Mechanism-specific rehabilitation management of complex regional pain syndrome: Proposed recommendations from evidence synthesis.

STUDY DESIGN: Narrative review. INTRODUCTION: There are a variety of treatments with demonstrated effectiveness for the management of complex regional pain syndrome (CRPS). However given the variability in symptom presentation in this population, therapists may be unsure what treatments would be most effective for individual clients. PURPOSE OF THE STUDY: To present a brief synthesis of the literature and propose a rehabilitation version of a mechanism-specific management algorithm to guide personalized treatment of CRPS. METHODS: A systematic search of the literature was conducted to identify all randomized controlled trials, systematic reviews, and clinical practice guidelines addressing rehabilitation of CRPS. Results were reviewed independently by 2 reviewers and final selection of articles was reached by consensus, Data was extracted using standardized forms, and a single rater gave quality ratings. Both reviewers then used the extracted data to present a synthesis of the evidence categorized by the proposed mechanisms of effect. RESULTS: A total of 111 articles were retrieved and reviewed for inclusion; 49 were selected for data extraction. A synthesis of the key recommendations was compiled into a rehabilitation-specific version of the mechanism-based management algorithm proposed by Gierthmühlen et al (2014). CONCLUSIONS: Consideration of mechanism-appropriate rehabilitation interventions may assist therapists to select the most appropriate and effective treatments from the body of evidence supporting rehabilitation of CRPS.

Barriers to Physiotherapists' Use of Professional Development Tools for Chronic Pain: A Knowledge Translation Study.

Purpose: The Pain Science Division (PSD) is a special interest group of the Canadian Physiotherapy Association that serves physiotherapists who have an interest in better understanding and managing patients' pain. The PSD developed evidence-based resources for its members with the goal of improving patient care by supporting professional development. However, online metrics tracking access to these resources indicated that access was low. The purpose of this study was to identify the barriers PSD members encountered to the use of PSD resources and to recommend interventions to address these barriers guided by the Theory and Techniques Tool (TTT). Method: We distributed an online survey to PSD members across Canada. We used the TTT, a knowledge translation tool, to guide the design of the questionnaire and identify actionable findings. Results: Response rates from 621 non-student members and 1,470 student members were 26.9% and 1.4%, respectively. Based on the frequency of practising physiotherapists' (n = 167) agreement with items in the TTT, the primary barriers to use of the PSD resources were forgetting that the resources were available and forgetting to use them. Conclusions: The TTT can be used to identify barriers to use of professional development tools.

Objectif : la division science de la douleur (DSD) est un groupe d'intérêt de l'Association canadienne de physiothérapie destiné aux physiothérapeutes qui souhaitent mieux comprendre et gérer la douleur des patients. La DSD a préparé des ressources fondées sur des données probantes pour ses membres afin d'améliorer les soins aux patients grâce au perfectionnement professionnel. Cependant, les mesures virtuelles qui surveillent l'accès à ces ressources ont révélé que cet accès était limité. La présente étude visait à établir les obstacles auxquels se sont heurtés les membres de la DSD pour utiliser les ressources de la DSD et à recommander des interventions afin d'écarter ces obstacles en fonction de l'outil Theory and Techniques (TTT). Méthodologie : les chercheurs ont distribué un sondage en ligne aux membres de la DSD du Canada. Ils ont utilisé le TTT, un outil d'application des connaissances, pour orienter la conception du questionnaire et déterminer les résultats réalisables. Résultats : le taux de réponse des 621 membres non étudiants et des 1 470 membres étudiants s'établissait à 26,9 % et à 1,4 %, respectivement. D'après la fréquence d'accord des physiothérapeutes en exercice (n = 167) avec les points du TTT, l'oubli de l'existence des ressources ou l'oubli de les utiliser étaient les principaux obstacles à l'utilisation des ressources de la DSD. Conclusions : le TTT peut être utilisé pour déterminer les obstacles à l'utilisation d'outils de perfectionnement professionnel.

Recommendations for a first Core Outcome Measurement set for complex regional PAin syndrome Clinical sTudies (COMPACT).

Complex regional pain syndrome (CRPS) is a persistent pain condition that remains incompletely understood and challenging to treat. Historically, a wide range of different outcome measures have been used to capture the multidimensional nature of CRPS. This has been a significant limiting factor in the advancement of our understanding of the mechanisms and management of CRPS. In 2013, an international consortium of patients, clinicians, researchers, and industry representatives was established, to develop and agree on a minimum core set of standardised outcome measures for use in future CRPS clinical research, including but not limited to clinical trials within adult populations. The development of a core measurement set was informed through workshops and supplementary work, using an iterative consensus process. "What is the clinical presentation and course of CRPS, and what factors influence it?" was agreed as the most pertinent research question that our standardised set of patient-reported outcome measures should be selected to answer. The domains encompassing the key concepts necessary to answer the research question were agreed as follows: pain, disease severity, participation and physical function, emotional and psychological function, self-efficacy, catastrophizing, and patient's global impression of change. The final core measurement set included the optimum generic or condition-specific patient-reported questionnaire outcome measures, which captured the essence of each domain, and 1 clinician-reported outcome measure to capture the degree of severity of CRPS. The next step is to test the feasibility and acceptability of collecting outcome measure data using the core measurement set in the CRPS population internationally.