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Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II. ob diese Behandlungsmaßnahmen schädliche.
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By continuing to browse this site you agree to us using cookies as described in About Cookies. Complex regional pain syndrome CRPS is a painful and disabling condition that usually manifests in response to trauma or surgery.
When it occurs, it is associated with significant pain and disability. It is thought to arise and persist as a consequence of a maladaptive pro-inflammatory response and disturbances in sympathetically-mediated vasomotor control, together with maladaptive peripheral and central neuronal plasticity.
CRPS can be classified into two Thrombophlebitis und Bath Guidelines recommend the inclusion of a variety of physiotherapy interventions as part of the multimodal treatment of people with CRPS, although their effectiveness is not known.
To determine the effectiveness of physiotherapy interventions for treating the pain and Thrombophlebitis und Bath associated with CRPS types I and II. We searched the following databases from Wunden an der Hand up to 12 February We also searched additional online sources for unpublished trials and trials in progress.
We included RCTs of physiotherapy interventions including manual therapy, ob, therapeutic exercise, electrotherapy, physiotherapist-administered education and cortically directed sensory-motor rehabilitation strategies employed in either a stand-alone fashion or in combination, compared with placebo, no treatment, another intervention or usual care, or of varying physiotherapy interventions compared with each other in ob with CRPS I and II.
Our primary outcomes of interest were patient-centred outcomes of pain intensity and functional disability. Two review authors independently evaluated those studies identified through the electronic searches for eligibility and subsequently extracted all relevant data from the included RCTs. Ob review authors independently performed 'Risk of bias' assessments and rated the quality of the body of evidence for the main outcomes using the Grading of Recommendations Assessment, Development and Evaluation GRADE approach.
We included 18 RCTs participants that tested the effectiveness of a broad range of physiotherapy-based interventions. Overall, there was a paucity of high quality evidence concerning physiotherapy treatment for pain and disability in people with CRPS I. Most included trials were at 'high' risk of bias 15 trials and the remainder were at 'unclear' risk of bias three trials. The Thrombophlebitis und Bath of the evidence was very low or low for all comparisons, according to the GRADE approach.
There was low to very low quality evidence that tactile discrimination training, stellate ganglion block via ultrasound and pulsed electromagnetic field therapy compared to placebo, and manual lymphatic drainage combined with and compared to either anti-inflammatories and physical therapy or exercise are not effective for treating pain in the short-term in people with CRPS I.
Laser therapy may provide small clinically insignificant, Thrombophlebitis und Bath, short-term, improvements in pain compared to interferential current therapy in people with CRPS I. Adverse events were only rarely reported in the included trials. The best available data show that GMI and mirror therapy may provide clinically meaningful improvements in pain and function in people with CRPS I although the quality of the supporting evidence is very low.
Evidence of the effectiveness of multimodal Behandlung von Krampfadern in 40 Krankenhaus, electrotherapy and manual lymphatic drainage for treating people with CRPS types I and II is generally absent or unclear, Thrombophlebitis und Bath.
Implications for clinical practice and future research are considered. Complex regional pain syndrome CRPS is a painful and disabling condition.
Most commonly it affects a person's arm and hand or leg and foot and may occur after a traumatic injury. There are two Thrombophlebitis und Bath of CRPS: Guidelines recommend physiotherapy, which could include different kinds of exercise therapy ob electrotherapy for instance, along with other medical treatments for treating the pain and disability associated with CRPS.
However, we do not know how well these treatments work. Which types of physiotherapy treatment are effective for ob the pain and disability associated with CRPS in adults? We searched for clinical trials of physiotherapy up to 12 February Overall we did not find any good quality clinical trials of physiotherapy aimed at reducing the pain and disability of CRPS I in adults.
Most included trials were not well designed and contained only small numbers of patients. We did find some low quality trials suggesting that two broadly similar types of rehabilitation training, known as 'graded motor imagery' GMI and 'mirror therapy', might be useful for reducing the pain and disability associated with CRPS I after traumatic events or surgery or a stroke.
From the limited evidence available it appears that some types of electrotherapy, Thrombophlebitis und Bath as ultrasound and pulsed electromagnetic field therapy, as well as a type of massage therapy known as manual lymphatic drainage, are not effective.
Most studies did not report on adverse events and so we do not know if these treatments have any harmful side-effects. On the whole, because of the limited number and low quality of available trials for the various physiotherapy treatments, we cannot be sure if any of the physiotherapy treatments we evaluated are effective for treating the pain and disability of CRPS I in adults, ob.
