry needling in treating patients with lower quarter trigger points.

Levels of Evidence

1     

Physiological rationales of physical therapy interventions in the management of primary dysmenorrhea: a critical review

Abstract

Background:

The mechanisms underlying the physical therapy interventions for obtaining relief from primary dysmenorrhea (PD) symptoms are not fully understood.

Objective:

To provide an overview of the physiological rationales from randomized controlled trials (RCTs) on how physical therapy interventions in the management of PD might work.

Methods:

Databases CINAHL, PEDro, Embase, Web of Science, Ovid Medline, and AMED were searched from database inception to October 2014 using related terms for dysmenorrhea and physical therapy interventions. Trials were independently selected and data extracted by two reviewers.

Results:

The search yielded 287 citations; 26 RCTs met the inclusion criteria and were included for review. Among the 26 included trials, eight trials on acupressure, seven on acupuncture, and five on TENS, two on spinal manipulation, one on low-level light therapy (LLLT), one on heat, one on far-infrared ray, and one on yoga were identified. The predominant physiological rationales identified in the RCTs are endogenous opioid mechanisms (n?=?12), gate-control theory (n?=?8), and traditional Chinese medicine (TCM) theory (n?=?6). A few trials reported up to four different rationales.

Conclusions:

The analgesic effect of acupuncture is primarily through the release of endogenous opioids and hormones. In addition, practitioners of TCM believe that acupuncture alleviates pain of PD by regulating the prostaglandin levels. Acupressure, heat, high frequency transcutaneous electrical nerve stimulation (TENS), and yoga are proposed to work by segmental inhibition of pain pathway.     

Effectiveness of dry needling techniques in patients with knee osteoarthritis: A systematic review and meta-analysis

BackgroundDry needling has been found to be effective in various myofascial pain syndromes and musculoskeletal conditions. However, there is a need to evaluate the effects of dry needling techniques in patients with knee osteoarthritis. Hence, the objective of this systematic review was to identify and critically review the evidence on the short-term and long-term effects of dry needling techniques in patients with knee osteoarthritis.MethodsDatabases such as Pubmed, Cochrane library, and Scopus were searched from their inception to July 2019 for randomized controlled trials using dry needling as an active intervention against control/sham/placebo treatment in patients with knee osteoarthritis. The quality of the selected studies was analyzed using Cochrane tool for assessment of risk of bias.ResultsOut of 247 studies, 9 studies were included in the review. The qualitative synthesis for myofascial trigger point dry needling showed contradictory results. The mean difference for periosteal stimulation was significant on pain and function immediately post-treatment (p < 0.00001). The mean difference for intramuscular electrical stimulation on pain was significant (p = 0.03), but marked heterogeneity was found among the studies.ConclusionGood quality studies on myofascial trigger point needling and intramuscular electrical stimulation are required to evaluate their effects in patients with knee osteoarthritis. The review demonstrates a moderate-quality evidence on the short-term effect of periosteal stimulation technique on pain and function in knee osteoarthritis. Future studies comparing the effects of various techniques of dry needling with different dosages and long-term follow up need to be conducted.     

Evidence for single-limb exercises on exercise capacity,quality of life,and dyspnea in patients with chronic obstructive pulmonary disease or chronic heart failure

Abstract

Background: Although single-limb exercise (SLE) has been used for patients with chronic obstructive pulmonary disease (COPD) and for patients with chronic heart failure (CHF), the evidence for SLE has not been evaluated systematically and remains unclear.

Objectives: Determine the evidence for the effect of SLE compared to any comparator on outcome measurements for exercise capacity, quality of life (QoL) or dyspnea in patients with COPD or CHF.

Methods: PubMed, PEDro, and CENTRAL databases were searched from inception until 31 May 2011. Searches started 1 April 2011. English language randomized controlled trials (RCTs) were included. Extraction of data was performed by two review authors. Data and evidence for SLE were summarized in accordance with grading of recommendations assessment, development and evaluation (GRADE) guidelines. Authors of included studies were contacted for missing data.

Results: Six RCTs (two COPD and four CHF) were included. Low to very low-quality evidence indicates that SLE significantly improved exercise capacity, but not dyspnea, in patients with COPD, and significantly improved exercise capacity outcomes compared to a control in patients with CHF. However, when SLE was compared to non-SLE regimes in patients with CHF, positive effects were found irrespective of training regime regarding exercise capacity and QoL.

Conclusions: SLE appears to be effective in both conditions especially regarding exercise capacity, and might be included in exercise programs in patients with COPD or CHF. However, the evidence is low to very low according to GRADE and more clinical studies of high quality are required.     

Does preoperative physiotherapy improve postoperative,patient-based outcomes in older adults who have undergone total knee arthroplasty? A systematic review

Background: Knee osteoarthritis (OA) is a leading cause of disability in older adults (≥60) in the UK. If nonsurgical management fails and if OA severity becomes too great, knee arthroplasty is a preferred treatment choice. Preoperative physiotherapy is often offered as part of rehabilitation to improve postoperative patient-based outcomes. Objectives: Systematically review whether preoperative physiotherapy improves postoperative, patient-based outcomes in older adults who have undergone total knee arthroplasty (TKA) and compare study interventions to best-practice guidelines. Method: A literature search of Randomized Controlled Trials (RCTs), published April 2004–April 2014, was performed across six databases. Individual studies were evaluated for quality using the PEDro Scale. Results: Ten RCTs met the full inclusion/exclusion criteria. RCTs compared control groups versus: preoperative exercise (n = 5); combined exercise and education (n = 2); combined exercise and acupuncture (n = 1); neuromuscular electrical stimulation (NMES; n = 1); and acupuncture versus exercise (n = 1). RCTs recorded many patient-based outcomes including knee strength, ambulation, and pain. Minimal evidence is presented that preoperative physiotherapy is more effective than no physiotherapy or usual care. PEDro Scale and critical appraisal highlighted substantial methodological quality issues within the RCTs. Conclusion: There is insufficient quality evidence to support the efficacy of preoperative physiotherapy in older adults who undergo total knee arthroplasty.     

Effectiveness of vestibular rehabilitation on concussion-induced vertigo: a systematic review

Background: Approximately 5% of all Americans have experienced a concussion sometime during their lifetime. The predominant symptoms associated with a concussion are physical issues, cognitive issues, emotional issues, and sleep disturbances; and one of the most common physical issues is vertigo.

Objectives: The purpose of this systematic review was to investigate the effectiveness of vestibular rehabilitation on concussion-induced vertigo.

Methods: Those databases that were utilized for search terms included CINAHL Complete, Proquest Medical Library, and PubMed. Each of these databases was examined from inception through the end of 2017. The search terms were ‘concussion’ OR ‘brain injury’ OR ‘head injury’ AND ‘vestibular rehabilitation’ OR ‘vestibular therapy’ AND ‘vertigo’ OR ‘dizziness’. The Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence system was used to assess the evidence level of each included study, and methodological rigor was assessed utilizing criteria set forth in a systematic review by Medlicott and Harris.

Results: Seven articles met the inclusion criteria and were included in the qualitative synthesis. Six of the seven studies had an evidence level of less than two, and four of the seven studies had weak methodological rigor. Despite these limitations, this systematic review demonstrated that vestibular rehabilitation is generally an effective intervention for individuals with concussion-induced vertigo, even in the presence of visual disorders.

Conclusions: Vestibular rehabilitation should be considered as a component of the plan of care for individuals who experience vertigo following a concussion.