上肢の複合性局所疼痛症候群患者TypeⅠに対する段階的曝露療法を用いた作業療法の試み—ケースシリーズ

Graded exposure in vivo in Occupational therapy practice for complex regional pain syndrome patients TypeⅠ due to upper extremity dysfunction: A case series

要旨：今回，段階的曝露療法を用いたプログラムの有効性を探索する目的で，上肢の複合性局所疼痛症候群（CRPS）TypeⅠ 8例を対象に実践を行った．CRPS状態（CRPSスコア），痛みの認知（PCS），心理（HADS），ADL（PDAS），上肢機能（HAND 20，STEF，握力，側副つまみ）の評価結果やプログラム内容を実施前後で調査した．結果，実施前後でCRPS状態，ADL，上肢機能に有意な改善を認めた．以上のことから，上肢のCRPS TypeⅠに対する認知行動学的プログラムを含む作業療法プログラムの有効性が示唆された．今後は本実践の効果の検証が必要である．

　The purpose of study was to examine changes in an occupational therapy intervention program. The program was based on cognitive behavioral therapy intervention that graded exposure in vivo with 8 participants suffering from complex regional pain syndrome due to upper extremity dysfunction. We compared the following assessments through intervention: Complex Regional Pain Syndrome (CRPS), Cognitive function for Pain Catastrophizing Scale (PCS), psychological status for Hospital Anxiety Depression Scale (HADS), Activity of daily living for Pain Disability Assessment Scale (PDAS), disability due to upper extremity dysfunction (HAND 20), body function related to upper extremity function by Simple Test for Evaluating hand Function (STEF), lateral pinch power, and grip strength examination. There was improvement in CRPS, PDAS, and HAND. However, there was no significant change for cognitive function nor psychological status. Cognitive behavioral therapy based on graded exposure in vivo improves upper limb dysfunction of CRPS type. However, it is necessary to replicate the assessments specific to CRPS and OT programs in the future.