A randomized trial of specialized versus standard neck physiotherapy in cervical dystonia 

Carl Counsell, Hazel Sinclair, Jillian Fowlie, Elaine Tyrell, Natalie Derry, Peter Meager, John Norrie, Donald Grosset

Research output: Contribution to journalArticle

6 Citations (Scopus)
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Abstract

Background: Anecdotal reports suggested that a specialized physiotherapy technique developed in France (the Bleton technique) improved primary cervical dystonia. We evaluated the technique in a randomized trial.
Methods: A parallel-group, single-blind, two-centre randomized trial compared the specialized outpatient physiotherapy programme given by trained physiotherapists up to once a week for 24 weeks with standard physiotherapy advice for neck problems. Randomization was by a central telephone service. The primary outcome was the change in the total Toronto Western Spasmodic Torticollis Rating (TWSTR) scale, measured before any botulinum injections that were due, between baseline and 24 weeks evaluated by a clinician masked to treatment. Analysis was by intention-to-treat.
Results: 110 patients were randomized (55 in each group) with 24 week outcomes available for 84. Most (92%) were receiving botulinum toxin injections. Physiotherapy adherence was good. There was no difference between the groups in the change in TWSTR score over 24 weeks (mean adjusted difference 1.44 [95% CI -3.63, 6.51]) or 52 weeks (mean adjusted difference 2.47 [-2.72, 7.65]) nor in any of the secondary outcome measures (Cervical Dystonia Impact Profile-58, clinician and patient-rated global impression of change, mean botulinum toxin dose). Both groups showed large sustained improvements compared to baseline in the TWSTR, most of which occurred in the first four weeks. There were no major adverse events. Subgroup analysis suggested a centre effect.
Conclusion: There was no statistically or clinically significant benefit from the specialized physiotherapy compared to standard neck physiotherapy advice but further trials are warranted.
Original languageEnglish
Pages (from-to)72-79
Number of pages8
JournalParkinsonism & Related Disorders
Volume23
Early online date18 Dec 2015
DOIs
Publication statusPublished - Feb 2016

Fingerprint

Torticollis
Neck
Botulinum Toxins
Physical Therapy Modalities
Injections
Intention to Treat Analysis
Physical Therapists
Random Allocation
Telephone
France
Outpatients
Outcome Assessment (Health Care)
Therapeutics

Keywords

  • torticollis
  • physical therapy modalities
  • single-blind method
  • disability
  • quality of life
  • evaluation

Cite this

A randomized trial of specialized versus standard neck physiotherapy in cervical dystonia . / Counsell, Carl; Sinclair, Hazel; Fowlie, Jillian ; Tyrell, Elaine; Derry, Natalie ; Meager, Peter ; Norrie, John; Grosset, Donald.

In: Parkinsonism & Related Disorders, Vol. 23, 02.2016, p. 72-79.

