94 CHAPTER 5 Abstract Background: Neuralgic amyotrophy (NA) is an acute inflammation of brachial plexus nerves 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 randomized controlled trial (RCT) patients with NA (aged ≥18 years, scapular dyskinesia, >8 weeks after onset) were randomized to either a MR or UC group. MR consisted of a diagnostic multidisciplinary consultation and 8 sessions 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 values was 8.60 (95%CI: 0.26-16.94, p=0.044). The proportion attaining a predetermined minimal clinically relevant SRQ-DLV improvement (≥12) was larger for MR (59%) than UC group (33%) with a number needed to treat of 4. Conclusions: This RCT shows that a MR program 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.
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