title: Are there diurnal variations in the results of the Dix-Hallpike manoeuvre?
abstract: This study examines diurnal variation in the result of the Dix-Hallpike manoeuvre when testing for benign paroxysmal positional vertigo in a randomised crossover study of the order of diagnostic testing in a community out-reach clinic for a tertiary neurological centre in Wellington, New Zealand. Study participants were adults referred for physiotherapy treatment. Dix-Hallpike manoeuvres were performed to both ears, and groups were randomly allocated to have a morning, then afternoon, sequence of testing or vice versa. The results of the Dix-Hallpike manoeuvres were digitally recorded and reviewed by a second blinded assessor. A total of 27 of 50 participants (54%) tested positive on at least one of the days, six of 27 (22%) had discordant results. The difference in marginal proportions was 0% (95% confidence interval: -9.6 to 9.6), p=1.0. The time of day is not a factor in false negative Dix-Hallpike manoeuvres, although 22% of those with positive results tested negative on one of the two measurements.
authors.affiliation: Capital and Coast Health District Health Board, Wellington Hospital, Newtown, Wellington, New Zealand.
authors.forename: Anne
authors.initials: A
authors.lastname: Burston
authors.forename: Stuart
authors.initials: S
authors.lastname: Mossman
authors.forename: Mark
authors.initials: M
authors.lastname: Weatherall
mesh_terms: D000368:Aged; D065635:Benign Paroxysmal Positional Vertigo; D002940:Circadian Rhythm / Q000502:physiology*; D018592:Cross-Over Studies; D003627:Data Interpretation, Statistical; D004244:Dizziness / Q000175:diagnosis; D004311:Double-Blind Method; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods*; D015203:Reproducibility of Results; D016896:Treatment Outcome; D014717:Vertigo / Q000175:diagnosis*