Affiliations: Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA | Department of Physical and Occupational Therapy, Massachusetts General Hospital, Boston, MA, USA
Note:  Corresponding author: Janet Callahan, MGH Institute of Health Professions, Charlestown Navy Yard, 36 First Avenue, Boston, MA 02129 4557, USA. Tel.: +1 617 726 5368; E-mail: firstname.lastname@example.org
Abstract: BACKGROUND: Cervical dystonia is the most common form of focal dystonia. Due to limitations of established surgical and pharmacological interventions for the treatment of cervical dystonia, various non-pharmacological and non-surgical interventions are being considered as alternative or adjunct treatment options. The aim of this systematic review was to assess the quality of evidence for the use of these interventions and their effectiveness in clinical practice. METHODS: Major databases including MEDLINE, CINAHL, PEDro and PsycINFO were searched for articles published in English from January 1996 to July 2013. A manual search of reference lists was also conducted. Two independent reviewers evaluated the methodological quality of included studies using Sackett's level of evidence and Structured Effectiveness Quality Evaluation Scale (SEQES). RESULTS: Ten studies were included in the review, four of which were at Sackett's level of evidence 2b. The single randomized control trial was under powered so definitive conclusions based on non-significant results could not be drawn. The two studies with the next highest level of evidence combined physical therapy with Botox injections, and demonstrated significant improvement in dystonia severity, pain and physical functioning. Half the studies reviewed were case studies. CONCLUSIONS: There is low to moderate evidence supporting the effectiveness of physical therapy in the treatment of cervical dystonia. Limitations included the methodological approaches employed in several of these studies. There is a need for further research to establish the effectiveness of physical therapy and other alternative non-surgical and non-pharmacological interventions for improving the long-term management of cervical dystonia.