Background: Primary dystonia is a chronic neurological movement disorder that causes abnormal muscle movements.\nPain and emotional distress may accompany these physical symptoms. Behavioural interventions are used to help\npeople with long term conditions improve their quality of life. Little is known about behavioural interventions applied\nto Dystonia. We report a systematic review of studies reporting current evidence of behavioural interventions for\npeople with primary dystonia.\nMethods: We did systematic searches of Medline, PsycINFO, AHMED and CINAHL. We assessed the methodological\nquality of included studies using a risk of bias tool. Any disagreements were resolved by liaising with an independent\nrater. Physiological outcomes such as dystonia severity and psychological outcomes such as sleep and depression were\nselected on the basis that primary dystonia causes motor and non-motor symptoms. No time limit was placed on the\nsearches. A narrative synthesis of the results is presented.\nResults: Of 1798 titles and abstracts screened, 14 full articles were retrieved and inclusion and exclusion criteria applied.\nOf these a final nine were eligible for the review (N = 73). Only two were Randomised Controlled Trials (RCTs). Using the\nMovement Disorders Society (MDS) dystonia classification, that was published after this work started, all of the included\nstudies were of idiopathic adult onset focal dystonia without associated features. These included: blepharospasm (eye\ndystonia) (N = 1), cervical dystonia (neck dystonia) (N = 2), writer�s cramp (hand dystonia) (N = 3) and the yips (N = 3). No\nstudies reported on dystonia that affects two or more body regions. Studies reported good adherence and response\nrates to treatment. Physiological and psychological improvements were noted in all studies at weekly, monthly and\nyearly follow-ups. Caution should be taken when interpreting the results because of the scarcity of RCTs identified, use\nof small sample sizes, and inappropriate statistical methods.\nConclusion: We identified few studies; mainly of poor methodological quality that all studied a focal dystonia. It\nis not possible to draw firm conclusions. Nevertheless, the data suggests that a combined behavioural therapy\napproach including relaxation practice for people with idiopathic adult onset focal dystonia merits further\ninvestigation.
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