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Short- and Long-term Outcomes of Children with Complex Regional Pain Syndrome Type I Treated with Exercise Therapy

Sherry, David D. M.D.; Wallace, Carol A. M.D.; Kelley, Claudia O.T.*; Kidder, Monica P.T.*; Sapp, Lyn R.N.

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Objective: To report the initial and long-term outcome after an intensive exercise therapy program for childhood complex regional pain syndrome, type I (CRPS).

Design: Prospective follow-up.

Setting: A children's hospital.

Subjects: We followed 103 children (87 girls; mean age = 13.0 years) with CRPS. Forty-nine subjects were followed for more than 2 years (mean = 5 years 3 months).

Interventions: An intensive exercise program (most received a daily program of 4 hours of aerobic, functionally directed exercises, 1-2 hours of hydrotherapy, and desensitization). No medications or modalities were used. All had a screening psychological evaluation, and 79 (77%) were referred for psychological counseling.

Main Outcome Measures: Outcomes included pain, presence of physical dysfunction, or recurrent episodes of CRPS or other disproportional musculoskeletal pain.

Results: The mean duration of exercise therapy was 14 days, but over the past 2 years has decreased to 6 days. Ninety-five children (92%) initially became symptom free. Of those followed for more than 2 years, 43 (88%) were symptom free (15, or 31%, of these patients had had a reoccurrence), 5 (10%) were fully functional but had some continued pain, and 1 (2%) had functional limitations. The median time to recurrence was 2 months; 79% of the recurrences were during the first 6 months after treatment.

Conclusion: Intense exercise therapy is effective in initially treating childhood CRPS and is associated with low rate of long-term symptoms or dysfunction.

Departments of Pediatrics, *Rehabilitation, and †Nursing, University of Washington, Children's Hospital & Medical Center, Seattle, Washington, U.S.A.

Manuscript submitted August 4, 1998; revision received May 11, 1999; accepted for publication June 28, 1999.

Address correspondence and reprint requests to Dr. David D. Sherry, Rheumatology, CH-73, Children's Hospital & Medical Center, 4800 Sand Point Way, NE, Seattle, WA 98105, U.S.A. E-mail: dsherry@u.washington.edu

This work supported by the Barbara & David Kipper and the Chas. and Ruth Levy Foundation.

© 1999 Lippincott Williams & Wilkins, Inc.