Jhb. Geertzen et al., RELATIONSHIP BETWEEN IMPAIRMENTS, DISABILITY AND HANDICAP IN REFLEX SYMPATHETIC DYSTROPHY PATIENTS - A LONG-TERM FOLLOW-UP-STUDY, Clinical rehabilitation, 12(5), 1998, pp. 402-412
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.