Feedback Intervention Using a Wearable Activity Monitor in a Patient With Early-Stage Upper Limb Complex Regional Pain Syndrome: A Case Report.

Patients in the early stages of Complex Regional Pain Syndrome (CRPS) of the upper extremities are unable to accurately perceive their own activity levels because of fear-avoidance beliefs and distortions in body perception, making them prone to falling into a "boom-and-bust cycle" characterized by alternating periods of overactivity and inactivity. The purpose of this case report is to examine the effect of a feedback intervention using an activity tracker (Fitbit) on "self-regulatory behavior." A woman in her 50s who worked as both an interpreter and translator was diagnosed with upper limb CRPS because of persistent pain following right-hand surgery. Due to her strong sense of responsibility and perfectionist personality, she exhibited a maladaptive activity pattern in which she forced herself to use her right hand even under severe pain, only to cease all activity for several days once she reached her limit. Initial assessments showed a Disabilities of the Arm, Shoulder, and Hand (DASH) score of 78, a Pain Catastrophizing Scale (PCS) score of 35, a Tampa Scale for Kinesiophobia score of 48, and a Pain Self-Efficacy Questionnaire (PSEQ) score of 23. The Fitbit data revealed exceptionally high activity (52 minutes) on a specific day, which the patient was unaware of. The intervention centered on "self-regulation" to correct distorted body perception based on objective data, and the following step-by-step program was implemented over eight weeks. (i) Initial Phase: feedback was provided through a three-step process - presentation of Fitbit data, verification of the patient's perception, and development of a specific action plan - and "Activity Pacing" was taught while correcting recall bias. (ii) Middle Phase: once resting pain was reduced through self-regulation, sensory re-education was conducted to correct pain predictions using a desensitization protocol with graded materials, body regions, and modalities. (iii) Final Phase: we applied gradual functional loading based on the morphological characteristics of objects and integrated the strategic self-regulation of "activity selection and concentration" into the performance of real-life roles. The DASH score improved from 78 to 57 (a 21-point improvement), and the PCS score improved from 35 to 26 (a nine-point improvement); both results exceeded the minimum clinically important difference (MCID). The Numerical Rating Scale (NRS) score at rest decreased from 10 to 3. Qualitatively, the patient acquired the ability to use the Fitbit data as a "mirror for self-regulation," and adaptive self-management behaviors - prioritizing energy allocation for important tasks while managing pain - were developed. Quantitative feedback from an activity tracker may be a useful intervention tool for promoting functional recovery and active behavioral changes in patients with early-stage CRPS by enabling them to self-regulate their subjective perception of activity based on actual physiological responses and by curbing disorganized overactivity.