Skip to main content

Advertisement

SpringerLink
Log in

Baseline predictors related to functional outcomes in patients older than sixty years with complex regional pain syndrome type 1 after distal radius fracture treated conservatively: a prospective observational study

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to analyze baseline predictors of functional outcomes six weeks and at one year follow-up in patients older than 60 years with complex regional pain syndrome type 1 (CRPS I) after distal radius fracture (DRF).

Methods

A total of 120 patients with CRPS I after DRF were prospectively recruited. Presumptive relevant factors were collected and analyzed as potential baseline predictors. Additionally, functional outcomes were assessed at the beginning of physiotherapy treatment, at six weeks after finishing physiotherapy treatment, and at one year follow-up. Patient-Rated Wrist Evaluation; Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire; Jamar dynamometer; and visual analog scale (VAS) were assessed.

Results

All participants completed the study. At 6 weeks, the main results showed an association of lower values of grip strength with female sex (p = 0.010), intra-articular DRFs (p = 0.030), longer immobilization time (p = 0.040), lower levels of physical activity (p < 0.001), higher levels of kinesiophobia (p = 0.010), and anxiety (p = 0.020). At 1-year follow-up, the results showed an association of lower values of DASH with higher BMI (p < 0.001) and longer immobilization time (p < 0.001); and higher values of VAS showed an association with older age (p = 0.010), higher BMI (p = 0.010), and lower levels of physical activity (p = 0.040).

Conclusion

At six weeks, factors such as BMI, immobilization time, physical activity, and kinesiophobia are associated with lower functional outcomes. Additionally, at one year follow-up, BMI, immobilization time, and physical activity continue to be associated with lower functional outcomes in patients with CRPS I after DRF treated conservatively.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Singer BR, McLauchlan GJ, Robinson CM et al (1998) Epidemiology of fractures in 15,000 adults: the influence of age and gender. J Bone Joint Surg Br 80:243–248

    Article  CAS  PubMed  Google Scholar 

  2. MacIntire NJ, Dewan N (2016) Epidemiology of distal radius fracture and factors predicting risk and prognosis. J Hand Ther 29:136–145

    Article  Google Scholar 

  3. Chung KC, Shauver MJ, Birkmeyer JD (2009) Trends in the United States in the treatment of distal radius fractures in the elderly. J Bone Joint Surg Am 91:1868–1873

    Article  PubMed  PubMed Central  Google Scholar 

  4. Huetteman HE, Shauver MJ, Malay S et al (2019) Variation in the treatment of distal radius fractures in the United States: 2010 to 2015. Plast Reconstr Surg 143:159–167

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Turner RG, Faber KJ, Athwal GS (2010) Complications of distal radius fractures. Hand Clin 26:85–96

    Article  Google Scholar 

  6. de Mos M, Sturkenboom MC, Huygen FJ (2009) Current understandings on complex regional pain syndrome. Pain Pract 9:86–99

    Article  PubMed  Google Scholar 

  7. Bruehl S (2010) An update on the pathophysiology of complex regional pain syndrome. Anesthesiology 113:713–725

    Article  PubMed  Google Scholar 

  8. Jellad A, Salah S, Ben Salah Frih Z (2014) Complex regional pain syndrome type I: incidence and risk factors in patients with fracture of the distal radius. Arch Phys Med Rehabil 95:487–492

    Article  PubMed  Google Scholar 

  9. Farzad M, Layeghi F, Hosseini A et al (2018) Investigate the effect of psychological factors in development of complex regional pain syndrome type I in patients with fracture of the distal radius: a prospective study. J Hand Surg Asian Pac 23:554–561

    Article  Google Scholar 

  10. Puchalski P, Zyluk A (2005) Complex regional pain syndrome type 1 after fractures of the distal radius: a prospective study of the role of psychological factors. J Hand Surg Br 30:574–580

    Article  CAS  PubMed  Google Scholar 

  11. Taskaynatan MA, Balaban B, Karlidere T et al (2005) Factitious disorders encountered in patients with the diagnosis of reflex sympathetic dystrophy. Clin Rheumatol 24:521–526

