Which patients with chronic reflex sympathetic dystrophy are most likely to benefit from physical therapy?

Background: Chronic reflex sympathetic dystrophy (RSD) is a painful and disabling disorder for which no treatment with proven effects exists. Physical therapy (PT) has been demonstrated to be effective for recently diagnosed RSD, but its value in chronic RSD has not yet been studied. Objective: To find predictors for successful use of PT in RSD with regard to (1) function, strength, and mobility and (2) patient satisfaction. Subjects: Fifty-four patients with chronic RSD, age range 21 to 65 years. Methods: All patients were treated in accordance with a standardized PT protocol for at least 6 months. The effects of treatment (functional status, strength, range of motion) and patient satisfaction measures (grade for result, would repeat, global effect) were evaluated at 12 months. Subgroup analyses were performed to find predictors for success of PT. Results: The subgroup analyses revealed that patients with better baseline function (especially of the hands) obtained better results and greater satisfaction. Greater satisfaction was also associated with less baseline pain and higher baseline range of motion and strength (of leg) values. In general, PT did not show large improvements on effect measures, and the patients' mean grade for the result was 3.8 (on a 10-point scale). Conclusions: In overall terms, PT did not influence functional parameters or give satisfaction to patients with chronic RSD in this study. A randomized trial is required to prove or exclude the actual value of PT for these patients.