A cross-sectional methodological study: evaluation of the examiner performance on the Dix-Hallpike test

Abstract

Purpose

The Dix-Hallpike test is recommended to diagnose Benign Paroxysmal Positional Vertigo (BPPV). This research aimed to quantify the movement of a healthy subject during the Dix-Hallpike test and determine what factors contribute to performance variation from the recommended head position with 20° cervical extension, 45° cervical rotation, and a brisk movement velocity.

Materials and methods

Examiners performed the Dix-Hallpike test 10 times. The examinee’s movement was recorded with Qualisys and processed with Visual3D. The proportion of variation in test performance within examiners, between examiners, and due to examiner position was calculated.

Results

Thirteen participants, 54% male and mean age 40, performed 50 cranial and 77 lateral Dix-Hallpike tests. Head position differed significantly from the recommendations with the cranial tests for extension (mean difference [MD] = 11.6°, p < 0.001) and rotation (MD = 4.8°, p < 0.001) and with lateral tests for extension (MD = 13.3°, p < 0.001). The largest proportion of variation was between examiners (60–91%), followed by within-examiners (3–16%). The examiner position contributed to 20% of the variation in the cervical rotation achieved. Tests lasted, on average, 1.80 s.

Conclusions

Differences within and between examiners visually estimating the Dix-Hallpike test endpoints may impede BPPV diagnosis accuracy.

Implications for Rehabilitation

• Vertigo diagnosis with the Dix-Hallpike may be improved by reducing inter-examiner differences with head positioning and velocity.

• With Dix-Hallpike testing, examiners should consider a cranial orientation relative to the examinee to better achieve the recommended head positioning.

• The cranial Dix-Hallpike and encouraging briskness as tolerated by the examinee should be emphasized with teaching the maneuver.

Keywords:

• Benign paroxysmal positional vertigo
• Dix-Hallpike
• vertigo
• performance parameters
• examiner position
• endpoint
• cervical extension

Acknowledgments

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Ethical approval

Ethics committee approval and informed consent are documented in the paper. The study was approved by The College of St. Scholastica Institutional Review Board (IRB protocol #: 1747289-1)

Disclosure statement

The authors report there are no competing interests to declare.

Data availability statement

The data that support the findings of this study are available from the corresponding author, [DL], upon reasonable request.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.