Effectiveness of conservative non- pharmacological interventions in people with muscular dystrophies: a systematic review and meta- analysis

Philp, Fraser ORCID: 0000-0002-8552-7869 (2023) Effectiveness of conservative non- pharmacological interventions in people with muscular dystrophies: a systematic review and meta- analysis. Journal of Neurology, Neurosurgery and Psychiatry, 95 (5). pp. 442-453.

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Official URL: http://dx.doi.org/10.1136/jnnp-2023-331988

Abstract

<h4>Introduction</h4>Management of muscular dystrophies (MD) relies on conservative non-pharmacological treatments, but evidence of their effectiveness is limited and inconclusive.<h4>Objective</h4>To investigate the effectiveness of conservative non-pharmacological interventions for MD physical management.<h4>Methods</h4>This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched Medline, CINHAL, Embase, AMED and Cochrane Central Register of Controlled Trial (inception to August 2022). Effect size (ES) and 95% Confidence Interval (CI) quantified treatment effect.<h4>Results</h4>Of 31,285 identified articles, 39 studies (957 participants), mostly at high risk of bias, were included. For children with Duchenne muscular dystrophy (DMD), trunk-oriented strength exercises and usual care were more effective than usual care alone in improving distal upper-limb function, sitting and dynamic reaching balance (ES range: 0.87 to 2.29). For adults with Facioscapulohumeral dystrophy (FSHD), vibratory proprioceptive assistance and neuromuscular electrical stimulation respectively improved maximum voluntary isometric contraction and reduced pain intensity (ES range: 1.58 to 2.33). For adults with FSHD, Limb-girdle muscular dystrophy (LGMD) and Becker muscular dystrophy (BMD), strength-training improved dynamic balance (sit-to-stand ability) and self-perceived physical condition (ES range: 0.83 to 1.00). A multicomponent programme improved perceived exertion rate and gait in adults with Myotonic dystrophy type 1 (DM1) (ES range: 0.92 to 3.83).<h4>Conclusions</h4>Low-quality evidence suggests that strength training, with or without other exercise interventions, may improve perceived exertion, distal upper limb function, static and dynamic balance, gait and well-being in MD. Although more robust and larger studies are needed, current evidence supports the inclusion of strength training in MD treatment, as it was found to be safe.

Item Type:	Article
Uncontrolled Keywords:	Humans, Muscular Dystrophy, Duchenne, Muscular Dystrophy, Facioscapulohumeral, Muscular Dystrophies, Limb-Girdle, Myotonic Dystrophy, Exercise, Adult, Child
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Population Health Faculty of Health and Life Sciences > Institute of Population Health > School of Health Sciences
Depositing User:	Symplectic Admin
Date Deposited:	13 Dec 2023 09:41
Last Modified:	20 Apr 2024 01:31
DOI:	10.1136/jnnp-2023-331988
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3177290