Objective: To evaluate the effectiveness of a specialized physical therapy (SPT) program on disability in cervical dystonia (CD) compared to regular physical therapy (RPT). Design: A single-blinded randomized controlled trial. Setting: This study was performed by a physical therapist in a primary health care setting. Measurements were performed at baseline, 6 and 12 months in the botulinum toxin (BoNT) outpatient clinic of the neurology department. Participants: Patients with primary CD and stable on BoNT treatment for 1 year (N=96). Main Outcome Measures: The primary outcome was disability assessed with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Secondary outcomes were pain, anxiety, depression, quality of life (QOL), and health related costs over 12 months. Results: A total of 72 participants (30 men, 42 women) finished the study: 40 received SPT, 32 RPT. No significant between group differences were found after 12 months of treatment (P=.326). Over these 12 months both groups improved significantly (P<.001) on the TWSTRS disability scale compared to baseline (SPT 1.7 points, RPT 1.0 points). Short Form 36 (SF-36) General Health Perceptions (P=.046) and self-perceived improvement (P=.007) showed significantly larger improvements after 12 months in favor of SPT. Total health related costs after 12 months were $1373±556 for SPT compared to $1614±917 for RPT. Conclusion: SPT revealed no significant differences compared to RPT after 12 months of treatment on the TWSTRS disability scale. Both groups showed similar improvements compared to baseline. Positive results in the SPT group were higher patient perceived effects and general health perception. Treatment costs were lower in the SPT group. With lower costs and similar effects, the SPT program seems to be the preferred program to treat CD.
Supported by the scientific fund of the Dutch Dystonia Patient Association, the Nuts-Ohra Fund (grant no. 1202-040), and the Jacques and Gloria Gossweiler Foundation.Disclosures: J.H. Koelman and M.A. Tijssen received unrestricted grants from Ipsen Pharmaceutical and Allergan Inc. for studies, teaching workshops on dystonia, and financing a specialized dystonia nurse. Neither Ipsen nor Allergan had a role in the study design, collection, analysis, or interpretation of data, the writing of the report, or the decision to submit the paper for publication. The other authors have nothing to disclose. Supported by the scientific fund of the Dutch Dystonia Patient Association, the Nuts-Ohra Fund (grant no. 1202-040), and the Jacques and Gloria Gossweiler Foundation. Disclosures: J.H. Koelman and M.A. Tijssen received unrestricted grants from Ipsen Pharmaceutical and Allergan Inc. for studies, teaching workshops on dystonia, and financing a specialized dystonia nurse. Neither Ipsen nor Allergan had a role in the study design, collection, analysis, or interpretation of data, the writing of the report, or the decision to submit the paper for publication. The other authors have nothing to disclose. We thank those who contributed to the development of the SPT program. We thank A.D.I. van Asselt, PhD for her advice on the evaluation of the costs. We also thank Jackie Senior, science editor, who revised the manuscript. Participating neurologists in the DystoniaNet: J.P. Blankevoort, A.J.W. Boon, R. van Dijl, J.L.A. Eekhof, J.W.J. Elting, B. van Harten, J.J. van Hilten, D.J. Kamphuis, A.G. Munts, J.W. Pasman, A.A. van der Plas, J. Samijn, D. Tavy, and F.H. Vermeij. Participating physical therapists in the DystoniaNet: A. Barel, S. van den Berg, T. Bloem, A. Croese, M. van Engen, P. Gunnink, T. Heemskerk, V. Kinket, M. Kuipers, W. Liebregts, R. Ouwehand, C. Regeer, M. Schneider, E. Timmerman, D. Westra, E. de Vries, H. Voeten, and H. Winnubst-Schaap. Supported by the scientific fund of the Dutch Dystonia Patient Association, the Nuts-Ohra Fund (grant no. 1202-040), and the Jacques and Gloria Gossweiler Foundation. Disclosures: J.H. Koelman and M.A. Tijssen received unrestricted grants from Ipsen Pharmaceutical and Allergan Inc. for studies, teaching workshops on dystonia, and financing a specialized dystonia nurse. Neither Ipsen nor Allergan had a role in the study design, collection, analysis, or interpretation of data, the writing of the report, or the decision to submit the paper for publication. The other authors have nothing to disclose.