    Article  Google Scholar 

  12. Dilek B, Yemez B, Kizil R et al (2012) Anxious personality is a risk factor for developing complex regional pain syndrome type I. Rheumatol Int 32:915–920

    Article  PubMed  Google Scholar 

  13. Tang JB, Giddins G (2016) Why and how to report surgeons’ levels of expertise. J Hand Surg Eur 41:365–366

    Article  Google Scholar 

  14. Harden NR, Bruehl S, Perez RSGM et al (2010) Validation of proposed diagnostic criteria (the "Budapest Criteria") for Complex Regional Pain Syndrome. Pain 150:268–274

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gutiérrez-Espinoza H, Rubio-Oyarzún D, Olguín-Huerta C et al (2017) Supervised physical therapy vs home exercise program for patients with distal radius fracture: a single-blind randomized clinical study. J Hand Ther 30:242–252

    Article  PubMed  Google Scholar 

  16. Gutiérrez-Espinoza H, Tabach-Apraiz A, Oyanadel-Maldonado M (2019) Physical therapy in patients with complex regional pain syndrome type I after distal radius fracture: a case series. J Phys Ther Sci 31:403–407

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gutiérrez-Espinoza H, Zavala-González J, Gutiérrez-Monclus R et al (2021) Functional outcomes after a physiotherapy program in elderly patients with complex regional pain syndrome type I after distal radius fracture: a prospective observational study. Hand (N Y) 28:15589447211063578

    Google Scholar 

  18. Topolski TD, LoGerfo J, Patrick DL et al (2006) The Rapid Assessment of Physical Activity (RAPA) among older adults. Prev Chronic Dis 3:A118

    PubMed  PubMed Central  Google Scholar 

  19. Mayer CJ, Steinman L, Williams B et al (2008) Developing a Telephone Assessment of Physical Activity (TAPA) questionnaire for older adults. Prev Chronic Dis 5:A24

    PubMed  Google Scholar 

  20. AO classification of fractures. Available at: https://www.aofoundation.org Accessed on 30 July 2021.

  21. Kreder HJ, Hanel DP, McKee M et al (1996) X-ray film measurements for healed distal radius fractures. J Hand Surg Am 21:31–39

    Article  CAS  PubMed  Google Scholar 

  22. Dario P, Matteo G, Carolina C et al (2014) Is it really necessary to restore radial anatomic parameters after distal radius fractures? Injury 45(Suppl 6):S21–S26

    PubMed  Google Scholar 

  23. Mulders MAM, Detering R, Rikli DA et al (2018) Association between radiological and patient-reported outcome in adults with a displaced distal radius fracture: a systematic review and meta-analysis. J Hand Surg Am 43:710–719

    Article  PubMed  Google Scholar 

  24. Mintken PE, Cleland JA, Whitman JM et al (2010) Psychometric properties of the Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in patients with shoulder pain. Arch Phys Med Rehabil 91:1128–1136

    Article  PubMed  Google Scholar 

  25. Sullivan MJ, Bishop SR, Pivik J (1995) The Pain Catastrophizing Scale: development and validation. Psychol Assess 7:524–532

    Article  Google Scholar 

  26. García Campayo J, Rodero B, Alda M et al (2008) Validación de la versión española de la Escala de la Catastrofización ante el Dolor en Fibromialgia. Med Clin 131:487–492

    Article  Google Scholar 

  27. Osman A, Barrios FX, Gutierrez PM et al (2000) The Pain Catastrophizing Scale: further psychometric evaluation with adult samples. J Behav Med 23:351–365

    Article  CAS  PubMed  Google Scholar 

  28. Keogh E, Book K, Thomas J et al (2010) Predicting pain and disability in patients with hand fractures: comparing pain anxiety, anxiety sensitivity and pain catastrophizing. Eur J Pain 14:446–451

    Article  Google Scholar 

  29. McCracken LM, Dhingra L (2002) A short version of the Pain Anxiety Symptoms Scale (PASS-20): preliminary development and validity. Pain Res Manag 7:45–50

