Two trials were categorised as blinded but the comparison of interest (exercise vs control) was not concealed from patients, which is part of the blinding criterion (Jadad et al 1996). When this is corrected, the Jadad scale does little to discriminate the quality GDC 0199 of the included studies, with 13 of the 15 studies scoring 2 out of 5. A sensitivity analysis conducted with a more discriminatory tool would indicate whether the estimate of the
effect changes with study quality. Physiotherapists should advise haemodialysis patients of the benefits of exercise training and prescribe an aerobic and strengthening training regimen tailored to each patient’s fitness, strength, and comorbidities. One issue we must consider carefully when prescribing the regimen is that exercise in non-dialysis periods may improve cardiovascular outcomes more, but exercise during dialysis is associated with greater adherence (Bennett et al 2010). “
“The Dix-Hallpike Test (DHT) is considered the gold standard assessment for the diagnosis of the vestibular disorder Benign Paroxysmal
Positional Vertigo (BPPV). BPPV is described as a ‘spinning’ sensation caused by head buy HA-1077 movement that typically lasts for 15 seconds and may be accompanied by nausea. Individuals classically describe these symptoms when turning over in bed but they may also occur when bending down or looking up (Noda et al 2011). BPPV occurs when free-floating debris enters one of the semicircular canals causing the endolymph to become gravity sensitive resulting in abnormal displacement of the cupula and consequential neural firing (Brandt & Steddin 1993). BPPV may be associated with head injuries and various inner ear problems, however in many cases whatever the cause is idiopathic, occurring at any age but most commonly between 50 and 70 years (Hornibrook 2011). The DHT should be used following a subjective assessment to confirm a diagnosis of BPPV. The DHT (Dix & Hallpike
1952) consists of a series of head movements conducted in order to stimulate the movement of the debris in the posterior semicircular canal which is responsible for symptoms in 90% of cases (Stavros et al 2002). The test can be carried out by any healthcare professional with knowledge of the vestibular system. The patient starts in a sitting position and their head is turned 45° towards the side to be tested. The assessor then assists them to lie down quickly and extends their neck 20° over the end of the plinth, maintaining 45° rotation. The assessor should be able to see the patient’s eyes and should observe for nystagmus. A positive response is elicited if rotational nystagmus is noted. The nystagmus will have a delayed onset of approximately 1–2 seconds following movement and it should subside after 10–20 seconds (Furman & Cass 1999). The direction of nystagmus will reverse on returning to a seated position and it will fatigue on repeated testing.