Physiotherapy Interventions and the Outcomes for Complex Regional Pain Syndrome (CRPS) Type 1 on the South Island of New Zealand – A Longitudinal, Prospective Case Series

Abstract

Physiotherapy is considered in pain medicine to be a key element in the management of Complex Regional Pain Syndrome (CRPS). This is the first paper to document and categorise all physiotherapy intervention methods used as well as evaluate the outcomes of a case series of 18 CRPS patients attending physiotherapy in a prospective, longitudinal study across a region. Outcomes were measured across the region of the South Island of New Zealand over 1 year through independent telephonic interviewing of the pain experience with the McGill Pain Questionnaire-short form, function with Foot Function Index for the lower limb or Disability of the Arm Shoulder and Hand for the upper limb, and quality of life with the World Health Organisation Disability Schedule. Clinical records were accessed for each CRPS participant following discharge from physiotherapy to categorise the intervention methods used. Seventeen participants received intervention for both functional restoration with pain modulation and only one participant received functional restoration with no pain modulation; 12 also received immobilisation with 10 receiving passive interventions. All outcome measures improved significantly by 6 months and were maintained at 1 year. Eighty five percent had their diagnosis of CRPS confirmed within 3 months of their injury; half had fracture as the precipitating injury for their onset of CRPS with a third following soft tissue injury and 11% following surgery. Physiotherapists showed a high variation with the intervention methods used and showed a greater proportion of intervention methods focusing on functional restoration followed by pain modulating interventions. Future research is necessary to define what physiotherapy interventions are efficacious in the management of CRPS.

Complex Regional Pain Syndrome in a Non-traumatic Case: A Case Report

“…Since CRPS lacks identifiable histopathologic or biochemical indicators, a clear and accurate description is required. CRPS is frequently diagnosed by exclusion, relying mainly on clinical examination and bone scans [ 9 ]. When seeking medical attention for shoulder pain, it is important to assess its location, nature, severity, onset, and duration, as well as any potential risk factors.…”

Conservatively treated distal radius fractures. Who is referred?

“…A study by Pons (2019) of the physiotherapy management of CRPS found that fractures were the inciting event for CRPS in 42% of patients, followed by soft tissue injury (36%), and surgery (21%). The incidence of CRPS reported in this study was low (0.8%).…”