Highlights
- •Therapists can act as patient champions in complex regional pain syndrome (CRPS).
- •Therapists act as change agents in an interdisciplinary CRPS community of practice.
- •Simple practice changes reduce the incidence of CRPS after distal radius fractures.
Abstract
Study Design
Implementation paper.
Introduction
Complex regional pain syndrome (CRPS) is relatively a common condition in the distal
radius fracture (DRF) population with the effects resulting in many sufferers experiencing
persistent pain and impairment 2 to 6 years after onset. Prevention is desirable as
there is no known proven cure.
Purpose of the Study
This study demonstrates how knowledge about CRPS and its prevention generated through
iterative studies can be translated into practice in the workplace and how an interdisciplinary
community of practice with therapists at the core can effect change.
Methods
A series of practice changes were introduced including a patient information leaflet,
a local gold standard for care of DRF, education for staff regarding risk factors
and early warning signs of CRPS, and simple patient and staff visual aids.
Results
The incidence of CRPS was reduced from 25% to 1% in the DRF population at the study
site, and collaborative care pathways were ingrained onto the working culture.
Discussion
The process of learning together fostered the development of an interdisciplinary
team with therapists acting as CRPS champions. Interdisciplinary team reflective practice
facilitated simple but effective interventions, which reduced the incidence of CRPS
in DRF population locally. It is not yet known whether this is transferable.
Conclusions
Simple interventions can have a significant impact on the incidence of CRPS in a community
of practice where a culture of team reflection and shared learning occurs.
Keywords
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References
- A complex regional pain syndrome type 1: risk factors, prevention and risk of recurrence.J Hand Surg Br. 2004; 29: 334-337
- Algodystrophy after Colles fracture is associated with secondary tightness of casts.J Bone Jt Surg. 1994; 76: 901-905
- The incidence of complex regional pain syndrome: a population-based study.Pain. 2007; 129: 12-20
- Impairments and activity limitations in subjects with chronic upper-limb complex regional pain syndrome type I.Arch Phys Med Rehabil. 2004; 85: 557-566
- The association between ACE inhibitors and the complex regional pain syndrome: suggestions for a neuro-inflammatory pathogenesis of CRPS.Pain. 2009; 142: 218-224
- Complex regional pain syndrome in adults UK guidelines for diagnosis, referral and management in primary and secondary care.(Available at:)http://crpsukdotcom.files.wordpress.com/2012/06/crps-guideline-may-012.pdfDate accessed: September 30, 2017
- Lost in knowledge translation: time for a map?.J Contin Educ Health Prof. 2006; 26: 13-24
- Defining knowledge translation.CMAJ. 2009; 181: 165-168
- A compilation of strategies for implementing clinical innovations in health and mental health.Med Care Res Rev. 2012; 69: 123-157
- Can we reduce the incidence of complex regional pain syndrome type I in distal radius fractures? The Liverpool experience.Hand Ther. 2016; 21: 123-130
- Key statistics and data.(Available at:)http://liverpool.gov.uk/council/key-statistics-and-data/data/population/Date accessed: January 21, 2018
- “The Change Masters: Corporate Entrepreneurs at Work”.Unwin Paper Backs, London1983
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JHT Read for Credit
Quiz: #538
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- #1.The suggested best approach to management of CRPS following DRFx is
- a.graded stress loading to the upper extremity
- b.AROM + graded resistive exercise
- c.prevention
- d.compression circumferential splinting
- a.
- #2.In developing their strategy to CRPS the authors credit_________ for the success their clinic noted
- a.a team approach
- b.encouraging patients to be “Pain Control Champions”
- c.strict adherence to treatment interventions
- d.the confluence of a “drug cocktail” and hands-on therapy
- a.
- #3.An initial questionnaire revealed that
- a.surgical residents were more knowledgeable about DRFx than were the hand therapists
- b.hand therapists were more knowledgeable about DRFx than were the surgical residents
- c.there was uniform knowledge about DRFx management, albeit limited in scope, across the various disciplines responsible for patient care
- d.there was inconsistent knowledge about DRFx management across the various professional disciplines responsible for patient care
- a.
- #4.Educational efforts were directed at
- a.the patients
- b.the staff
- c.both a and b above
- d.university faculty
- a.
- #5.This article identifies and describes the known proven method to cure CRPS following DRFx
- a.true
- b.false
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Accepted:
January 30,
2018
Received in revised form:
January 29,
2018
Received:
November 6,
2017
Identification
Copyright
© 2018 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.
