Background & Aims
CRPS is a painful condition that often develops following trauma or surgery to a limb. CRPS’s unremitting symptoms are associated with long-term disability, poor psychological health, decreased emotional and social well-being, and reduced quality of life. Effective treatment for persistent CRPS is notoriously difficult. Although rehabilitation interventions are often recommended for CRPS treatment, disparities occur between guidelines regarding the optimal rehabilitation interventions for CRPS treatment. Additionally, the neurophysiological basis of these interventions remains unclear, and the outcomes used to explore their effectiveness are inconsistent. This scoping review will explore the rehabilitation interventions used for the treatment of adults living with CRPS, describing their neurophysiological bases, and examining the outcomes used to test their effectiveness.
Methods
This scoping review was carried out using the Joanna Briggs Institute (JBI) methodology. MEDLINE (PubMed), Embase, Scopus, APA PsycINFO (EBSCO), CINAHL, Cochrane, Scopus, OpenGrey Google, ProQuest Dissertations, and Theses Global ProQuest were searched for studies in English published between 2007-2023, coinciding with the development of the Budapest Criteria for CRPS diagnosis. Studies that described any form of rehabilitation delivered by a healthcare professional for adults with CRPS were included. Three independent reviewers in pairs of two screened the titles, abstracts, and full texts of the selected studies. Data collection was performed using a data extraction tool developed by the researchers based on the standardized JBI tool. The results summarised the description of rehabilitation interventions, the neurophysiological bases of the interventions, and the outcomes to assess their effectiveness.
Results
Database searches yielded 624 titles, of which 65 studies met the inclusion criteria. Reviews (17), experimental designs (26), observational designs (3), clinical and case series (12), surveys (1), clinical guidelines (2), qualitative studies (1), and opinion papers (3) were included. Rehabilitation interventions for adults with CRPS were grouped into: educational interventions (e.g., pain neuroscience education), physical exercise interventions (e.g., range of movement), psychological/brain interventions (e.g., mirror therapy), exposure-based therapies (e.g., pain exposure therapy), and passive therapies (e.g., transcutaneous electrical nerve stimulation). There was a limited reporting regarding the neurophysiological bases of these interventions. Pain and disability were the most common outcomes used to assess the effectiveness of CRPS rehabilitation interventions, although other outcome measures such as body perception disturbances, pain-related fear, or pain acceptance were used.
Conclusions
This review provides the current state of the art in rehabilitation interventions used in adults with CRPS. We found a large heterogeneity in the rehabilitation strategies used in adult CRPS rehabilitation, and a broad range of outcome measures, which complicates comparisons among studies. Mechanisms of CRPS rehabilitation interventions are often insufficiently described. To develop a “best practice” model of rehabilitation intervention in CRPS, a better understanding of the neuropsychological mechanisms underlying rehabilitation interventions is required. Besides, consistency regarding outcome measures used to investigate the effectiveness of these interventions is essential. Then, these “best practice” models can be tested against usual or minimal care.
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Presenting Author
Marc Aureli Pique Batalla
Poster Authors
Topics
- Specific Pain Conditions/Pain in Specific Populations: Complex Regional Pain Syndrome (CRPS)