Clinical recommendations to guide physical therapy practice for Huntington disease

Abstract

Objective: In the past decade, an increasing number of studies have examined the efficacy of physical therapy interventions in people with Huntington disease (HD).

Methods: We 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.

Results: We 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.

Conclusions: There is strong evidence to support physical therapy interventions to improve fitness, motor function, and gait in persons with HD.

Figure 1. A global survey of health care providers with expertise in the treatment of individuals with late-stage HD yielded the prevalence of physical therapy interventions used

Of the 102 survey respondents, 45 endorsed working with individuals with late-stage HD. Of those, 82.2% endorsed the use of positioning, 71.1% used ROM exercise, 73.3% used active movement, 48.9% included respiratory exercises, 88.9% incorporated education to support patients, medical staff, and caregivers, 35.6% reported using additional interventions for late-stage care, and only 2.2% of respondents (i.e., 1 respondent) did not use any of these strategies. HD = Huntington disease; ROM = range of motion.

Figure 2. Patient/client management for individuals with Huntington disease using the clinical practice guideline