title: A randomized trial of specialized versus standard neck physiotherapy in cervical dystonia.
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.
  
  
  CONCLUSIONS
  There was no statistically or clinically significant benefit from the specialized physiotherapy compared to standard neck physiotherapy advice but further trials are warranted.
authors.affiliation: Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK. Electronic address: carl.counsell@abdn.ac.uk.
authors.forename: Carl
authors.initials: C
authors.lastname: Counsell
authors.affiliation: Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Govan Road, Glasgow G51 4TF, UK.
authors.forename: Hazel
authors.initials: H
authors.lastname: Sinclair
authors.affiliation: Department of Physiotherapy, Woodend Hospital, Eday Road, Aberdeen AB15 6XS, UK.
authors.forename: Jillian
authors.initials: J
authors.lastname: Fowlie
authors.affiliation: Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Govan Road, Glasgow G51 4TF, UK.
authors.forename: Elaine
authors.initials: E
authors.lastname: Tyrrell
authors.affiliation: Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
authors.forename: Natalie
authors.initials: N
authors.lastname: Derry
authors.affiliation: The Dystonia Society, 2nd Floor, 89 Albert Embankment, London SE1 7TP, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Meager
authors.affiliation: Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
authors.forename: John
authors.initials: J
authors.lastname: Norrie
authors.affiliation: Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Govan Road, Glasgow G51 4TF, UK.
authors.forename: Donald
authors.initials: D
authors.lastname: Grosset
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D016037:Single-Blind Method; D014103:Torticollis / Q000534:rehabilitation*; D016896:Treatment Outcome
keywords: Disability; Evaluation; Physical therapy modalities; Quality of life; Single-blind method; Torticollis