title: Pain exposure physical therapy (PEPT) compared to conventional treatment in complex regional pain syndrome type 1: a randomised controlled trial.
abstract: OBJECTIVE
  To compare the effectiveness of pain exposure physical therapy (PEPT) with conventional treatment in patients with complex regional pain syndrome type 1 (CRPS-1) in a randomised controlled trial with a blinded assessor.
  
  
  METHODS
  The study was conducted at a level 1 trauma centre in the Netherlands.
  
  
  METHODS
  56 adult patients with CRPS-1 participated. Three patients were lost to follow-up.
  
  
  METHODS
  Patients received either PEPT in a maximum of five treatment sessions, or conventional treatment following the Dutch multidisciplinary guideline.
  
  
  METHODS
  Outcomes were assessed at baseline and at 3, 6 and 9 months after randomisation. The primary outcome measure was the Impairment level Sum Score--Restricted Version (ISS-RV), consisting of visual analogue scale for pain (VAS-pain), McGill Pain Questionnaire, active range of motion (AROM) and skin temperature. Secondary outcome measures included Pain Disability Index (PDI); muscle strength; Short Form 36 (SF-36); disability of arm, shoulder and hand; Lower Limb Tasks Questionnaire (LLTQ); 10 m walk test; timed up-and-go test (TUG) and EuroQol-5D.
  
  
  RESULTS
  The intention-to-treat analysis showed a clinically relevant decrease in ISS-RV (6.7 points for PEPT and 6.2 points for conventional treatment), but the between-group difference was not significant (0.96, 95% CI -1.56 to 3.48). Participants allocated to PEPT experienced a greater improvement in AROM (between-group difference 0.51, 95% CI 0.07 to 0.94; p=0.02). The per protocol analysis showed larger and significant between-group effects on ISS-RV, VAS-pain, AROM, PDI, SF-36, LLTQ and TUG.
  
  
  CONCLUSIONS
  We cannot conclude that PEPT is superior to conventional treatment for patients with CRPS-1. Further high-quality research on the effects of PEPT is warranted given the potential effects as indicated by the per protocol analysis.
  
  
  BACKGROUND
  NCT00817128 and NTR 2090.
authors.affiliation: Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Karlijn J
authors.initials: KJ
authors.lastname: Barnhoorn
authors.affiliation: Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Henk
authors.initials: H
authors.lastname: van de Meent
authors.affiliation: Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Robert T M
authors.initials: RT
authors.lastname: van Dongen
authors.affiliation: Department of Orthopedics, Physical Therapy, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Klomp
authors.affiliation: Department of Epidemiology, Biostatistics and Medical Technology Assessment, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Groenewoud
authors.affiliation: Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Han
authors.initials: H
authors.lastname: Samwel
authors.affiliation: Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Maria W G
authors.initials: MW
authors.lastname: Nijhuis-van der Sanden
authors.affiliation: Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Jan Paul M
authors.initials: JP
authors.lastname: Frölke
authors.affiliation: Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands.
authors.forename: J Bart
authors.initials: JB
authors.lastname: Staal
mesh_terms: D000328:Adult; D020918:Complex Regional Pain Syndromes / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010349:Patient Compliance; D026741:Physical Therapy Modalities / Q000009:adverse effects; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome
keywords: PAIN MANAGEMENT; REHABILITATION MEDICINE