Abstract:Introduction: Complex regional pain syndrome is a multifaceted condition, which is relatively common after distal radius fracture. Method: A series of audits and service evaluations were conducted from 2004 to 2013 to investigate the incidence of complex regional pain syndrome type I and any correlation to tight, restrictive, over-flexed casts. Simple subsequent clinical and patient management changes were implemented and impact re-evaluated. Results: These audits have contributed to organisational learning an… Show more
“…Most patients have short‐lasting CRPS which may improve within a few months, even without treatment (Zyluk, ), so that these patients are best treated in non‐specialized care, provided by healthcare professionals who have had standard training within their discipline (e.g., physiotherapist and general practitioner—see Figure ); early treatment is highly likely to shorten the time of suffering for many patients (Gillespie et al, ).Standard 5: Referral to specialized care must be initiated for those patients who do not have clearly reducing pain and improving function, within 2 months of commencing treatment for their CRPS, despite good patient engagement in rehabilitation.…”
Section: Resultsmentioning
confidence: 99%
“…Immobilization of the CRPS limb should be avoided wherever possible. (Gillespie et al, ; Oerlemans, Oostendorp, de Boot, & Goris, /10).Standard 13: Patient's limb function, overall function and activity participation, including in the home and at work or school, must be assessed early and repeatedly as appropriate. Patients should have access to vocational rehabilitation (as relevant).Standard 14: Patients with CRPS must have access to rehabilitation treatment, delivered by physiotherapists and/or occupational therapists, as early as possible in their treatment pathway.…”
Section: Resultsmentioning
confidence: 99%
“…Most patients have short-lasting CRPS which may improve within a few months, even without treatment (Zyluk, 1998), so that these patients are best treated in non-specialized care, provided by healthcare professionals who have had standard training within their discipline (e.g., physiotherapist and general practitioner-see Figure 3); early treatment is highly likely to shorten the time of suffering for many patients (Gillespie et al, 2016).…”
Section: Standardmentioning
confidence: 99%
“…Immobilization of the CRPS limb should be avoided wherever possible. (Gillespie et al, 2016;Oerlemans, Oostendorp, de Boot, & Goris, 1999/10).…”
Section: Physical and Vocational Rehabilitationmentioning
confidence: 99%
“…It is thought to be pathological not psychopathological in origin (Beerthuizen et al, ; Beerthuizen, van 't Spijker, Huygen, Klein, & de Wit, ). Most patients will improve over time (de Mos et al, ; Zyluk, ), although appropriate management very likely hastens recovery (Gillespie, Cowell, Cheung, & Brown, ). However, full recovery is less common, and many patients will be left with varying degrees of persistent pain and functional impairment (Bean, Johnson, Heiss‐Dunlop, & Kydd, ).…”
Background
Complex regional pain syndrome is a painful and disabling post‐traumatic primary pain disorder. Acute and chronic complex regional pain syndrome (CRPS) are major clinical challenges. In Europe, progress is hampered by significant heterogeneity in clinical practice. We sought to establish standards for the diagnosis and management of CRPS.
Methods
The European Pain Federation established a pan‐European task force of experts in CRPS who followed a four‐stage consensus challenge process to produce mandatory quality standards worded as grammatically imperative (must‐do) statements.
Results
We developed 17 standards in 8 areas of care. There are 2 standards in diagnosis, 1 in multidisciplinary care, 1 in assessment, 3 for care pathways, 1 in information and education, 4 in pain management, 3 in physical rehabilitation and 2 on distress management. The standards are presented and summarized, and their generation and consequences were discussed. Also presented are domains of practice for which no agreement on a standard could be reached. Areas of research needed to improve the validity and uptake of these standards are discussed.
Conclusion
The European Pain Federation task force present 17 standards of the diagnosis and management of CRPS for use in Europe. These are considered achievable for most countries and aspirational for a minority of countries depending on their healthcare resource and structures.
Significance
This position statement summarizes expert opinion on acceptable standards for CRPS care in Europe.
