A Day-hospital Approach to Treatment of Pediatric Complex Regional Pain Syndrome Initial Functional Outcomes

Objectives: To examine clinical outcomes of an interdisciplinary day-hospital treatment program (comprised of physical, occupational, and cognitive-behavioral therapies with medical and nursing services) for pediatric complex regional pain syndrome (CRPS). Methods: The study is a longitudinal case series of consecutive patients treated in a day-hospital pediatric pain rehabilitation program. Participants were 56 children and adolescents with ages 8 to 18 years (median = 14 y) with CRPS spectrum conditions who failed to progress sufficiently with a previous outpatient and/or inpatient treatments. Patients participated in daily physical therapy, occupational therapy, and psychological treatment and received nursing and medical care as necessary. The model places equal emphasis on physical and cognitive-behavioral approaches to pain management. Median duration of stay was 3 weeks. Outcome measures included assessments of physical, occupational, and psychological functioning at program admission, discharge, and at posttreatment follow-up at a median of 10 months after discharge. Scores at discharge and follow-up were compared with measures on admission by Wilcoxon tests, paired t tests, or analysis of variance as appropriate, with corrections for multiple comparisons. Results: Outcomes demonstrate clinically and statistically significant improvements from admission to discharge in pain intensity (P < 0.001), functional disability (P < 0.001), subjective report of limb function (P < 0.001), timed running (P < 0.001), occupational performance (P < 0.001), medication use (P < 0.01), use of assistive devices (P < 0.001), and emotional functioning (anxiety, P < 0.001; depression, P < 0.01). Functional gains were maintained or further improved at follow-up. Discussion: A day-hospital interdisciplinary rehabilitation approach seems effective in reducing disability and improving physical and emotional functioning and occupational performance among children and adolescents with CRPSs that have failed to improve with outpatient treatment.