Agreement Between Physical Therapists in Diagnosing Benign Paroxysmal Positional Vertigo

Area of Science:

• Vestibular Rehabilitation
• Neurology
• Physical Therapy Diagnostics

Background:

• Benign paroxysmal positional vertigo (BPPV) is a common condition managed by physical therapists.
• Limited data exists on the diagnostic reliability of physical therapists for BPPV.

Purpose of the Study:

• To assess the inter-rater reliability among physical therapists in identifying nystagmus and diagnosing BPPV.

Main Methods:

• Thirty-eight patients with positional vertigo underwent standardized positioning tests (supine-to-sit, supine roll, Dix-Hallpike).
• Eye movements were recorded using video goggles.
• Three therapists from two specialized clinics independently reviewed videos, documented nystagmus, and diagnosed BPPV.
• Kappa statistics were used to measure agreement between therapists.

Main Results:

• Therapists demonstrated substantial to almost perfect agreement in identifying nystagmus (κ = 0.57–1).
• High agreement was observed in diagnosing BPPV, including side, canal, and mechanism (κ = 0.81–1).
• Agreement in diagnosis was achieved even with occasional disagreements in nystagmus characteristics.

Conclusions:

• Experienced physical therapists exhibit strong agreement in diagnosing common forms of BPPV.
• Reliability in diagnosing BPPV supports its management within physical therapy settings.
• Further research may be needed for atypical or central nystagmus presentations.