    Article  PubMed  Google Scholar 

  30. McCracken LM, Zayfert C, Gross RT (1992) The Pain Anxiety Symptoms Scale: development and validation of a scale to measure fear of pain. Pain 50:67–73

    Article  PubMed  Google Scholar 

  31. MacDermid JC (1996) Development of scale for patient rating of wrist pain and disability. J Hand Ther 9:178–183

    Article  CAS  PubMed  Google Scholar 

  32. Mehta S, MacDermid JC, Richardson J et al (2015) A systematic review of the measurement properties of the patient- rated wrist evaluation. J Orthop Sports Phys Ther 45:289–298

    Article  PubMed  Google Scholar 

  33. Alfie V, Gallucci G, Boretto J et al (2017) Patient-rated wrist evaluation: Spanish Version and Evaluation of Its Psychometric Properties in Patients with Acute Distal Radius Fracture. J Wrist Surg 6:216–219

    Article  PubMed  PubMed Central  Google Scholar 

  34. Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29:602–608

    Article  CAS  PubMed  Google Scholar 

  35. Kleinlugtenbelt YV, Krol RG, Bhandari M et al (2018) Are the patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaire used in distal radial fractures truly valid and reliable? Bone Joint Res 7:36–45

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Hervás MT, Navarro Collado MJ, Peiró S et al (2006) Spanish version of the DASH questionnaire. Cross-cultural adaptation, reliability, validity and responsiveness. Med Clin (Barc) 127:441–447

    PubMed  Google Scholar 

  37. Hamilton A, Balnave R, Adams R (1994) Grip strength testing reliability. J Hand Ther 7:163–170

    Article  CAS  PubMed  Google Scholar 

  38. Richards L, Palmiter-Thomas P (1996) Grip strength measurement: a critical review of tools, methods, and clinical utility. Crit Rev Phys Rehabil Med 8:87–109

    Article  Google Scholar 

  39. Coldham F, Lewis J, Lee H (2006) The reliability of one vs three grip trials in symptomatic and asymptomatic subjects. J Hand Ther 19:318–326

    Article  Google Scholar 

  40. Crosby CA, Wehbé MA, Mawr B (1994) Hand strength: normative values. J Hand Surg Am 19:665–670

    Article  CAS  PubMed  Google Scholar 

  41. Roberts HC, Denison HJ, Martin HJ et al (2011) A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing 40:423–429

    Article  PubMed  Google Scholar 

  42. Trampish US, Franke J, Jedamzik N et al (2012) Optimal Jamar dynamometer handle position to assess maximal isometric hand strength in epidemiological studies. J Hand Surg Am 37:2368–2373

    Article  Google Scholar 

  43. McCormack HM, Horne DJ, Sheather S (1988) Clinical applications of visual analogue scale: a critical review. Psychol Med 18:1007–1019

    Article  CAS  PubMed  Google Scholar 

  44. Ring D, Barth R, Barsky A (2010) Evidence-based medicine: disproportionate pain and disability. J Hand Surg Am 35:1345–1347

    Article  PubMed  Google Scholar 

  45. Barth RJ, Haralson R (2007) Differential diagnosis for complex regional pain syndrome. Guides Newsletter 12(1-4):12–16

    Google Scholar 

  46. Del Piñal F (2023) Diagnosis and outcomes of 225 consecutive cases of CRPS of the hand. Plast Reconstr Surg Mar 24. Epub ahead of print

  47. Jo YH, Kim K, Lee BG et al (2019) Incidence of and risk factors for complex regional pain syndrome type 1 after surgery for distal radius fractures: a population-based study. Sci Rep 9:4871

    Article  PubMed  PubMed Central  Google Scholar 

  48. Dutton LK, Rhee PC (2021) Complex regional pain syndrome and distal radius fracture: etiology, diagnosis, and treatment. Hand Clin 37:315–322

    Article  PubMed  Google Scholar 

  49. Bickerstaff DR, Kanis JA (1994) Algodystrophy: an under recognized complication of minor trauma. Br J Rheumatol 33:240–248