Research output: Contribution to journalArticle

Counsell, Carl ; Sinclair, Hazel ; Fowlie, Jillian ; Tyrell, Elaine ; Derry, Natalie ; Meager, Peter ; Norrie, John ; Grosset, Donald. / A randomized trial of specialized versus standard neck physiotherapy in cervical dystonia . In: Parkinsonism & Related Disorders. 2016 ; Vol. 23. pp. 72-79.
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abstract = "Background: Anecdotal reports suggested that a specialized physiotherapy technique developed in France (the Bleton technique) improved primary cervical dystonia. We evaluated the technique in a randomized trial.Methods: A parallel-group, single-blind, two-centre randomized trial compared the specialized outpatient physiotherapy programme given by trained physiotherapists up to once a week for 24 weeks with standard physiotherapy advice for neck problems. Randomization was by a central telephone service. The primary outcome was the change in the total Toronto Western Spasmodic Torticollis Rating (TWSTR) scale, measured before any botulinum injections that were due, between baseline and 24 weeks evaluated by a clinician masked to treatment. Analysis was by intention-to-treat.Results: 110 patients were randomized (55 in each group) with 24 week outcomes available for 84. Most (92{\%}) were receiving botulinum toxin injections. Physiotherapy adherence was good. There was no difference between the groups in the change in TWSTR score over 24 weeks (mean adjusted difference 1.44 [95{\%} CI -3.63, 6.51]) or 52 weeks (mean adjusted difference 2.47 [-2.72, 7.65]) nor in any of the secondary outcome measures (Cervical Dystonia Impact Profile-58, clinician and patient-rated global impression of change, mean botulinum toxin dose). Both groups showed large sustained improvements compared to baseline in the TWSTR, most of which occurred in the first four weeks. There were no major adverse events. Subgroup analysis suggested a centre effect.Conclusion: There was no statistically or clinically significant benefit from the specialized physiotherapy compared to standard neck physiotherapy advice but further trials are warranted.",
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author = "Carl Counsell and Hazel Sinclair and Jillian Fowlie and Elaine Tyrell and Natalie Derry and Peter Meager and John Norrie and Donald Grosset",
note = "We thank: the patients who took part; Monsieur John-Pierre Bleton for training the physiotherapists; Gladys McPherson (Senior IT Manager), Adesoji Adeyemi (programmer) and Diana Collins (data entry) from the Centre for Healthcare Randomised Trials, University of Aberdeen who provided the randomisation and database service; and the funders including The Dystonia Society, the RS Macdonald Charitable Trust, The Sir Halley Stewart Trust, The Foyle Foundation and The Garfield Weston Foundation. The Dystonia Society and other funders had no role in the design, conduct, analysis or writing of the report or the decision to submit the manuscript.",
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T1 - A randomized trial of specialized versus standard neck physiotherapy in cervical dystonia 

AU - Counsell, Carl

AU - Sinclair, Hazel

AU - Fowlie, Jillian

AU - Tyrell, Elaine

AU - Derry, Natalie

AU - Meager, Peter

AU - Norrie, John

AU - Grosset, Donald

N1 - We thank: the patients who took part; Monsieur John-Pierre Bleton for training the physiotherapists; Gladys McPherson (Senior IT Manager), Adesoji Adeyemi (programmer) and Diana Collins (data entry) from the Centre for Healthcare Randomised Trials, University of Aberdeen who provided the randomisation and database service; and the funders including The Dystonia Society, the RS Macdonald Charitable Trust, The Sir Halley Stewart Trust, The Foyle Foundation and The Garfield Weston Foundation. The Dystonia Society and other funders had no role in the design, conduct, analysis or writing of the report or the decision to submit the manuscript.

PY - 2016/2

Y1 - 2016/2

N2 - Background: Anecdotal reports suggested that a specialized physiotherapy technique developed in France (the Bleton technique) improved primary cervical dystonia. We evaluated the technique in a randomized trial.Methods: A parallel-group, single-blind, two-centre randomized trial compared the specialized outpatient physiotherapy programme given by trained physiotherapists up to once a week for 24 weeks with standard physiotherapy advice for neck problems. Randomization was by a central telephone service. The primary outcome was the change in the total Toronto Western Spasmodic Torticollis Rating (TWSTR) scale, measured before any botulinum injections that were due, between baseline and 24 weeks evaluated by a clinician masked to treatment. Analysis was by intention-to-treat.Results: 110 patients were randomized (55 in each group) with 24 week outcomes available for 84. Most (92%) were receiving botulinum toxin injections. Physiotherapy adherence was good. There was no difference between the groups in the change in TWSTR score over 24 weeks (mean adjusted difference 1.44 [95% CI -3.63, 6.51]) or 52 weeks (mean adjusted difference 2.47 [-2.72, 7.65]) nor in any of the secondary outcome measures (Cervical Dystonia Impact Profile-58, clinician and patient-rated global impression of change, mean botulinum toxin dose). Both groups showed large sustained improvements compared to baseline in the TWSTR, most of which occurred in the first four weeks. There were no major adverse events. Subgroup analysis suggested a centre effect.Conclusion: There was no statistically or clinically significant benefit from the specialized physiotherapy compared to standard neck physiotherapy advice but further trials are warranted.

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KW - torticollis

KW - physical therapy modalities

KW - single-blind method

KW - disability

KW - quality of life

KW - evaluation

U2 - 10.1016/j.parkreldis.2015.12.010

DO - 10.1016/j.parkreldis.2015.12.010

M3 - Article

VL - 23

SP - 72

EP - 79

JO - Parkinsonism & Related Disorders

JF - Parkinsonism & Related Disorders

SN - 1353-8020

ER -