Clinical recommendations to guide physical therapy practice for Huntington disease

Abstract

ObjectiveIn the past decade, an increasing number of studies have examined the efficacy of physical therapy interventions in people with Huntington disease (HD). MethodsWe performed a mixed-methods systematic review using Joanna Briggs Institute (JBI) methodology and included experimental and observational study designs. The search resulted in 23 quantitative studies and 3 qualitative studies from which we extracted data using JBI standardized extraction tools. Results of this review suggested that physical therapy interventions may improve motor impairments and activity limitations in people with HD. Here, we expand on the review findings to provide specific recommendations to guide clinical practice. ResultsWe recommend the following specific physical therapy interventions for people with HD: aerobic exercise (grade A evidence), alone or in combination with resistance training to improve fitness and motor function, and supervised gait training (grade A evidence) to improve spatiotemporal features of gait. In addition, there is weak (grade B) evidence that exercise training improves balance but does not show a reduction in the frequency of falls; inspiratory and expiratory training improves breathing function and capacity; and training of transfers, getting up from the floor, and providing strategies to caregivers for involvement in physical activity in the midstages of HD may improve performance. There is expert consensus for the use of positioning devices, seating adaptations, and caregiver training in late stages of HD. ConclusionsThere is strong evidence to support physical therapy interventions to improve fitness, motor function, and gait in persons with HD.This clinical practice guideline provides clinical recommendations for physical therapy interventions and patientreported outcomes for individuals with Huntington disease (HD). The target audience are rehabilitation professionals and referring physicians providing care to persons with HD. The recommendations should be interpreted by the clinician in the context of their specific clinical practice and the patient's impairments, goals, and disease stage, while considering the potential for harm.We used the Joanna Briggs Institute (JBI) method for critical appraisal of research, assignment of evidence to the literature, and assignment of levels of strength to the recommendation. The JBI method allows for inclusion of experimental study designs other than randomized controlled trial, such as observational study designs, retrospective and prospective cohort studies, expert consensus, and qualitative studies. The inclusion of a wide range of study designs (i.e., all levels of evidence) was critical, given the paucity of randomized controlled trials involving physical therapy in HD. The guideline is organized according to the level of evidence and the grade of the recommendation (tables 1 and 2) underpinning action statements. A summary of action statements, a description of each action statement, and research recommendations are provided.Each individual articl...

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