It is possible that some treatments, such as GMI or mirror therapy, might be effective. Further high quality clinical trials of physiotherapy are needed in order to find out if any of the different types of physiotherapy treatment are effective at improving pain and Thrombophlebitis und Bath in people with CRPS.
Kompleksni regionalni bolni sindrom tipa I i II: Kompleksni regionalni bolni sindrom engl. Wir suchten bis zum Die meisten der eingeschlossenen Studien waren methodisch schwach und schlossen nur eine kleine Anzahl von Patienten ein.
Aufgrund der begrenzten Anzahl und geringen Qualität der verfügbaren Studien wissen wir insgesamt nicht, ob, ob die von uns begutachteten physiotherapeutischen Behandlungsmethoden die Schmerzen und Behinderung bei CRPS I bei Erwachsenen wirksam verringern können.
Weitere hochwertige physiotherapeutische klinische Studien sind erforderlich um herauszufinden, ob eine oder ggf. Complex regional pain syndrome CRPS is a persistent, painful and disabling condition that usually, ob, but not exclusively, manifests in response to acute trauma or surgery Goebel ; Shipton Two sub-categories of CRPS have been described: CRPS is characterised by symptoms and signs typically confined to a body region or limb, but which may become more widespread van Rijn The Budapest criteria proposed by Harden have enhanced diagnostic accuracy and are now widely accepted Goebel Current understanding implicates multiple mechanisms including complex contributions from Thrombophlebitis und Bath maladaptive pro-inflammatory response and a disturbance Heparin-Salbe von Krampfadern in den Beinen Bewertungen sympathetically mediated vasomotor control, ob, together with maladaptive peripheral and central neuronal plasticity Bruehl ; Bruehl ; Marinus was Terry Varizen Parkitny Thrombophlebitis und Bath Furthermore, ob, mechanisms, and in consequence symptoms and signs, may vary between individuals and within individuals over the time course of the disorder, Thrombophlebitis und Bath, thus heightening the complexity Marinus Ob incidence of CRPS is not accurately known but population estimates indicate an incidence of somewhere between five and 26 cases perperson-years Marinus A likely conservative year period prevalence rate for CRPS of CRPS is three to four times more likely to occur in women than in men, and although it may occur at any Thrombophlebitis und Bath throughout the lifespan it tends to occur more frequently with increasing age Shipton Genetic susceptibility may serve as an aetiological risk factor for the development of Thrombophlebitis und Bath de Rooij In individuals who develop CRPS after a fracture, intra-articular fracture, fracture-dislocation, Thrombophlebitis und Bath, pre-existing rheumatoid arthritis, pre-existing musculoskeletal co-morbidities e.
Psychological traits, such as depression, anxiety, ob, neuroticism and anger, have so far been discounted as risk factors for the development of CRPS Beerthuizen Lohnbergalthough further prospective studies are required to substantiate this assertion Harden Preliminary data suggest that interference with activities of daily living, sleep, ob, work and recreation is common and further contributes to a diminished quality of life Ob ; Geertzen ; Kemler ; Sharma Studies into the course of CRPS present contradictory findings.
Whilst some studies have reported complete and partial symptom resolution within one year Sandroni ; Zylukother studies have indicated more protracted symptoms and impairments lasting from three to nine years de Mos ; Geertzen ; Vaneker In addition, emerging evidence suggests that people with CRPS of an upper limb which develops less often in response to a fracture and whose affected limb is colder ob the contralateral limb, may experience significantly longer disease duration than people with CRPS of a lower limb which occurs more commonly after fracture and whose affected limb is warmer than the contralateral limb de Mos ob Although guidelines for the treatment of CRPS recommend an interdisciplinary multimodal approach, comprising pharmacological and interventional pain management strategies together with rehabilitation, Thrombophlebitis und Bath, psychological therapy and educational strategies Goebel ; Harden ; Perez ; Stanton-HicksThrombophlebitis und Bath, determining the optimal approach to therapy remains clinically challenging Cossins ; O'Connell Guidelines recommend the inclusion of a variety of physiotherapy interventions as part of the multimodal treatment of CRPS Goebel ; Perez ; Stanton-Hicks but their Krampfadern in der Fußpflege is ob known.
Physiotherapy has been defined as "the ob of disorders with physical agents and methods" Anderson and for CRPS could include any of the following interventions employed either as stand-alone interventions or in combination: The precise mechanisms of action through which various physiotherapy interventions are purported to relieve the pain and disability associated with CRPS are not fully understood.
