Children's Hospital Boston, MA 02115, USA.
Clin J Pain. 2012 Nov-Dec;28(9):766-74. doi: 10.1097/AJP.0b013e3182457619.
To examine clinical outcomes of an interdisciplinary day-hospital treatment program (comprised of physical, occupational, and cognitive-behavioral therapies with medical and nursing services) for pediatric complex regional pain syndrome (CRPS).
The study is a longitudinal case series of consecutive patients treated in a day-hospital pediatric pain rehabilitation program. Participants were 56 children and adolescents with ages 8 to 18 years (median=14 y) with CRPS spectrum conditions who failed to progress sufficiently with a previous outpatient and/or inpatient treatments. Patients participated in daily physical therapy, occupational therapy, and psychological treatment and received nursing and medical care as necessary. The model places equal emphasis on physical and cognitive-behavioral approaches to pain management. Median duration of stay was 3 weeks. Outcome measures included assessments of physical, occupational, and psychological functioning at program admission, discharge, and at posttreatment follow-up at a median of 10 months after discharge. Scores at discharge and follow-up were compared with measures on admission by Wilcoxon tests, paired t tests, or analysis of variance as appropriate, with corrections for multiple comparisons.
Outcomes demonstrate clinically and statistically significant improvements from admission to discharge in pain intensity (P<0.001), functional disability (P<0.001), subjective report of limb function (P<0.001), timed running (P<0.001), occupational performance (P<0.001), medication use (P<0.01), use of assistive devices (P<0.001), and emotional functioning (anxiety, P<0.001; depression, P<0.01). Functional gains were maintained or further improved at follow-up.
A day-hospital interdisciplinary rehabilitation approach seems effective in reducing disability and improving physical and emotional functioning and occupational performance among children and adolescents with CRPSs that have failed to improve with outpatient treatment.
探讨针对儿科复杂性区域疼痛综合征（CRPS）的跨学科日间医院治疗方案（包括物理、职业和认知行为疗法以及医疗和护理服务）的临床结果。
本研究为连续病例系列纵向研究，纳入在日间医院儿科疼痛康复计划中接受治疗的患者。参与者为 56 名年龄在 8 至 18 岁（中位数=14 岁）的患有 CRPS 谱条件的儿童和青少年，他们在先前的门诊和/或住院治疗中未能取得足够进展。患者每天接受物理治疗、职业治疗和心理治疗，并根据需要接受护理和医疗服务。该模式同等重视身体和认知行为方法来管理疼痛。中位住院时间为 3 周。结局指标包括在入院时、出院时和出院后 10 个月的随访时评估身体、职业和心理功能。使用 Wilcoxon 检验、配对 t 检验或适当的方差分析比较出院和随访时的评分与入院时的评分，对多次比较进行校正。
结果显示，从入院到出院，疼痛强度（P<0.001）、功能障碍（P<0.001）、肢体功能主观报告（P<0.001）、计时跑步（P<0.001）、职业表现（P<0.001）、药物使用（P<0.01）、辅助设备使用（P<0.001）和情绪功能（焦虑，P<0.001；抑郁，P<0.01）方面均有临床和统计学意义的显著改善。在随访时，功能增益得以维持或进一步改善。
日间医院多学科康复方法似乎可有效减少残疾，改善儿童和青少年 CRPS 患者的身体和情绪功能以及职业表现，这些患者在门诊治疗后未能改善。
