Abstract
Background: Neuralgic
amyotrophy (NA) is an acute inflammation of nerves within the brachial plexus
territory leading to severe pain and multifocal paresis resulting in >60% of
patients having residual complaints and functional limitations correlated with
scapular dyskinesia. Our primary aim was to compare the effects of
multidisciplinary rehabilitation (MR), focused on motor relearning to improve
scapular dyskinesia and self-management strategies for reducing pain and
fatigue, with usual care (UC) on shoulder, arm and hand functional capability
in patients with NA.
Methods: In a
non-blinded randomised controlled trial (RCT), patients with NA (aged≥18 years,
scapular dyskinesia, >8 weeks after onset) were randomised to either an MR
or an UC group. MR consisted of a diagnostic multidisciplinary consultation and
eight sessions of physical and occupational therapy. Primary outcome was
functional capability of the shoulder, arm and hand assessed with the Shoulder
Rating Questionnaire–Dutch Language Version (SRQ-DLV).
Results: We included
47 patients with NA; due to drop-out, there were 22 participants in MR and 15
in UC for primary analysis. The mean group difference adjusted for sex, age and
SRQ-DLV baseline score was 8.60 (95%CI: 0.26 to 16.94, p=0.044). The proportion
attaining a minimal clinically relevant SRQ-DLV improvement (≥12) was larger
for the MR group (59%) than the UC group (33%) with a number needed to treat of
4.
Conclusion: This RCT
shows that an MR programme focused on motor relearning to improve scapular
dyskinesia, combined with self-management strategies for reducing pain and
fatigue, shows more beneficial effects on shoulder, arm and hand functional
capability than UC in patients with NA. Trial registration number NCT03441347.
| Original language | English |
|---|---|
| Pages (from-to) | 474-481 |
| Number of pages | 8 |
| Journal | Journal of Neurology, Neurosurgery and Psychiatry |
| Volume | 94 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - 1 Jun 2023 |
| Externally published | Yes |
Bibliographical note
Funding Information:This work was financially supported by the Prinses Beatrix Spierfonds (W.OR16-05).Several authors of this publication are members of the Radboudumc Neuromuscular Center, Netherlands Neuromuscular Center and the European Reference Network for Rare Neuromuscular Diseases.
Publisher Copyright:
© 2023 BMJ Publishing Group. All rights reserved.
Keywords
- neuromuscular
- peripheral neuropathology
- randomised trials
- rehabilitation