Theories underpinning the use of manual therapies to relieve pain include the induction of peripheral or central nervous system-mediated analgesia, or both Bialosky ; Goats Therapeutic exercise may induce analgesia, via endorphin-mediated inhibition Nijsand improve function, and by extension disability, by restoring range of movement at affected joints and improving neuromuscular function Kisner Theories underlying the use of electrotherapy modalities for pain relief variously include spinal cord-mediated ob, heat- or cold-mediated analgesia and anti-inflammatory effects Atamaz ; Robertson Pain neuroscience education may reduce pain and disability by helping Thrombophlebitis und Bath to better understand the biological processes underlying their pain in a way that positively changes pain perceptions and attitudes Louw Other rehabilitation strategies, ob, such GMI or mirror therapy, may provide pain relief or increase mobility, or both, ob, by ameliorating maladaptive somatosensory and motor cortex reorganisation Moseley ; Moseley A number of systematic reviews suggest that physiotherapy interventions e.
However, the inclusion of non-randomised clinical trials and case series designs, together with the exclusion of studies involving Thrombophlebitis und Bath with CRPS II as well as those published in a language other than English, may have biased these conclusions.
Furthermore, ob, the methodologies used for conducting systematic reviews have been substantially revised in recent years, such as those recommended within the Grading of Recommendations Assessment, Development and Evaluation GRADE approach for describing the alle Lungenembolie of the evidence Balshemwhich has not been utilised in previous reviews.
Given the limitations of existing ob reviews, together with the availability of potentially numerous physiotherapy treatment strategies for CRPS, an up-to-date systematic review of the evidence from randomised clinical trials for the effectiveness of these interventions may assist clinicians in their treatment choices and inform future clinical guidelines that may be of use to policymakers Thrombophlebitis und Bath those who commission health care for people with CRPS.
We included randomised controlled trials RCTs including those of parallel, cluster-randomised and cross-over design published in any language.
We excluded studies in which participants were not randomised to intervention groups. We included trials of adults, aged 18 years or older, diagnosed with CRPS I or II, or with an alternative diagnostic label for these conditions e. We grouped trials according to diagnosis i. Since the use of ob diagnostic criteria for CRPS is inconsistent across studies Reinderswe included trials that used established or validated diagnostic criteria, including the Veldman criteria VeldmanThrombophlebitis und Bath, the Ob Association for the Study of Pain IASP criteria MerskeyBruehl criteria BruehlBudapest criteria Harden and Atkins criteria Atkinsas well as studies that either predate these criteria or use non-standard diagnostic criteria.
We included all randomised controlled comparisons of physiotherapy interventions, Thrombophlebitis und Bath, employed in either a stand-alone fashion or in combination, compared with placebo, no Thrombophlebitis und Bath, another intervention or usual care, or of varying physiotherapy interventions compared with each other, which were aimed at treating pain or disability, or both, associated with CRPS. We included trials in which non-physiotherapists e.
After the publication of our Cochrane protocol, Smart we decided to exclude studies that evaluated non-physiotherapy based interventions e. We presented and analysed primary outcomes as change on a continuous scale or in a dichotomised format as the proportion of participants in each group who attained a predetermined threshold of improvement. For example, we judged cut-points from which to interpret the likely clinical importance of pooled effect sizes according to provisional criteria proposed in the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials IMMPACT consensus statement Dworkin Specifically, reductions in pain intensity compared with baseline were judged as follows:.
We planned to analyse and present secondary outcomes as change Mittel für Schiffe mit Varizen a continuous scale or in a dichotomised format but a lack of data did not permit any such analyses.
For example, equivalent measures of treatment effect with respect to PGIC have been defined as: Future updates may allow such analyses where relevant data are available. She and the review authors ran these searches, Thrombophlebitis und Bath.
We used a combination of controlled vocabulary, i, Thrombophlebitis und Bath. The search strategies are in Appendix 1.
On completion of the electronic searches we searched the reference lists of all eligible studies in order to identify additional relevant studies.
In addition we screened the reference lists of key physiotherapy textbooks and previous systematic reviews. We sent the list of included trials to a content expert to help identify any additional relevant studies, Thrombophlebitis und Bath.
In order to minimise the impact of publication bias we searched the following registers and databases to identify unpublished research as well as research in progress:. Two review authors KMS and BMW independently assessed the titles and abstracts of studies we identified by the search strategy for eligibility, ob.
If the eligibility of a trial was unclear from the title and venarus flebodia oder detraleks Krampf, we assessed the full-text article. We excluded trials that did not match the inclusion criteria see the ' Criteria for considering studies for this review ' section.
We resolved any disagreements between review authors regarding a study's inclusion by discussion.
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Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II. ob diese Behandlungsmaßnahmen schädliche.
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