Background
Duchenne muscular dystrophy (DMD) is a severe X-linked disorder causing progressive muscle degeneration and loss of ambulation. Physical therapy (PT) is vital for maintaining motor function, delaying contractures, and improving quality of life. However, the long-term impact of PT interventions on rehabilitation outcomes remains unclear. This meta-analysis evaluates PT’s effectiveness in enhancing functional outcomes and quality of life in DMD.
Objectives
To assess the effects of PT on motor function, range of motion, quality of life, and disease progression in DMD. Secondary objectives included comparing specific PT modalities and determining optimal intervention timing and frequency.
Methods
Systematic searches in PubMed, Embase, Cochrane Library, and ClinicalTrials.gov followed PRISMA guidelines. Included studies were randomized controlled trials (RCTs), non-randomized trials, and observational studies. Two reviewers performed data extraction, with disputes resolved by a third. Risk of bias was assessed using Cochrane Risk of Bias 2.0 and ROBINS-I. Random-effects models and GRADE were used for analysis.
Results
Twenty-two studies with 1,487 participants met inclusion criteria. PT significantly improved North Star Ambulatory Assessment (NSAA) scores compared to standard care (mean difference: 3.2, 95% CI: 2.1–4.3, p < 0.001). Daily stretching, strength training, and aquatic therapy were most effective. PT reduced lower-limb contracture risk by 29% (RR: 0.71, 95% CI: 0.58–0.85, p < 0.001) and slowed decline in joint range of motion, especially in the ankles and knees. Quality of life, assessed by Pediatric Quality of Life Inventory (PedsQL), improved significantly (mean increase: 6.4 points, 95% CI: 4.2–8.6, p < 0.001). Combining aquatic therapy with land-based PT yielded superior gains in mobility and quality of life. Stretching ≥5 days weekly better preserved range of motion than less frequent sessions.
Conclusion
PT improves motor function, preserves range of motion, and enhances quality of life in DMD. Daily stretching, aquatic therapy, and strength training provide the most benefits. Personalized regimens tailored to disease stage and individual needs are recommended. Further research should refine timing and frequency for sustained outcomes.