Upper limb activity over time in complex regional pain syndrome type 1 as objectively measured with an upper limb-activity monitor: an explorative multiple case study.
ABSTRACT An upper limb-activity monitor (ULAM) has been developed to determine activity limitations in complex regional pain syndrome type 1 (CRPS1). The ULAM is based on 24h ambulatory monitoring of body segment accelerations and enables valid and objective quantification of mobility and upper limb activity in transversal studies.
To explore upper limb activity over time in acute upper limb CRPS1 as measured with the ULAM in a longitudinal study, and to compare this to time courses of other outcome measures for activity limitations and impairments.
Four subjects were measured four times during a treatment protocol. Several ULAM outcome measures related to upper limb usage and mobility, three questionnaires (RASQ, DASH, RAND36), and six impairment outcome indicators (VAS-momentary pain, VAS-pain resulting from effort, volume, temperature, active range of motion, strength) were used.
Objectively measured upper limb activity frequently improved; improvements of >5% were found for 63% of the ULAM outcome measures at final assessment. The ULAM outcome measures had a time course more similar to the body-part and CRPS1 specific questionnaire RASQ than the other questionnaires. The time course of impaired temperature was most often in accordance with the ULAM, and both VAS scores showed least accordance.
Clear changes in upper limb activity over time were frequently found as objectively measured with the ULAM, and relationships among the time courses of the ULAM and other outcome measures were largely explainable. The ULAM can validly assess upper limb activity over time in CRPS1, but between-measurement variability needs careful consideration.
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ABSTRACT: To conduct a systematic review of the quality and extent of psychometric examinations of disease-specific outcome measures for complex regional pain syndrome (CRPS). Health database searches yielded 23 papers covering 19 assessment instruments. Each article was scored for quality using a 12-item structured tool; data were also extracted for comparison of tool content. Article quality ratings ranged from 25 to 88%. Six of the tools were specific to the upper extremity; 5 for the lower extremities while the remaining 8 were general. Many 'general' tools focused on a single construct, such as pain, skin temperature or allodynia. Most psychometric data was based on small studies (mean n=33); only one study addressed all relevant issues of reliability, validity and responsiveness. Despite the variety of outcome measurement tools reported for CRPS rehabilitation, large gaps in both comprehensiveness and supporting psychometric evidence remain. Comprehensive, relevant and psychometrically sound tools for monitoring treatment outcomes are needed to address the pain and functional limitations experienced by this population.Disability and Rehabilitation 12/2011; 34(13):1059-69. DOI:10.3109/09638288.2011.626835 · 1.84 Impact Factor
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ABSTRACT: There has been a shift in rehabilitation medicine from conventional evaluation procedures towards more quantitative approaches. However, up to now, a quantitative evaluation procedure for upper limb prostheses that is applicable outside of the laboratory or clinical environment has not been established. The requirement for such a procedure arises from the findings of a number of recent studies suggesting that unilateral trans-radial amputees do not involve their prosthesis in task performance in real life situations, even if they are able to demonstrate the use of the prosthesis in the clinical environment. This suggests that laboratory, or clinic-based assessments are limited in the information they provide to clinicians or designers of new prostheses. Further, self-report approaches, such as questionnaires or interviews rely on accurate recall and reporting by subjects, an approach that has been shown to be flawed in other rehabilitation and public health domains. Therefore, this chapter reports a study investigating the feasibility of quantifying the nature and duration of tasks performed with a myoelectric prosthesis by means of an activity monitor. It was hypothesised that by monitoring the prosthesis hand opening and closing it may be possible to identify the manipulation phase. Such information could be used to segment acceleration signals, measured from arm-located accelerometers, which may contain information characterising the task(s) being performed and differentiate it/them from other tasks. The results of this study indicate that, by using a neural network classifier, customised for each user, acceleration signals measured during the manipulation phase of task performance could accurately characterise the task being performed. The implications of these findings and future work are discussed here.11/2009: pages 33-63;
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ABSTRACT: We report a case of type 1 complex regional pain syndrome (CRPS I) of the left leg following the implantation of an artificial disc type in the L4/5 segment of the lumbar spine using a midline left-sided retroperitoneal approach. This approach included the mobilisation of the sympathetic trunk with incision and resection of the intervertebral disc. The perioperative and immediate postoperative periods were uneventful, but on the second postoperative day the patient complained of a progressive allodynia of the whole left leg in combination with weakness of the limb. Neurological examination did not reveal any radicular deficit or paresis. A sympathetic reaction following the mobilisation of the sympathetic trunk during the ventral preparation of the spine was suspected and investigated further. A diagnosis of CRPS I was proposed, and the patient was treated with analgesia, co-analgesics for pain alienation, and systemic corticosteroid therapy. A computed tomography-guided sympathetic block and lymphatic drainage were performed. Following conservative orthopaedic rehabilitation therapy, the degree of pain, allodynia, weakness, and swelling were reduced and the condition of the patient was ameliorated. The cost-benefit ratio of spinal arthroplasty is still controversial. The utility of this paper is to debate a possible cause of a painful complication, which can invalidate the results of a successful operation.European Spine Journal 07/2011; 20 Suppl 2(S2):S278-83. DOI:10.1007/s00586-011-1691-z · 2.47 Impact Factor