Identifying recommendations to improve therapy-led management of complex regional pain syndrome in England

Background:
Complex Regional Pain Syndrome (CRPS) is a distressing pain condition that can lead to significant burdens for individuals and society. A small number of specialist CRPS-practice services exist, but access is limited; most patients are managed in local hospitals or community settings. In a series of phases, we sought to understand the needs and perspectives of therapy practitioners across the care pathway in England and to identify recommendations to improve therapy-led management of CRPS.

Methods:
In phase 1, we disseminated an e-survey to physiotherapists, occupational therapists and hand therapists across a range of settings. Phase 2 comprised semi-structured interviews with therapists and patients. Online stakeholder events (phase 3) were convened to review findings and prioritise suggestions to enhance CRPS care.

Results:
Seventy-seven therapists responded to the e-survey and 31 semi-structured interviews were conducted (n = 10 patients, n = 9 therapists from specialist CRPS-practice services, n = 12 therapists from other settings). N = 11 therapists and n = 5 patients participated in the stakeholder events. Findings indicated pathways of care are complex, but similarities exist in therapy approaches across settings, albeit with longer, more frequent appointments in specialist CRPS-practice services. Recommendations to improve CRPS management included: additional education provision for therapists (including better access to CRPS ‘experts’), CRPS education for other clinicians, streamlining of patient pathways, and improving patient information.

Conclusions:
This work highlights opportunities to improve therapy-led care for people living with CRPS. Findings will be valuable in informing UK clinical guidelines and strengthening initiatives to enhance support for therapists.