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ICF-based Multidisciplinary Rehabilitation Program for Complex Regional Pain Syndrome of the Hand: Efficacy, Long-term Outcomes, and Impact of Therapy Duration

Overview
Journal BMC Surg
Publisher Biomed Central
Specialty General Surgery
Date 2020 Dec 1
PMID 33256710
Citations 5
Authors
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Abstract

Background: Complex regional pain syndrome (CRPS) is a rare but feared complication in hand surgery. Although multimodal therapy concepts are recommended, there is only low evidence on efficacy of such approaches. Furthermore, recommendations regarding therapy duration are lacking. Aim of this study was to validate the efficacy of an International Classification of Functioning, Disability and Health (ICF)-based multidisciplinary rehabilitation concept for treatment of CRPS of the hand and to find correlations between therapy duration and outcome measures.

Methods: Patients with CRPS of the hand after occupational trauma that underwent an ICF-based rehabilitation program between 2010 and 2014 were included in this retrospective study. Besides demographic data, outcomes included pain (VAS), range of motion assessed by fingertip-to-palm-distance (PTPD) and fingernail-to-table-distance (FTTD) as well as strength in grip, 3-point pinch and lateral pinch. All measures were gathered at admission to and discharge from inpatient rehabilitation therapy as well as at follow-up. Statistical analysis included paired t-test, ANOVA and Pearson's correlation analysis.

Results: Eighty-nine patients with a mean age of 45 years were included in this study. Duration of rehabilitation therapy was 53 days on average. All outcomes improved significantly during rehabilitation therapy. Pain decreased from 6.4 to 2.2. PTPD of digit 2 to 5 improved from 2.5, 2.8, 2.6, and 2.3 cm to 1.3, 1.4, 1.2, and 1.1 cm, respectively. FTTD of digit 2 to 5 decreased from 1.5, 1.7, 1.5, and 1.6 cm to 0.6, 0.8, 0.7, and 0.7 cm, respectively. Strength ameliorated from 9.5, 3.7, 2.7 kg to 17.9, 5.6, 5.0 kg in grip, lateral pinch, and 3-point pinch, respectively. Improvement in range of motion significantly correlated with therapy duration. 54% of patients participated at follow-up after a mean of 7.5 months. Outcome measures at follow-up remained stable compared to discharge values without significant differences.

Conclusion: The ICF-based rehabilitation concept is a reliable and durable treatment option for CRPS of the hand. Range of motion improved continuously with therapy duration and thus may serve as an indicator for optimum length of therapy.

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References
1.
Strickland J, Idler R, Lourie G, Plancher K . The hypothenar fat pad flap for management of recalcitrant carpal tunnel syndrome. J Hand Surg Am. 1996; 21(5):840-8. DOI: 10.1016/S0363-5023(96)80201-2. View

2.
Miller C, Williams M, Heine P, Williamson E, OConnell N . Current practice in the rehabilitation of complex regional pain syndrome: a survey of practitioners. Disabil Rehabil. 2017; 41(7):847-853. DOI: 10.1080/09638288.2017.1407968. View

3.
Harhaus L, Neubrech F, Hirche C, Schilling T, Kohler H, Mayr A . [Complex regional pain syndrome following distal fractures of the radius : Epidemiology, pathophysiological models, diagnostics and therapy]. Unfallchirurg. 2016; 119(9):732-41. DOI: 10.1007/s00113-016-0217-x. View

4.
Buller M, Schulz S, Kasdan M, Wilhelmi B . The Incidence of Complex Regional Pain Syndrome in Simultaneous Surgical Treatment of Carpal Tunnel Syndrome and Dupuytren Contracture. Hand (N Y). 2017; 13(4):391-394. PMC: 6081783. DOI: 10.1177/1558944717718345. View

5.
Smart K, Wand B, OConnell N . Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II. Cochrane Database Syst Rev. 2016; 2:CD010853. PMC: 8646955. DOI: 10.1002/14651858.CD010853.pub2. View