Standardized physical therapy for cervical dystonia.

Background:

Cervical Dystonia (CD) is characterized by involuntary muscle contraction of the neck and abnormal positions of the head that affects daily life activities and social life of patients. Patients are usually treated with botulinum toxin injections into the neck muscles to decrease the abnormal head postures and pain. In addition, many patients are referred for physiotherapy with the aim to improve their functioning in daily life. A recent systematic review on allied health interventions in CD shows a lack of intervention studies that underpin or refute the effectiveness of physical therapy.



Study objectives:

Our main goal is to evaluate the effectiveness and cost-utility of a standardized physical therapy (PT) programme compared with regular physiotherapy, both as add-on treatment to BTX-injections, on the ability of CD patients to perform everyday activities.



Study design:

Multi-centre Single blind Randomized Controlled Trial.



Study population:

100 patients with idiopathic cervical dystonia treated with botulinum toxin injections.



Primary outcome:

The primary outcome is disability in daily functioning, assessed with the disability subscale of the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) after one year. The primary outcome for the economic evaluation is the costs per quality adjusted life-year.



Intervention:

Patients in the intervention group will receive Botuline Toxin (BTX) injection combined with a standardized PT program for 12 months according to the best evidence- / best practice treatment guideline. Interventions will be provided by specially trained therapists. Patients in the control group will receive BTX injections in combination with 12 months regular PT.



Measurements:

All data will be collected at baseline, after six months and after one year. In order to determine the additional effects of a PT program, measurements will be performed just before the botuline injections when botuline has the least effect on the symptoms of dystonia . Measurements will be performed by an independent blind assessor.



Expected results:

It is expected that disability due to CD will be more reduced by BTX injections in combination with a standardized PT programme according the treatment guideline than by BTX injections in combination with regular PT.

Disability due to Cervical Dystonia will be more reduced by Botulinum toxin injections in combination with PT according the treatment guideline than by BTX injections in combination with regular PT.

Baseline, after six months and 12 months.

Patients in the intervention group will receive Botuline Toxin (BTX) injection combined with a standardized PT program for 12 months consisting of muscle stretching, artherogenic mobilistions and excersize therapy. Interventions will be provided by specially trained therapists.



Patients in the control group will receive BTX injections in combination with 12 months regular PT provided by common Dutch pracices.