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Is Physiotherapy Effective for Children With Complex Regional Pain Syndrome Type 1?

Bialocerkowski, Andrea E. PhD*; Daly, Anne MManipTher

doi: 10.1097/AJP.0b013e318220196a
Review Article

Objectives This study synthesized current research evidence on the effectiveness of physiotherapy for the management of children diagnosed with complex regional pain syndrome type 1 (CRPS-1), to provide up-to-date physiotherapy treatment recommendations, and to identify areas that require further investigation.

Methods Nine electronic databases were searched for quantitative studies that evaluated the effect of physiotherapy on children with CRPS-1. The methodological quality of the studies was evaluated using the Critical Review Form. Data were extracted regarding the study design, participant characteristics, types of outcome measures used, and physiotherapy technique used and its effectiveness.

Results The search strategy identified 303 potential studies, of which 12 met the inclusion criteria (1 randomized controlled trial, 1 comparative study, 10 case series). The methodological quality of all studies was rated as poor to fair. The “stand-alone” value of physiotherapy could not be determined as physiotherapy was prescribed in conjunction with psychological and medical interventions. There is low volume and poor-to-fair quality evidence which suggests that physiotherapy prescribed with other interventions may lead to short-term improvement in the signs and symptoms of CRPS-1 or functional ability in children with CRPS-1, and the relapse rate may be moderately high.

Discussion High-quality studies are required in this area. These studies should evaluate a package of care (which includes physiotherapy); they should investigate the effects of physiotherapy treatments that have proven effectiveness in adults with CRPS-1; they should use psychometrically sound measures to evaluate outcome; and the nature of physiotherapy should be detailed in future publications to enable replication in the clinical setting.

*School of Biomedical and Health Sciences, University of Western Sydney, Sydney

Department of Physiotherapy, Austin Health, Melbourne, Australia

This study was funded in part by a New Research Project Development Grant, awarded to Andrea Bialocerkowski, from the School of Biomedical and Health Sciences, the University of Western Sydney, Penrith, Australia. The authors declare no conflict of interest.

Reprints: Andrea E. Bialocerkowski, PhD, School of Biomedical and Health Sciences (Campbelltown Campus), Locked Bag, 1797, Penrith South DC 1797, Australia (e-mail:

Received August 18, 2010

Accepted April 17, 2011

© 2012 Lippincott Williams & Wilkins, Inc.