Gunstig effect van adjuvante fysiotherapie (en in mindere mate van ergotherapie) vergeleken met maatschappelijk werk bij posttraumatische dystrofie van één bovenste extremiteit: een gerandomiseerd gecontroleerd klinisch onderzoek

To investigate the effectiveness and cost of adjuvant physical therapy (PT) and occupational therapy (OT) in patients with reflex sympathetic dystrophy (RSD) as well as the influence of these in reducing the percentage of impairment.

Design

Prospective randomised controlled trial, with one-year follow-up.

Method

At the university hospitals of Nijmegen and Amsterdam (Free University), the Netherlands, 135 patients who had been suffering from RSD of one upper limb for less than one year were randomised to receive PT, OT, or a control treatment (CT; social work) on a per protocol basis. They also received medical treatment on a per protocol basis. Improvement in the ‘Impairment level sumscore’ (ISS) was assessed both during and after one year. A difference of 5 ISS points between the groups was defined as clinically relevant. Furthermore, the severity of disability and the percentage of impairment were measured and tested on an exploratory basis, one year after the patient's inclusion in the study. The cost-effectiveness of the adjuvant interventions was also calculated.

Results

PT and to a lesser extent OT resulted in a significant and also more rapid improvement in the ISS compared to CT (for intention-to-treat analysis and per-protocol analysis the respective improvement in scores were: PT 5 and 7 points, OT 3.5 and 5 points, one year after inclusion). On a disability level, a positive trend was found in favour of OT. The percentage of impairment did not significantly differ between the three groups. PT was more favourable than OT with respect to the incremental cost-effectiveness ratio.

Conclusion

Both PT and OT contributed to the recovery from RSD of the upper limb. At the disorder level PT had the greatest and most rapid effect and was also the most cost-effective. The added value of PT and OT was not reflected in better outcomes on percentage of impairment compared with the control treatment one year after inclusion.