“…Most patients have short‐lasting CRPS which may improve within a few months, even without treatment (Zyluk, ), so that these patients are best treated in non‐specialized care, provided by healthcare professionals who have had standard training within their discipline (e.g., physiotherapist and general practitioner—see Figure ); early treatment is highly likely to shorten the time of suffering for many patients (Gillespie et al, ).Standard 5: Referral to specialized care must be initiated for those patients who do not have clearly reducing pain and improving function, within 2 months of commencing treatment for their CRPS, despite good patient engagement in rehabilitation.…”
Section: Resultsmentioning
confidence: 99%
“…Immobilization of the CRPS limb should be avoided wherever possible. (Gillespie et al, ; Oerlemans, Oostendorp, de Boot, & Goris, /10).Standard 13: Patient's limb function, overall function and activity participation, including in the home and at work or school, must be assessed early and repeatedly as appropriate. Patients should have access to vocational rehabilitation (as relevant).Standard 14: Patients with CRPS must have access to rehabilitation treatment, delivered by physiotherapists and/or occupational therapists, as early as possible in their treatment pathway.…”
Section: Resultsmentioning
confidence: 99%
“…Most patients have short-lasting CRPS which may improve within a few months, even without treatment (Zyluk, 1998), so that these patients are best treated in non-specialized care, provided by healthcare professionals who have had standard training within their discipline (e.g., physiotherapist and general practitioner-see Figure 3); early treatment is highly likely to shorten the time of suffering for many patients (Gillespie et al, 2016).…”
Section: Standardmentioning
confidence: 99%
“…Immobilization of the CRPS limb should be avoided wherever possible. (Gillespie et al, 2016;Oerlemans, Oostendorp, de Boot, & Goris, 1999/10).…”
Section: Physical and Vocational Rehabilitationmentioning
confidence: 99%
“…It is thought to be pathological not psychopathological in origin (Beerthuizen et al, ; Beerthuizen, van 't Spijker, Huygen, Klein, & de Wit, ). Most patients will improve over time (de Mos et al, ; Zyluk, ), although appropriate management very likely hastens recovery (Gillespie, Cowell, Cheung, & Brown, ). However, full recovery is less common, and many patients will be left with varying degrees of persistent pain and functional impairment (Bean, Johnson, Heiss‐Dunlop, & Kydd, ).…”
Background
Complex regional pain syndrome is a painful and disabling post‐traumatic primary pain disorder. Acute and chronic complex regional pain syndrome (CRPS) are major clinical challenges. In Europe, progress is hampered by significant heterogeneity in clinical practice. We sought to establish standards for the diagnosis and management of CRPS.
Methods
The European Pain Federation established a pan‐European task force of experts in CRPS who followed a four‐stage consensus challenge process to produce mandatory quality standards worded as grammatically imperative (must‐do) statements.
Results
We developed 17 standards in 8 areas of care. There are 2 standards in diagnosis, 1 in multidisciplinary care, 1 in assessment, 3 for care pathways, 1 in information and education, 4 in pain management, 3 in physical rehabilitation and 2 on distress management. The standards are presented and summarized, and their generation and consequences were discussed. Also presented are domains of practice for which no agreement on a standard could be reached. Areas of research needed to improve the validity and uptake of these standards are discussed.
Conclusion
The European Pain Federation task force present 17 standards of the diagnosis and management of CRPS for use in Europe. These are considered achievable for most countries and aspirational for a minority of countries depending on their healthcare resource and structures.
Significance
This position statement summarizes expert opinion on acceptable standards for CRPS care in Europe.
Objective
To conduct a systematic review to identify which tools are being used to assess body perception disturbances in Complex Regional Pain Syndrome (CRPS) and to provide an evidence‐based recommendation in the selection of an assessment tool, based on measurement properties.
Databases and data treatment
Five electronic databases (EMBASE, Pubmed, PsycInfo, Science Direct and Web of Science) were searched for English or French written articles, with no time restrictions. All original articles using a body perception assessment tool with adult patients with CRPS were selected, regardless of their design (controlled trials, single case, qualitative study). Two investigators screened abstracts, selected full articles and extracted data independently.
Results
Thirty‐eight full‐text papers were obtained and three main methods to evaluate body perception disturbances were identified: The Bath Body Perception Disturbance Scale, the Neglect‐like Symptoms questionnaire adapted from Galer and the patient's body perception description. No full psychometric assessments were found. The Limb Laterality Recognition Task was also used in conjunction with another method.
Conclusions
Three main assessment methods for CRPS body perception disturbances are currently used. Full psychometric evaluation has not been completed for any of the assessment methods. As a consequence, we could not fully apply the COSMIN guideline. To date, there is no agreement concerning the use of a specific questionnaire or scale. The results indicate a need for further research such as psychometric properties of these questionnaires.
Significance
This systematic review identified body perception disturbances assessment methods and their the psychometric properties in order to provide help and guidance to researchers and clinicians to investigate those clinical features.
IntroductionComplex Regional Pain Syndrome (CRPS) is a disabling and distressing chronic pain condition characterised by a range of sensory, motor, autonomic and trophic symptoms. Guidelines recommend early referral for therapies that promote movement of the painful limb. However, evidence suggests a lack of defined therapy pathways for CRPS.AimsThe current study aims to explore CRPS therapy management in centres of excellence in England, and outside of these settings, to understand what facilitates and hinders best practice. The overall aim is to develop a draft stratified package of care to expedite patient access to optimal CRPS therapy across the management pathway.Methods and AnalysisSemi‐structured interviews will be conducted with therapists working in CRPS centres of excellence and with therapists in other settings. Observations of therapy interventions in CRPS centres of excellence and interviews with patients who have received this care, will also help to identify potential key care package components. Interview data will be analysed using thematic analysis, mapped to the Theoretical Domains Framework (TDF), and Intervention Mapping Adapt (IMA) framework. Observations will be described and documented using the TDF headings.ConclusionA triangulation protocol for qualitative health research will be used to integrate all data. Online stakeholder events will be held using consensus methods to agree a draft package of care for future implementation following further refinement, testing and evaluation.Clinical Trial RegistrationThe trial was registered with ISRCTN registry on 24 February 2022 (ISRCTN16917807).
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