95 CLINICAL OUTCOME AFTER OUTPATIENT REHABILITATION IN NA 5 Introduction Neuralgic amyotrophy (NA) is a common (incidence 1:1000) 3 and distinct peripheral nervous system disorder characterized by episode(s) of acute severe pain in the upper extremity. 5 An acute autoimmune inflammation of the brachial plexus nerves leads to multifocal paresis and recovery is usually slow and incomplete. 6, 7, 182 Two to three years after disease onset, 60% of patients have residual paresis, more than 50% are restricted by pain, 63% experience severe fatigue, and 82% have limitations in performing activities of daily living. 8 These residual complaints and functional limitations are strongly correlated with persisting scapular dyskinesia and increased fatigability of the affected muscles. 8 To date, there are no validated treatment options for NA, 9, 182 although corticosteroid treatment in the acute phase appears to be effective. 183, 184 Only in selected cases with demonstrated nerve narrowing, so called hourglass constrictions, surgical neurolysis may be indicated. 185 Usual care (UC) in patients with NA typically entails physical therapy with strength training, which in more than 50% has limited to no effect or can even aggravate symptoms. 8 Since More than 60% of patients with NA experience residual complaints8, 10 an effective intervention to improve daily activities and participation is essential. As a relationship has been shown between scapular dyskinesia, increased fatigability and pain,6 altered shoulder biomechanics may lead to strain of both paretic and compensating muscles, even when paresis is no longer present. 182 We recently empirically confirmed the clinical suspicion that cerebral (mal)adaptations play a role in this altered motor control and residual complaints in NA. 2, 122 In a pilot study we showed a positive effect of a specifically designed multidisciplinary outpatient rehabilitation program (MR) combining physical and occupational therapy to address scapular dyskinesia and to manage residual complaints and limitations. 1 ThisMR focuses on improvingmotor control, scapular stability and coordination, combined with training self-management strategies for reducing pain and fatigue. Here, we report a randomized controlled trial (RCT) to investigate whether the effects of this MR are more beneficial than the effects of UC on shoulder, arm and hand functional capabilities and with regard to residual complaints (pain and fatigue) in patients with NA and scapular dyskinesia. Methods Study objectives Our primary aim was to compare the effects of a targeted MR to UC in patients with NA and scapular dyskinesia, directly after treatment. The primary outcome was selfreported functional capability of the shoulder, arm and hand assessed with the Shoulder Rating Questionnaire – Dutch Language Version (SRQ-DLV). 34 A variety of secondary outcome measures was selected a priori, representing most domains of the International Classification of Functioning, disability and health (ICF). Our secondary aim was to assess long term effects of this targeted MR on the primary and secondary outcomes.
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