Boyce, MJ, Lam, L, Chang, F, Mahant, N, Fung, VSC & Bradnam, L 2017, 'Validation of Fear of Falling and Balance Confidence Assessment Scales in Persons With Dystonia.', Journal of Neurologic Physical Therapy, vol. 41, no. 4, pp. 239-244.View/Download from: UTS OPUS or Publisher's site
Falls are problematic for people living with neurological disorders and a fear of falling can impact on actual falls. Fear of falling is commonly assessed using the Falls Self-Efficacy Scale International (FES-I) or the Activities-specific Balance Confidence (ABC) Scale. These scales can predict risk of falling. We aimed to validate the FES-I and the ABC in persons with dystonia.We conducted an online survey of people with dystonia, collecting information on demographics, 6-month falls history, dystonia disability, and the FES-I and ABC scales. Scales were validated for structural validity and internal consistency. We also examined goodness-of-fit, convergent validity, and predictive validity, and determined cutoff scores for predicting falls risk.Survey responses (n = 122) showed that both FES-I and ABC scales have high internal validity and convergent validity with the Functional Disability Questionnaire in persons with dystonia. Each scale examines a single factor, fear of falling (FES-I) and balance confidence (ABC). At least one fall was reported by 39% of participants; the cutoff value for falls risk was found to be 29.5 and 71.3 for the FES-I and the ABC respectively.The FES-I and the ABC scales are valid scales to examine fear of falling and balance confidence in persons with dystonia. Fear of falling is high and balance confidence is low and both are worse in those with dystonia who have previously fallen.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A182).
Boyce, MJ, Canning, CG, Mahant, N, Morris, J, Latimer, J & Fung, VSC 2013, 'Active exercise for individuals with cervical dystonia: A pilot randomized controlled trial', Clinical Rehabilitation, vol. 27, no. 3, pp. 226-235.View/Download from: Publisher's site
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. © 2012 The Author(s).
Boyce, MJ, Canning, CG, Mahant, N, Morris, J, Latimer, J & Fung, VSC 2012, 'The Toronto Western Spasmodic Torticollis Rating Scale: Reliability in neurologists and physiotherapists', Parkinsonism and Related Disorders, vol. 18, no. 5, pp. 635-637.View/Download from: Publisher's site
Introduction: Inter-rater reliability for the Toronto Western Spasmodic Torticollis Rating Scale has been determined for neurologists, but not for physiotherapists. We assessed the inter-rater reliability of scoring the clinical severity subscale of the Toronto Western Spasmodic Torticollis Rating Scale by two physiotherapists and two neurologists. Methods: Seven individuals with cervical dystonia were assessed on video a total of 23 times. The assessments were randomized and rated by all raters. Results: Reliability for all raters considered together, assessed by the Intraclass Correlation Coefficient (ICC 2,1) was 0.74 (p < 0.001, 95% CI 0.46-0.88). Reliability for the two clinician groups was not significantly different: neurologists ICC (2,1) = 0.75 (p < 0.001, 95% CI 0.44-0.89), physiotherapists ICC (2,1) = 0.82 (p < 0.001, 95% CI 0.30-0.94). Conclusion: The clinical severity subscale of the Toronto Western Spasmodic Torticollis Rating Scale can be assessed with good inter-rater reliability when physiotherapists and neurologists are represented in the same rater pool. © 2012.
Novak, I, Campbell, L, Boyce, M & Fung, VSC 2010, 'Botulinum toxin assessment, intervention and aftercare for cervical dystonia and other causes of hypertonia of the neck: International consensus statement', European Journal of Neurology, vol. 17, no. SUPPL. 2, pp. 94-108.View/Download from: Publisher's site
Dystonia in the neck region can be safely and effectively reduced with injections of Botulinum neurotoxin-A and B. People with idiopathic cervical dystonia have been studied the most. Benefits following injection include increased range of movement at the neck for head turning, decreased pain, and increased functional capacity (Class I evidence, level A recommendation). The evidence for efficacy and safety in patients with secondary dystonia in the neck is unclear based on the lack of rigorous research conducted in this heterogeneous population (level U recommendation). Psychometrically sound assessments and outcome measures exist to guide decision-making (Class I evidence, level A recommendation). Much less is known about the effectiveness of therapy to augment the effects of the injection (Class IV, level U recommendation). More research is needed to answer questions about safety and efficacy in secondary spastic neck dystonia, effective adjunctive therapy, dosing and favourable injection techniques. © 2010 EFNS.