Long-Term Specialized Physical Therapy in Cervical Dystonia: Outcomes of a Randomized Controlled Trial

Published:February 20, 2019DOI:


      • Specialized physical therapy (SPT) revealed no significant differences compared to regular physical therapy (RPT) after 12 months of treatment on the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) disability scale.
      • SPT and RPT showed comparable improvements on the TWSTRS disability scale compared to baseline.
      • SPT showed significant larger improvements on general health perceptions and self-perceived improvement than RPT.
      • SPT reduced health care costs by $366 per patient on average, compared to RPT.
      • SPT is preferred over RPT with comparable effects on disability, lower health care costs, and better outcomes on general health perceptions and self-perceived improvement.



      To evaluate the effectiveness of a specialized physical therapy (SPT) program on disability in cervical dystonia (CD) compared to regular physical therapy (RPT).


      A single-blinded randomized controlled trial.


      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.


      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.


      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.


      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.


      List of abbreviations:

      ADL (activities of daily living), BoNT (botulinum toxin), CD (cervical dystonia), CDQ-24 (Craniocervical Dystonia Questionnaire), CI (confidence interval), FDQ (Functional Disability Questionnaire), PT (physical therapy), QOL (quality of life), RCT (randomized controlled trial), RPT (regular physical therapy), SF-36 (Short Form 36), SPT (specialized physical therapy), TWSTRS (Toronto Western Spasmodic Torticollis Rating Scale)
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