A Physical Therapy Approach for Evaluation and Treatment of Complex Regional Pain Syndrome-1 via Telemedicine: A Case Report

Abstract

BACKGROUND: There is a lack of evidence supporting virtual physical therapy for patients with chronic regional pain syndrome-I (CRPS-1). CASE PRESENTATION: A 51-year-old female presented to physical therapy via telemedicine for an evaluation and treatment of chronic regional pain syndrome-I of her left foot. Chief complaints included pain, intolerance to gravity-dependent positions such as sitting, standing, and walking, and sensitivity to touch and temperature. Signs and symptoms were consistent with the diagnosis of CRPS-1. The treatment sessions were performed through a 2-way video conferencing system accessed on both party's laptops. The physical therapist guided the patient through interventions that were feasible to perform in the constructs of her home without additional external support. Treatment included pain neuroscience education, desensitization, graded motor imagery, strengthening, and neurodynamic mobilizations. OUTCOME AND FOLLOW-UP: At eight weeks, the patient made significant improvements in function consistent with her increased score from 9/30 to 21/30 on the Patient Specific Functional Scale (PSFS). Additionally, the patient demonstrated improved tolerance to temperature changes and gravity-dependent positioning without adverse effects such as blisters or edema. This was further recognized by her ability to shower for 8-10 minutes with warm water and sleep without elevating her leg, both of which she was unable to perform at the start of her care. DISCUSSION: This case study reviews the effects of a multimodal treatment approach with the inclusion of interventions that target the central and peripheral nervous systems. Furthermore, the efficacy of telemedicine as a delivery of care model is explored in this subgroup of the chronic pain population. JOSPT Cases 2023;3(1):21–25. Epub: 12 January 2023. doi:10.2519/josptcases.2023.10825