A Day-hospital Approach to Treatment of Pediatric Complex Regional Pain Syndrome: Initial Functional Outcomes
Open accessAbstract
OBJECTIVES: 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). METHODS: 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. RESULTS: 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. DISCUSSION: 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.
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For specific conditions, such as CRPS, early individualized intensive physical therapy is considered best.
“There are also data to suggest that for specific conditions, such as CRPS, early individualized intensive physical therapy is considered best [108,109].”
From Best-evidence for the rehabilitation of chronic pain part 1: Pediatric pain (2019) · cites this paper as [108]
The Methods (Description of treatment; page not provided) describe individualized physical therapy within an intensive day-hospital program for children with CRPS. But the Participants section says these children had failed to progress with conventional outpatient treatment, so this does not establish that early treatment is best. The Discussion favors an integrated approach rather than physical therapy alone. (LLM, conf=0.87)
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- Authors
- Logan, D. E., Carpino, E. A., Chiang, G., Condon, M., Firn, E., Gaughan, V. J., Hogan, M., Leslie, D. S., Olson, K., Sager, S., Sethna, N., Simons, L. E., Zurakowski, D., & Berde, C. B.
- Affiliations
- Boston Children's Hospital (US)
- Franciscan Hospital for Children (US)
- Corresponding author
- Logan, Deirdre E.
- Carpino, Elizabeth A.
- Chiang, Gloria
- Condon, Marianne
- Firn, Emily
- Gaughan, Veronica J.
- Hogan, Melinda
- Olson, Katie
- Sager, Susan
- Sethna, Navil
- Simons, Laura E.
- Zurakowski, David
- Berde, Charles B.
- Venue
- The Clinical Journal of Pain
- Published
- 2012-11
- Volume
- 28
- Issue
- 9
- Pages
- 766-774
- ISSN
- 0749-8047 (ISSN-L)
- PMC
- PMC3884573
- OpenAlex
- W2324396819
- Cited by
- 152
- References
- 44
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 6 · 2023: 8 · 2022: 11 · 2021: 9 · 2020: 12 · 2019: 14 · 2018: 7 · 2017: 12 · 2016: 18 · 2015: 14 · 2014: 15 · 2013: 13 · 2012: 5
- FWCI
- 20.06
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Clinical Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Wellcome Trust
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD067202)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Keywords
- complex regional pain syndrome, pediatric CRPS, day hospital, interdisciplinary rehabilitation, pain rehabilitation, physiotherapy, occupational therapy, cognitive behavioral therapy, functional disability, pain intensity, emotional functioning, adolescents, treatment outcomes
- MeSH terms
- Adolescent, Child, Female, Persons with Disabilities, Hospitalization, Humans, Longitudinal Studies, Male, Motor Activity, Occupational Therapy, Patient Discharge, Predictive Value of Tests, Psychiatric Status Rating Scales, Retrospective Studies, Cognitive Behavioral Therapy, Treatment Outcome, Complex Regional Pain Syndromes, Self Report, Pain Management
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