De Pauw Joke, Van der Velden Kevin, Meirte Jill, Van Daele Ulrike, Truijen Steven, Cras Patrick, Mercelis Rudy, De Hertogh Willem
Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium,
J Neurol. 2014 Oct;261(10):1857-65. doi: 10.1007/s00415-013-7220-8. Epub 2014 Jan 12.
Cervical dystonia is a form of adult-onset, focal dystonia characterized by involuntary contractions of the neck muscles, leading to a disabling, abnormal head posture. CD has a great impact on the activities of daily living (ADL) and quality of life. Currently, the most widely used and recommended first line treatment is botulinum toxin type A (BoNT/A) injections. Physiotherapy is a potentially useful adjuvant, but little is known about its effectiveness. Consequently, our objective was to investigate the effectiveness of physiotherapy alone or as an adjuvant treatment to BoNT/A injections in cervical dystonia (CD) by means of a systematic literature review. Two online databases, PubMed and Web of Science, were searched for articles describing the effectiveness of physiotherapy treatment for CD. After screening, based on predefined in- and exclusion criteria, 16 studies were retained. Their methodological quality was assessed according to Cochrane guidelines. The methodological quality of most studies was low. Examples of shortcomings are small sample sizes, lack of randomization or blinding, and diversity in therapeutic techniques and outcome measures. Only seven studies were clinical trials; the remaining were either case reports or case series. The reported physiotherapy treatments included EMG biofeedback training, muscular elongation, postural exercises and electrotherapy. Improvements in head position, pain, cervical range of motion, quality of life and ADL have been reported, which is promising. Cautious interpretation on the effectiveness of physiotherapy as an adjuvant therapy is required. Before firm conclusions can be drawn, additional high quality trials are needed.
颈部肌张力障碍是一种成人起病的局灶性肌张力障碍，其特征为颈部肌肉不自主收缩，导致致残性异常头位。颈部肌张力障碍对日常生活活动（ADL）和生活质量有很大影响。目前，最广泛使用且推荐的一线治疗方法是注射A型肉毒毒素（BoNT/A）。物理治疗是一种潜在有用的辅助治疗方法，但对其有效性了解甚少。因此，我们的目的是通过系统的文献综述，研究物理治疗单独或作为BoNT/A注射辅助治疗颈部肌张力障碍（CD）的有效性。在两个在线数据库PubMed和Web of Science中检索描述物理治疗对CD有效性的文章。根据预先确定的纳入和排除标准进行筛选后，保留了16项研究。根据Cochrane指南评估其方法学质量。大多数研究的方法学质量较低。缺点包括样本量小、缺乏随机化或盲法以及治疗技术和结局测量方法的多样性。只有7项研究是临床试验；其余的是病例报告或病例系列。报告的物理治疗方法包括肌电图生物反馈训练、肌肉伸展、姿势锻炼和电疗法。据报道，在头位、疼痛、颈部活动范围、生活质量和ADL方面有改善，这很有前景。对物理治疗作为辅助治疗的有效性需要谨慎解读。在得出确切结论之前，还需要更多高质量的试验。
