Active exercise for individuals with cervical dystonia: a pilot randomized controlled trial

Objective: To investigate the feasibility and effectiveness of an active exercise program for cervical dystonia. Design: Pilot randomized controlled, single-blind trial of a 12-week intervention followed by a four-week follow-up period. Setting: Supervised physiotherapy and outcome measurement sessions were conducted in a hospital outpatient physiotherapy setting. Participants also performed exercises at home. Subjects: Twenty participants with idiopathic cervical dystonia were randomized into an experimental (n = 9) or control (n = 11) group. Two participants from the experimental group and one from the control group dropped out. Interventions: The experimental group undertook a semi-supervised active exercise program aimed at correcting the dystonic head position, plus relaxation. The control group performed relaxation only. Main outcome measures: Feasibility of the intervention was assessed by recording adherence, muscle soreness, and adverse events. The primary outcome measure was blinded analysis of the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) score. Results: The active exercise program was feasible and safe, with participants in the experimental group completing 84% of prescribed training sessions in the 12-week intervention period. There were no adverse events in either group, while mild muscle soreness was reported by 66% of the experimental group. There was no significant difference between groups at post-test or follow-up. The difference between groups of -1.9 (95% confidence interval (CI) -9.0-5.2) on the TWSTRS demonstrates a trend towards greater improvement for the experimental group. Conclusion: Active exercise for people with cervical dystonia is feasible and can be completed with good adherence and no adverse effects.