Resilience in patients with amputation because of Complex Regional Pain Syndrome type I

Abstract

Purpose: Although controversial, an amputation for longstanding and therapy-resistant Complex Regional Pain Syndrome Type I (CRPS-I) may improve quality of life and pain intensity. Resilience, the way people deal with adversity in a positive way may be related to these positive outcomes. This study focused on the relationship between resilience and post-amputation outcomes, i.e. quality of life, pain and recurrence of CRPS-I and psychological distress. Method: Twenty-six patients with an amputation related to CRPS-I filled in the Connor-Davidson Resilience Scale (CD-RISC), World Health Organisation -- Quality of life Assessment (WHOQOL-Bref) and the Symptom Checklist-90 Revised (SCL-90-R). An interview was conducted and a physical examination performed. Results were compared with reference groups from literature and a control group from the outpatient rehabilitation clinic at our medical center. Results: Resilience correlated significantly with all domains of the WHOQOL-Bref (ρ ranged from 0.41 to 0.72) and negatively with all domains of the SCL-90-R (ρ ranged from −0.39 to −0.68). Patients with an amputation because of CRPS-I have higher scores on resilience and quality of life than the control group. Resilience was lower in patients who reported CRPS-I symptoms compared to those who did not. Conclusions: The results confirmed our hypothesis that patients with an amputation because of CRPS-I who have a higher resilience also have a higher quality of life and experience lower psychological distress. The prognostic value of resilience in this patient group requires further research.

Implications for Rehabilitation

• Until characteristics of patients with positive quality of life outcome have been further unraveled, amputation for CRPS-I should only be performed in expertise centers.

• Resilience, the process of adapting well in the face of adversity, should be further explored in Rehabilitation Medicine research in general.

• Measurement of resilience should be a standard procedure when patients with CRPS-I request an amputation.

• Improving resilience of patients in in- and outpatient rehabilitation clinics might be an additional treatment in rehabilitation care.

• Amputation
• complex regional pain syndrome
• prognostic relevance
• resilience

Acknowledgements

We thank the reviewers of Disability and Rehabilitation for their detailed and thoughtful remarks on the first draft of this manuscript which have improved the final version considerably.