目的:本研究的目的是评估住院治疗对降低门诊选择用尽的CRPS患者疾病活动的益处。此外,该研究试图确定预测疾病活动度降低的患者相关结局变量.
方法:主要结局是疾病严重程度(CRPS严重程度评分,范围0-16点))。次要结果包括抑郁症,焦虑,物理功能,疼痛干扰,疲劳,睡眠障碍,参与社会角色和活动的能力,所有这些都使用Promis-29进行评估.此外,痛苦的灾难,神经性疼痛,生活质量,疼痛自我效能感,药物摄入量,并根据当前国际商定的建议检查患者的全球变化印象,出院时评估,出院后三个月和六个月。进行混合效应模型以确定与CRPS严重程度相关的基线变量。
结果:25名患者完成了该计划(平均年龄49.28(SD11.23)岁,92%女性,平均症状持续时间8.5(SD6.5)个月)。结果显示基线和疾病活动放电之间显著降低(CSS-2.36,p<0.0001),疼痛(PROMIS-29疼痛-0.88,p=0.005)和情绪功能(PROMIS-29抑郁-5.05,p<0.001;疲劳-4.63,p=0.002)。对于疼痛干扰,可以观察到基线和出院之间减少的中度证据(2.27,p=0.05),社会参与(PROMIS-29+1.93,p=0.05),焦虑(PROMIS-29-3.32,p=0.02)和身体功能(PROMIS-29+1.3,p=0.03)。出院时,92%的患者(25人中有23人)报告其总体状况有所改善。在后续阶段,3个月(MQS-8.22,p=0.002)和6个月(MQS-8.69,p=0.001)后可减少药物摄入量,3个月后(PROMIS-29+1.72,0.03)和6个月后(PROMIS-29+2.38,0.008)睡眠进一步改善。在混合模型中,研究表明,基线时疼痛较轻的患者也表现出疾病活动度较低.
结论:这项研究的结果证实,CRPS患者的住院跨学科治疗可以改善疾病活动,疼痛,物理功能,情感功能,和社会参与。大多数改善在出院后保持了六个月。大多数患者报告说,他们的整体状况在研究期间有所改善。
OBJECTIVE: The aim of this
study was to evaluate the benefit of inpatient treatment in reducing disease activity in patients with complex regional pain syndrome (CRPS) who have exhausted outpatient options. Furthermore, the
study sought to identify patient-related outcome variables that predict a reduction in disease activity.
METHODS: The primary outcome was disease severity (CRPS Severity Score, range 0-16 points). Secondary outcomes included depression, anxiety, physical function, pain interference, fatigue, sleep disturbance, and the ability to participate in social roles and activities, all of which were assessed using the PROMIS-29. Furthermore, pain catastrophizing, neuropathic pain, quality of life, pain self-efficacy, medication intake, and the patient\'s global impression of change were examined in accordance with current international agreed recommendations, assessed at discharge, 3-month, and 6-month post-discharge. Mixed-effects models were conducted to identify baseline variables associated with CRPS severity.
RESULTS: Twenty-five patients completed the program (mean age 49.28 [SD 11.23] years, 92% females, mean symptom duration 8.5 [SD 6.5] months). Results showed a significant reduction between baseline and discharge of disease activity (CSS -2.36, P < .0001), pain (PROMIS-29 pain -0.88, P = .005), and emotional function (PROMIS-29 depression -5.05, P < .001; fatigue -4.63, P = .002). Moderate evidence for a reduction between baseline and discharge could be observed for pain interference (+2.27, P = .05), social participation (PROMIS-29 + 1.93, P = .05), anxiety (PROMIS-29 -3.32, P = .02) and physical function (PROMIS-29 + 1.3, P = .03). On discharge, 92% of patients (23 of 25) reported improvement in their overall condition. In the follow-up period, medication intake could be reduced after 3 (MQS -8.22, P = .002) and 6 months (MQS -8.69, P = .001), and there was further improvement in social participation after 3 months (PROMIS-29 + 1.72, 0.03) and sleep after 6 months (PROMIS-29 + 2.38, 0.008). In the mixed models, it was demonstrated that patients experiencing less pain at baseline also exhibited lower disease activity.
CONCLUSIONS: The results of this
study confirm that inpatient interdisciplinary treatment of CRPS patients improves disease activity, pain, physical function, emotional function, and social participation. Most improvements were maintained for up to 6 months after discharge. The majority of patients reported that their overall condition had improved during the
study period.