RELATIONSHIP BETWEEN IMPAIRMENTS, DISABILITY AND HANDICAP IN REFLEX SYMPATHETIC DYSTROPHY PATIENTS - A LONG-TERM FOLLOW-UP-STUDY

Objective: To determine the relationship between impairments, disabili ty and handicap in reflex sympathetic dystrophy (RSD) patients. Design : A long-term follow-up study of upper extremity RSD patients. Setting : A university hospital. Subjects: Sixty-five patients, 3-9 years (mea n interval 5.5 years) after RSD of the upper extremity (mean age 50.2 years). Main outcome measures: impairments: range of motion, moving tw o point discrimination, muscle strength of the hand and pain were meas ured. Disability was assessed with the Groningen Activity Restriction Scale (GARS) and handicap was assessed with three subscales (social fu nctioning, role limitations due to physical problems and role limitati ons due to emotional problems) of the RAND-36. Results: After RSD of t he upper extremity, 62% of the patients are limited in activities of d aily living (ADL) and/or instrumental ADL(IADL). Pain and restrictions in forward flexion of the shoulder, thumb opposition and grip strengt h are the most important impairments limiting ADL and IADL. Patients w ith limitations in ADL and IADL are significantly more handicapped tha n patients without limitations. Pain is the most important factor cont ributing to handicap. Conclusion: The relationship between impairments and disability and between disability and handicap in RSD patients is weak to moderate. Pain is the most important factor leading to disabi lity and handicap.