Does prior failed shock-wave lithotripsy impact outcomes of ureterorenoscopy? A systematic review and meta-analysis.

IMPORTANCE

Complex regional pain syndrome (CRPS) limits self-care, work, and independence due to pain, sensory, and motor dysfunction. Early intervention, including occupational therapy, may reduce long-term disability and support adaptive strategies.

OBJECTIVE

To assess CRPS incidence and risk factors after distal limb injuries (primary objective) and evaluate the Budapest Criteria's effectiveness and identify rehabilitation-focused interventions, emphasizing occupational therapy (secondary objectives).

DESIGN

Retrospective cohort study of 556 adults with distal limb injuries (2015-2023). Data were extracted from medical records, including diagnostic codes, clinical notes, and therapy documentation. Descriptive and regression analyses identified risk factors and treatments.

SETTING

Single academic medical center.

PARTICIPANTS

A total of 556 patients with distal limb injuries, 241 of whom met the Budapest Criteria for CRPS (M age = 48.7 yr; SD = 26.0; 179 were female).

OUTCOMES AND MEASURES: Primary measures included injury characteristics, CRPS classification, pain severity, and treatments. Secondary measures were risk factors and therapy involvement within 1 yr of diagnosis. All primary and secondary outcomes were preplanned and queried once from medical records.

RESULTS

Among 241 CRPS cases, 69.7% affected the lower limb (CRPS Type 1: 20.3%; CRPS Type 2: 18.7%; unclear: 61%). Diagnostic delays were, on average, 39.7 mo (SD = 63.6). Pain scores averaged 6.7 (for rest) and 7.9 (for activity). Treatments included medications (83%), therapies (66.8%), and injections (17.8%). Occupational therapy participation was significantly higher among accurately classified cases p = .0210).

CONCLUSIONS AND RELEVANCE: Standardized diagnostic criteria and early occupational therapy engagement were associated with improved documentation. Future research should explore the role of rehabilitation in CRPS care. Plain-Language Summary: This study examined how complex regional pain syndrome is diagnosed and treated, with a focus on its effects on daily activities and how early intervention can improve recovery. Complex regional pain syndrome is a painful condition that can develop after an injury, leading to challenges with movement and participation in everyday tasks. Researchers analyzed medical records to understand how often doctors used the Budapest Criteria, the standard guidelines for diagnosing complex regional pain syndrome, and found that, in many cases, the criteria were not properly documented, which may lead to diagnostic uncertainty. The study also emphasized the importance of rehabilitation, especially occupational therapy and physical therapy, as the first step in treatment, followed by medications if symptoms persisted. These findings underscore the need for consistent diagnostic practices and early occupational therapy engagement to support function and recovery in people with complex regional pain syndrome.