uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Physiotherapy in Cervical Dystonia: Six experimental single-case studies
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Clinical Neurophysiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
Show others and affiliations
2008 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 24, no 4, 275-290 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to explore the outcome of a physiotherapy program targeted to improve the quality of life of people with cervical dystonia (CD) by reducing pain, improving awareness of postural orientation, increasing muscle strength, and reducing the effort of moving the head and neck. In six single case studies, the primary outcome measure for each case was the Cervical Dystonia Questionnaire (CDQ) to measure the impact of the program on the individuals' quality of life. Secondary outcome measures were identified for the different components of the physiotherapy program: Visual Analogue Scale (pain); Postural Orientation Index (postural orientation awareness); and Movement Energy Index (effort of moving head and neck). Each of the cases had the severity of their problems scored on the Toronto Western Spasmodic Torticollis Scale. The study period was 26 weeks: 2 weeks' baseline period, 4 weeks' treatment period, and 20 weeks' follow-up. All measures except the Movement Energy Index (MEI) and CDQ-24 were taken three times per week for the first 6 weeks of the study and then once at 3 and 6 months. The MEI was taken once a week during the pretreatment and the treatment periods and during the first 2 weeks of follow-up and also after 3 and 6 months of follow-up. The CDQ-24 was taken once in the pretreatment period, once after completion of treatment, once 2 weeks after treatment, and once at 3 and 6 months of follow-up. Five of the six case studies reported an increase in quality of life at 6-month follow-up, as measured on the CDQ-24. Three of the six cases reported a reduction in pain and severity of the dystonia and had improved scores on the postural orientation measure at 6-month follow-up. All six patients had a reduction in the movement energy scores, but this was not significant. The outcomes of the six case studies would suggest that further investigation is required to show the effectiveness of physiotherapy programs in the management of CD.

Place, publisher, year, edition, pages
2008. Vol. 24, no 4, 275-290 p.
National Category
URN: urn:nbn:se:uu:diva-97890DOI: 10.1080/09593980701884816PubMedID: 18574753OAI: oai:DiVA.org:uu-97890DiVA: diva2:172990
Available from: 2008-11-28 Created: 2008-11-28 Last updated: 2014-11-13Bibliographically approved
In thesis
1. Multidimensional Aspects of Dystonia: Description and Physiotherapy Management
Open this publication in new window or tab >>Multidimensional Aspects of Dystonia: Description and Physiotherapy Management
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aims: The overall aim of this research was to increase the knowledge about dystonia by identifying factors that influence self-reported quality of life and health in this disorder and to determine what factors predict disability. A further aim was to develop an objective outcome measure for quantifying the movement dysfunction in cervical dystonia (CD) and evaluate effects of physiotherapy.

Methods: A descriptive correlative design was adopted for study I (n=351), with a questionnaire covering physical activity, satisfaction with treatment, physiotherapy or not, and quality of life and health measured with the Craniocervical Dystonia Questionnaire (CDQ-24) and the Cervical Dystonia Impact Profile, respectively.

In study II a CD group (n=6) was compared with a control group (n=6). Head movements were measured with a motion capture system, and a Movement Energy Index (MEI) was calculated. In study III an experimental single-case design (n=6) was used, with continuous assessments during pre-treatment, intervention and follow-up. Quality of life, measured with CDQ-24, was the primary outcome measure.

A prospective correlative design was applied in study IV (n=179), where data from questionnaires were collected on inclusion and 2 months later. Independent variables were: duration of dystonia, severity of dystonia, pain intensity, catastrophizing, self-efficacy, fatigue, kinesiophobia, depression, anxiety and physical activity; and the dependent variables were the Neck Disability Index and the Functional Disability Questionnaire.

Results: Study I indicated that physical activity and satisfaction with treatment were associated with quality of life and health in dystonia. In study II the groups differed significantly concerning MEI in all movement directions. Mean MEI was significantly higher in patients than in controls. Positive treatment outcomes were reported by all patients in study III, mainly with reduced pain and reduced CD severity during the treatment period. Five of the six patients reported increased quality of life at the 6-month follow-up. Perceived self-efficacy, fatigue, pain intensity and anxiety contributed significantly to disability prediction in study IV.

Conclusion: These investigations have increased the knowledge of dystonia from a multidimensional perspective and the results could be valuable in developing new treatment strategies.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2008. 63 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 404
disability, dystonia, health, movement analysis, physiotherapy, quality of life
National Category
urn:nbn:se:uu:diva-9417 (URN)978-91-554-7364-8 (ISBN)
Public defence
2008-12-19, IX, Universitetshuset, Övre Slottsgatan 2, Uppsala, 13:00
Available from: 2008-11-28 Created: 2008-11-28Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Zetterberg, LenaHalvorsen, KjartanAquilonius, Sten-MagnusLindmark, Birgitta
By organisation
PhysiotheraphyClinical NeurophysiologyNeurology
In the same journal
Physiotherapy Theory and Practice

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 448 hits
ReferencesLink to record
Permanent link

Direct link