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复杂性区域疼痛综合征:临床实践国际调查。

Complex regional pain syndrome: An international survey of clinical practice.

机构信息

CRPS Service, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.

Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.

出版信息

Eur J Pain. 2019 Nov;23(10):1890-1903. doi: 10.1002/ejp.1463. Epub 2019 Aug 22.

Abstract

BACKGROUND

Published guidelines promote best practice in complex regional pain syndrome (CRPS) treatment and management; however, these recommendations are not always applied in clinical practice. Understanding existing care internationally will help inform future patient and health professional service delivery, education initiatives and content of clinical guidelines.

METHODS

An e-survey was conducted in order to gain an insight into routine CRPS clinical practice. Health professionals and academics, from the field of CRPS, were recruited from an international population. Quantitative and qualitative data were elicited. Data were mapped onto a framework to identify macro-regional factors.

RESULTS

Of the 260 survey respondents, 96% (n = 241) provided clinical care for people with CRPS, with academics not involved in patient care also responding. Half of respondents expressed difficulty in recognizing the symptoms of CRPS but treatment aims corresponded with published guidelines. However, a lack of resources and fragmented care were reported as barriers to early intervention. Service constraints were most frequently reported by European respondents. Five themes emerged from the qualitative data: the benefit of interdisciplinary working; the importance of symptom management; need for early diagnosis and intervention; establishing a collaborative partnership with patients; the value of education for patients and health professionals.

CONCLUSIONS

Our data suggest that more work is required to raise awareness of the Budapest CRPS diagnostic criteria so as to promote early diagnosis and intervention. Future work to optimize clinical effectiveness should consider enhancing interdisciplinary service delivery that encourages a collaborative patient/clinician partnership; includes excellent patient education; and addresses modifiable patient-related factors.

SIGNIFICANCE

Health professionals expressed some level of difficulty recognizing the signs and symptoms of CRPS despite the majority of health professionals having had clinical experience exceeding 6 years in the field of CRPS. More work is required to raise awareness amongst clinicians of the Budapest CRPS diagnostic criteria so as to promote early diagnosis and intervention Health professionals' treatment aims reflected the current clinical guidelines however, a lack of resources and fragmented care were frequently cited as barriers to achieving these.

摘要

背景

已发布的指南促进了复杂区域疼痛综合征(CRPS)治疗和管理方面的最佳实践;然而,这些建议在临床实践中并不总是得到应用。了解国际上现有的护理情况将有助于为未来的患者和卫生专业人员服务提供、教育计划和临床指南的内容提供信息。

方法

为了深入了解 CRPS 的常规临床实践情况,我们进行了一项电子调查。从 CRPS 领域招募了国际范围内的卫生专业人员和学者。收集了定量和定性数据。将数据映射到一个框架上,以确定宏观区域因素。

结果

在 260 名调查参与者中,96%(n=241)为 CRPS 患者提供临床护理,包括不参与患者护理的学者也做出了回应。一半的参与者表示难以识别 CRPS 的症状,但治疗目标与已发布的指南相符。然而,资源不足和护理碎片化被报告为早期干预的障碍。服务限制最常被欧洲参与者报告。从定性数据中出现了五个主题:跨学科工作的好处;症状管理的重要性;需要早期诊断和干预;与患者建立合作关系;患者和卫生专业人员教育的价值。

结论

我们的数据表明,需要做更多的工作来提高对布达佩斯 CRPS 诊断标准的认识,以促进早期诊断和干预。未来为优化临床效果而开展的工作应考虑加强跨学科服务提供,鼓励协作的医患伙伴关系;包括出色的患者教育;并解决可改变的患者相关因素。

意义

尽管大多数卫生专业人员在 CRPS 领域拥有超过 6 年的临床经验,但他们在识别 CRPS 的体征和症状方面仍存在一定程度的困难。需要做更多的工作来提高临床医生对布达佩斯 CRPS 诊断标准的认识,以促进早期诊断和干预。卫生专业人员的治疗目标反映了当前的临床指南,但资源不足和护理碎片化经常被认为是实现这些目标的障碍。

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