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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.
- randomised trials
- rehabilitation
- peripheral neuropathology
- neuromuscular
Data availability statement
Data are available upon reasonable request.
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Data availability statement
Data are available upon reasonable request.
Footnotes
Twitter @RLustenhouwer
RMJJ, RL, BGMvE and MJLG contributed equally.
Contributors RMJJ and RL contributed equally to this paper and share first authorship. All authors contributed to the conception and interpretation of data, and gave critical revisions for intellectual content and final approval of the version to be published. Additionally, RMJJ and RL contributed to data analysis. RL, IGMC, RCH, NvA, BGMvE and JG contributed to the study concept design. JG is responsible for overall content as guarantor and accepts full responsibility for the finished work and the conduct of the study, had access to the data and controlled the decision to publish.
Funding 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.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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