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Is physiotherapy effective for children with complex regional pain syndrome type 1?
Andrea E Bialocerkowski1, Anne Daly
1School of Biomedical and Health Sciences, University of Western Sydney, Sydney, Australia. a.bialocerkowski@uws.edu.au
Insights
Physiotherapy, combined with other treatments, may offer short-term relief for children with complex regional pain syndrome type 1 (CRPS-1), but evidence quality is low. Further high-quality research is needed to confirm effectiveness and guide treatment.
Area of Science:
- Pediatric Pain Management
- Rehabilitation Medicine
- Evidence Synthesis
Background:
- Complex Regional Pain Syndrome type 1 (CRPS-1) is a debilitating condition in children.
- Effective management strategies for pediatric CRPS-1 are crucial for improving function and quality of life.
- Current evidence on physiotherapy's role in pediatric CRPS-1 requires synthesis to inform clinical practice.
Purpose of the Study:
- To synthesize current research on physiotherapy effectiveness for pediatric CRPS-1.
- To develop updated physiotherapy treatment recommendations for children with CRPS-1.
- To identify research gaps in the management of pediatric CRPS-1.
Main Methods:
- A systematic search of nine electronic databases was conducted for quantitative studies.
- Studies evaluating physiotherapy interventions for children with CRPS-1 were included.
- Methodological quality was assessed using the Critical Review Form, with data extraction on study design, participants, outcomes, and interventions.
Main Results:
- Twelve studies met inclusion criteria, predominantly case series, with poor to fair methodological quality.
- The independent effect of physiotherapy could not be isolated due to combined interventions.
- Limited evidence suggests physiotherapy with other treatments may yield short-term functional improvements, but relapse rates can be moderate.
Conclusions:
- High-quality research is essential for establishing effective pediatric CRPS-1 management.
- Future studies should assess comprehensive care packages including physiotherapy.
- Investigating physiotherapy treatments proven effective in adults and using validated outcome measures is recommended.
Objectives:
This study synthesized current research evidence on the effectiveness of physiotherapy for the management of children diagnosed with complex regional pain syndrome type 1 (CRPS-1), to provide up-to-date physiotherapy treatment recommendations, and to identify areas that require further investigation.
Methods:
Nine electronic databases were searched for quantitative studies that evaluated the effect of physiotherapy on children with CRPS-1. The methodological quality of the studies was evaluated using the Critical Review Form. Data were extracted regarding the study design, participant characteristics, types of outcome measures used, and physiotherapy technique used and its effectiveness.
Results:
The search strategy identified 303 potential studies, of which 12 met the inclusion criteria (1 randomized controlled trial, 1 comparative study, 10 case series). The methodological quality of all studies was rated as poor to fair. The "stand-alone" value of physiotherapy could not be determined as physiotherapy was prescribed in conjunction with psychological and medical interventions. There is low volume and poor-to-fair quality evidence which suggests that physiotherapy prescribed with other interventions may lead to short-term improvement in the signs and symptoms of CRPS-1 or functional ability in children with CRPS-1, and the relapse rate may be moderately high.
Discussion:
High-quality studies are required in this area. These studies should evaluate a package of care (which includes physiotherapy); they should investigate the effects of physiotherapy treatments that have proven effectiveness in adults with CRPS-1; they should use psychometrically sound measures to evaluate outcome; and the nature of physiotherapy should be detailed in future publications to enable replication in the clinical setting.
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