    Article  CAS  PubMed  Google Scholar 

  50. Beerthuizen A, Stronks DL, Van't Spijker A et al (2012) Demographic and medical parameters in the development of complex regional pain syndrome type 1 (CRPS1): prospective study on 596 patients with a fracture. Pain 153:1187–1192

    Article  PubMed  Google Scholar 

  51. Roumen RM, Hesp WL, Bruggink ED (1991) Unstable Colles` fractures in elderly patients. A randomised trial of external fixation for displacement. J Bone Joint Surg Br 73:307–311

    Article  CAS  PubMed  Google Scholar 

  52. Zollinger PE, Tuinebreijer WE, Breederveld RS et al (2007) Can vitamin C prevent complex regional pain syndrome in patients with wrist fractures? A randomized, controlled, multicenter dose-response study. J Bone Joint Surg Am 89:1424–1431

    Article  CAS  PubMed  Google Scholar 

  53. Roh YH, Lee BK, Noh JH et al (2014) Factors associated with complex regional pain syndrome type I in patients with surgically treated distal radius fracture. Arch Orthop Trauma Surg 134:1775–1781

    Article  PubMed  Google Scholar 

  54. Gutiérrez-Espinoza H, Araya-Quintanilla F, Olguín-Huerta C et al (2022) Effectiveness of surgical versus conservative treatment of distal radius fractures in elderly patients: a systematic review and meta-analysis. Orthop Traumatol Surg Res 108:103323

    Article  PubMed  Google Scholar 

  55. Gutiérrez-Espinoza H, Araya-Quintanilla F, Cuyul-Vásquez I et al (2023) Effectiveness and safety of different treatment modalities for patients older than 60 years with distal radius fracture: a network meta-analysis of clinical trials. Int J Environ Res Public Health 20:3697

    Article  PubMed  Google Scholar 

  56. Lichtman DM, Bindra RR, Boyer MI et al (2010) Treatment of distal radius fractures. J Am Acad Orthop Surg 18:180–189

    Article  Google Scholar 

  57. Gutiérrez-Monclus R, Gutiérrez-Espinoza H, Zavala-González J et al (2019) Correlation between radiological parameters and functional outcomes in patients older than 60 years of age with distal radius fracture. Hand (N Y) 14:770–775

    Article  Google Scholar 

  58. Azzopardi T, Ehrendorfer S, Coulton T et al (2005) Unstable extra-articular fractures of the distal radius: a prospective, randomised study of immobilisation in a cast versus supplementary percutaneous pinning. J Bone Joint Surg Br 87:837–840

    Article  CAS  Google Scholar 

  59. Jaremko JL, Lambert RG, Rowe BH et al (2007) Do radiographic indices of distal radius fracture reduction predict outcomes in older adults receiving conservative treatment? Clin Radiol 62:65–72

    Article  CAS  PubMed  Google Scholar 

  60. Synn AJ, Makhni EC, Makhni MC et al (2009) Distal radius fractures in older patients: is anatomic reduction necessary? Clin Orthop Relat Res 467:1612–1620

    Article  PubMed  Google Scholar 

  61. Grewal R, MacDermid JC (2007) The risk of adverse outcomes in extra-articular distal radius fractures is increased with malalignment in patients of all ages but mitigated in older patients. J Hand Surg Am 32:962–970

    Article  PubMed  Google Scholar 

  62. Vranceanu AM, Bachoura A, Weening A et al (2014) Psychological factors predict disability and pain intensity after skeletal trauma. J Bone Joint Surg Am 96:e20

    Article  PubMed  Google Scholar 

  63. Das De S, Vranceanu AM, Ring DC (2013) Contribution of kinesiophobia and catastrophic thinking to upper-extremity-specific disability. J Bone Joint Surg Am 95:76–81

    Article  PubMed  Google Scholar 

  64. Roh YH, Lee BK, Noh JH et al (2014) Effect of anxiety and catastrophic pain ideation on early recovery after surgery for distal radius fractures. J Hand Surg Am 39:2258–2264

    Article  PubMed  Google Scholar 

  65. Nijs J, Lluch Girbes E, Lundberg M et al (2015) Exercise therapy for chronic musculoskeletal pain: Innovation by altering pain memories. Man Ther 20:216–220

