Agreement between vestibular elective physical therapy students and experienced physical therapists in identifying nystagmus during positional testing and diagnosing benign paroxysmal positional vertigo (BPPV)

Main Article Content

Laura P. Kennedy-Rynne
Anne K. Galgon


Purpose: The aim of this study is to measure the effectiveness of a vestibular elective in preparing students to perform nystagmus identification and diagnosing benign paroxysmal positional vertigo (BPPV) through an investigation of agreement between student performances and experienced physical therapists.

Methods: Seven students watched eye movement videos during positioning testing of 14 patients. Students recorded the nystagmus characteristics for each position and made diagnoses. The students completed additional surveys. Pairwise percent agreement and kappa statistics (κ) were used to compare agreement between each students’ conclusions to those of an experienced physical therapist obtained from a previous study. Krippendorff’s alpha (α) was used to analyze the overall reliability of student ability for these skills.

Results: Interrater agreement between students and the expert was fair to almost perfect (κ = 0.22 to 1) in identifying nystagmus, and slight to almost perfect (κ = −0.02 to 1) in diagnosing BPPV. There was moderate agreement between students to identify nystagmus (α = 0.58–0.65, average agreement = 80–83%) during positional testing, and fair to moderate agreement to diagnose BPPV (α = 0.38 to 0.53, average agreement = 64–74%). Agreement was higher in cases of typical BPPV presentations. Students reported the task as difficult, had the necessary knowledge, and wanted more practice. Correlations (r = 0.76 to 0.82) were seen between clinical experience with BPPV and lower perceived difficulty.

Conclusion: Students are capable of identifying nystagmus and diagnosing typical BPPV; however, students may require more practice, clinical experience, and mentorship to improve reliability. The results may help determine educational needs to prepare clinicians to manage individuals with BPPV.

Author Biographies

Laura P. Kennedy-Rynne, Department of Physical Therapy, Saint Joseph’s University, Philadelphia, PA, USA

Laura Kennedy-Rynne has been clinically practicing vestibular and orthopedic physical therapy since graduating from Temple University's Doctor of Physical Therapy program in 2015. She has also been assistant teaching both vestibular and musculoskeletal based content within the Doctor of Physical Therapy programs of Temple University, Thomas Jefferson University, and St. Joseph's University. She has a special interest in the treatment of vestibular disorders within an outpatient context and furthing the knowledge of students to grow the vestibular treatment niche.

Anne K. Galgon, Department of Physical Therapy, Saint Joseph’s University, Philadelphia, PA, USA

Dr. Anne Galgon is an Associate Professor in the Department of Physical Therapy at Saint Joseph’s University.   Dr. Galgon holds a Masters in Physical Therapy from Hahnemann University and a Doctor of Philosophy in Movement Sciences from Drexel University. Dr. Galgon is a board-certified clinical specialist in neurological physical therapy with advanced training in vestibular rehabilitation. Prior to starting at SJU held faculty positions in physical therapy programs at Neumann University and Temple University, and University of the Sciences where she taught courses in movement sciences, neurosciences, evidence-based practice and clinical management of neuromuscular and vestibular disorders. Her current research focuses on physical therapy management of vestibular disorders.


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Article Details

physical therapy education, benign paroxysmal positional vertigo, reliability
Original Research Articles
How to Cite
Kennedy-Rynne, L. P., & Galgon, A. K. (2024). Agreement between vestibular elective physical therapy students and experienced physical therapists in identifying nystagmus during positional testing and diagnosing benign paroxysmal positional vertigo (BPPV). The Journal of Clinical Education in Physical Therapy, 6.