The comparison between physiotherapy in home and physiotherapy by expert physiotherapist in patients with Duchenne muscular dystrophy: Randomized controlled trial

Abstract

The aim of this study was to comparison between physiotherapy in home and physiotherapy by expert physiotherapist in patients with Duchenne muscular dystrophy. Materials and Methods: The present study was a randomized clinical trial. All children under 15 years of age referred to the neurology clinic or physiotherapy department of the Children's Educational and Medical Center od Tabriz with a diagnosis of Duchenne muscular dystrophy, which were diagnosed genetically or by biopsy and confirmed by a specialist, were included in the study between October 2018 and March 2018. The sample size for this study was 50 and the sampling method in this study was census. Patients were alternately divided into two groups. The first group was taught physiotherapy in home by training companions and the second group received physiotherapy by a skilled physiotherapist. In both groups, two sessions of physiotherapy were performed weekly. The evaluated parameters were examined in both groups in tow categories of laboratory and clinical. Clinical parameters evaluated included muscle pain (ranged from 0 to 10), number of muscle cramps per week, muscle weakness in the four limbs, the upper limb was evaluated according to the international Brooke criterion (scores 1 to 6) and the lower limbs were evaluated according to the NSAA criterion (scores 1 to 34 with 17 items). Also, the severity of muscle atrophy was classified based on clinical judgment into four grades of normal, low, moderate and severe. These parameters were evaluated and compared twice before treatment and 6 months after treatment. Results: In this study, among the status of muscle parameters in the two groups of patients, none of them, including the number of muscle cramps per week, muscle atrophy status, grade of muscle pain, total score of upper limb muscle strength (Brook) and the total score of lower limb muscle strength (NSAA), there was no statistically significant difference between the two groups of physiotherapy at home and physiotherapy by a physiotherapist (P> 0.05). Also, among the status of muscle parameters in the period before and after treatment in the group of physiotherapy in home, the parameters of the number of muscle cramps per week (P = 0.003) and the total score of lower limb muscle strength (NSAA) (P = 0.001) significantly increased and the parameters of grade of muscle pain (P = 0.035) and the total score of upper limb muscle strength (Brook) (P = 0.041) decreased significantly; On the other hand, among the status of muscle parameters in the period before and after treatment in the group of physiotherapy by the physiotherapist, the parameter of the total score of lower limb muscle strength (NSAA) (P = 0.020) significantly increased and the parameters of the number of muscle cramps per week (P = 0.001) and grade of muscle pain (P = 0.009) decreased significantly.