OBJECTIVE: To evaluate the effectiveness of a specialized physical therapy (SPT) program on disability in cervical dystonia (CD) compared to regular physical therapy (RPT). DESIGN: A single blinded randomized controlled trial. SETTING: This study was performed by physical therapist in a primary healthcare setting. Measurements were performed at baseline, six and 12 months in the Botulinum Toxin (BoNT) outpatient clinic of the neurology department. PARTICIPANTS: 96 patients with primary CD and stable on BoNT treatment for one year. MAIN OUTCOME MEASURES: The primary outcome was disability assessed with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Secondary outcomes were, pain, anxiety, depression, quality of life and health related costs over 12 months. RESULTS: 72 participants (30 males/42 females) finished the study: 40 received SPT, 32 RPT. No significant between group differences were found after 12 months of treatment (p = 0.326). Over these 12 months both groups improved significantly (p < 0.000) on the TWSTRS disability scale compared to baseline (SPT 1.7 points, RPT 1.0 points). SF-36 General Health perceptions (p = 0.046) and self-perceived improvement (p = 0.007) showed significantly larger improvements after 12 months in favour of SPT. Total health related costs after 12 months were $1,373 (SD 556) for SPT compared to $1,614 (SD 917) for RPT. CONCLUSION: SPT revealed no significant differences compared to RPT after 12 months of treatment on the TWSTR disability scale. Both groups showed similar improvements compared to baseline. Positive results in the SPT group were higher patient perceived effects and general health perception. Treatment costs were lower in the SPT group. With lower costs and similar effects, the SPT program seems to be the preferred program to treat CD.

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