Report of a focus group survey of current practice in the therapeutic treatment of Complex Regional Pain Syndrome in the United Kingdom

Abstract

Complex Regional Pain Syndrome (CRPS) typically affects the hand following trauma. It is characterised by pain, altered sensation, motor disturbance, oedema, functional limitation and psychological disturbance. There is no definitive curative treatment for CRPS and controversy exists regarding the most effective combination of interventions for the treatment of this syndrome (Siddiqui et al 2001). A study was commissioned in 2006 to explore the therapeutic interventions being implemented with patients with CRPS in the UK. Sixty therapists at the British Association of Hand Therapists annual conference consented to participate in focus group discussions. Categories were established to identify all therapeutic modalities currently used by participants. Therapists utilised the following therapeutic techniques: functional activity, exercise, education, support, sensory re-education, desensitisation, stress loading, pressure garments, mirror visual feedback, splints and psychological strategies, amongst others. The identified interventions were then reviewed against evidence in the recent literature. There is insufficient evidence to support the use of a single set of multidisciplinary interventions (Stanton-Hicks et al 2002) to address the primary long-term goals of functional restoration and pain relief. This study has, however, highlighted that this is achieved through the treatment of individual symptoms, using multiple therapeutic interventions and algorithms in a multidisciplinary approach.

An occupational perspective in hand therapy: A scoping review

“…The purposeful tasks were determined by the occupational therapist, defined as activities selected to develop skills for performance in occupations (Che Daud et al, 2016b). This is similar to functional activities outlined as a contemporary therapeutic treatment method utilised by therapists in a study by Ramsey (2008). Although these interventions seemed to focus on occupations, it appeared that there were still reductions to a 'mechanistic default', as described by Robinson et al (2016), as the main focus was often still on biomechanical components rather than occupation.…”

“…Without rigorous research design, the link between an occupational perspective and patient outcomes in hand therapy is unsubstantiated. Only three studies used qualitative methods to explore therapists’ perceptions of their practice relating to an occupational perspective (Che Daud et al., 2016a; Colaianni et al., 2015; Ramsey, 2008). Further research observing and exploring occupational therapists’ actions, understandings and meanings in relation to an occupational perspective in hand therapy practice is required.…”

Complex regional pain syndrome: An international survey of clinical practice

“…To gain an insight into routine CRPS clinical practice and better understand what care is being delivered globally, we conducted an international e-survey of clinical practice. Previous surveys investigating CRPS clinical practice have focused primarily on identifying current interventions used within specialist groups, such as health practitioners involved in rehabilitation (Miller, Williams, Heine, Williamson, & O'Connell, 2017), American interventional pain specialists (Burton, Hassenbusch, Warneke, Racz, & Stanton-Hicks, 2004), and delegates at a British Hand Therapists annual conference (Ramsey, 2008). CRPS clinical practice has not been investigated more extensively in relation to the characteristics of the health professionals providing the care, the care pathway and treatment aims.…”