    Article  PubMed  Google Scholar 

  66. Gutiérrez-Espinoza H, Olguín-Huerta C, Cuyul-Vásquez I et al (2021) Association between body mass index and functional outcomes in elderly patients with extra-articular distal radius fracture: a prospective observational study. Indian J Orthop 55:1009–1014

    Article  PubMed  PubMed Central  Google Scholar 

  67. An R, Shi Y (2015) Body weight status and onset of functional limitations in U.S. middle-aged and older adults. Disabil Health J 8:336–344

    Article  PubMed  Google Scholar 

  68. Jones CB (2011) Management of upper extremity injuries in obese patients. Orthop Clin North Am 42:11–19

    Article  PubMed  Google Scholar 

  69. Celis-Morales CA, Lyall DM, Anderson J et al (2017) The association between physical activity and risk of mortality is modulated by grip strength and cardiorespiratory fitness: evidence from 498 135 UK-Biobank participants. Eur Heart J 38:116–122

    Google Scholar 

  70. Geneen LJ, Moore RA, Clarke C et al (2017) Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev 14(1):CD011279

    Google Scholar 

  71. Sjøgaard K, Sjøgaard G (2017) Physical activity as cause and cure of muscular pain: evidence of underlying mechanisms. Exerc Sport Sci Rev 45:136–145

    Article  PubMed  PubMed Central  Google Scholar 

  72. Lima LV, Abner TSS, Sluka KA (2017) Does exercise increase or decrease pain? Central mechanisms underlying these two phenomena. J Physiol 595:4141–4150

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Blair SN, Cheng Y, Holder JS (2001) Is physical activity or physical fitness more important in defining health benefits? Med Sci Sports Exercise 33:S379–S399

    Article  CAS  Google Scholar 

  74. Sluka KA, O'Donnell JM, Danielson J et al (2013) Regular physical activity prevents development of chronic pain and activation of central neurons. J Appl Physiol 114:725–733

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clínica Indisa, Santiago, Chile

    Javier Román-Veas

  2. Instituto Traumatológico, Santiago, Chile

    Rodrigo Gutiérrez-Monclus

  3. Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain

    José Francisco López-Gil

  4. Department of Environmental Health, T.H Chan School of Public Health, Harvard University, Boston, USA

    José Francisco López-Gil

  5. Departamento de Morfología, Facultad de Medicina, Universidad Andres Bello, Santiago, Chile

    Juan Valenzuela-Fuenzalida

  6. Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile

    Felipe Araya-Quintanilla

  7. Escuela de Fisioterapia, Universidad de las Américas, 170504, Quito, Ecuador

    Héctor Gutiérrez-Espinoza

  8. Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar

    Elizabet Hagert

  9. Dept of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden

    Elizabet Hagert

Authors
  1. Javier Román-Veas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rodrigo Gutiérrez-Monclus
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. José Francisco López-Gil
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Juan Valenzuela-Fuenzalida
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Felipe Araya-Quintanilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Héctor Gutiérrez-Espinoza
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Elizabet Hagert
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JR-V and HG-E designed the study. HG-E, FA-Q, RG-M, and JV-F collected the data. JR-V, RG-M, and EH wrote the first draft of the manuscript. FA-Q and JL-G performed the statistical analysis. HG-E supervised the project. All authors revised and approved the final manuscript.

Corresponding author

Correspondence to Héctor Gutiérrez-Espinoza.

Ethics declarations

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Central Metropolitan Health Service of Chile, who approved the study protocol on 4 January 2017 (no. 142/2017).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent to publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

ESM 1

(DOCX 231 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Román-Veas, J., Gutiérrez-Monclus, R., López-Gil, J.F. et al. Baseline predictors related to functional outcomes in patients older than sixty years with complex regional pain syndrome type 1 after distal radius fracture treated conservatively: a prospective observational study. International Orthopaedics (SICOT) 47, 2275–2284 (2023). https://doi.org/10.1007/s00264-023-05880-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-023-05880-0

Keywords

Search

Navigation