575: A Web-Based Survey of Rehabilitation Practices and Perspectives for CRPS in Japan

Topic: Education, Societal Impact, and Others
Subtopic: Education

Background and Aims: Contemporary clinical guidelines for addressing complex regional pain syndrome (CRPS), a disabling condition, recommend multimodal, mechanism-informed rehabilitation. [1,2] To date, evidence remains insufficient to conclusively support rehabilitative intervention. [3,4] Translation of guideline principles into clinical practice is thus challenging. While multinational surveys have described rehabilitation practices, national-level data are scarce in Japan. We aimed to (1) describe reported rehabilitation practices and perspectives for CRPS among Japanese physical therapists (PTs) and occupational therapists (OTs), (2) compare these with multinational survey data, and (3) examine whether reported implementation differs from therapists’ CRPS case experience.

Methods: A cross-sectional web-based survey was conducted between June 2024 and March 2025 among Japanese PTs and OTs. Respondents reported their frequency of implementation of rehabilitative intervention modalities, awareness of CRPS diagnostic frameworks, and use of assessment and outcome measures using a three-category frequency scale. Implementation frequencies were compared with multinational data published by Miller et al. [5] using Fisher’s exact test with post hoc analyses and effect sizes (Cramer’s V). Associations between reported implementation frequency and therapists’ CRPS case experience (0, 1–5, and >6 cases) were also examined.

Results: In total, 107 therapists (76 PTs and 31 OTs) with generally limited clinical exposure to CRPS participated. Educational and exercise-based interventions were the most frequently reported. Compared with prior multinational data, Japanese therapists reported lower uptake and endorsement of several guideline-recommended interventions, particularly psychological/brain-targeted (e.g., mirror therapy) and exposure-based approaches (e.g., tactile desensitization), with moderate to large between-survey differences (Cramer’s V = 0.3–0.6). Reported implementation frequency did not differ with therapists’ CRPS case experience (Cramer’s V ≤ 0.22). Use of established diagnostic criteria and multidimensional outcome measures, including those recommended by COMPACT, was inconsistent across respondents.

Conclusions: Rehabilitation practices and perspectives on CRPS among Japanese PTs and OTs varied widely and displayed limited alignment with contemporary guidelines. Diagnostic awareness and use of multidimensional outcome measures were also inconsistent, with little differentiation with different clinical experience levels. These findings highlight ongoing challenges in implementing guideline-recommended, multimodal CRPS rehabilitation in routine clinical settings and underscore a need for targeted professional education, service-level support, and implementation-focused research.

References: [1] Goebel A, Barker CH, Turner-Stokes L. Complex regional pain syndrome in adults: UK guidelines for diagnosis, referral and management in primary and secondary care. London: RCP, 2018. https://www.rcplondon.ac.uk/guidelines-policy/complex-regional-pain-syndrome-adults
[2] Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Medicine 2007;8:326-331. doi:10.1111/j.1526-4637.2006.00169.x
[3] Shafiee E, MacDermid J, Packham T, Walton D, Grewal R, Farzad M. The Effectiveness of Rehabilitation Interventions on Pain and Disability for Complex Regional Pain Syndrome: A Systematic Review and Meta-analysis. Clin J Pain 2023;39(2):91-105. doi: 10.1097/AJP.0000000000001089.
[4] Smart KM, Ferraro MC, Wand BM, O'Connell NE. Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) type 1 and 2. Cochrane Database of Systematic Reviews 2022; 5(5):CD010853. doi:10.1002/14651858.CD010853.pub3
[5] Miller C, Williams M, Heine P, Williamson E, O'connell N. Current practice in the rehabilitation of complex regional pain syndrome: a survey of practitioners. Disabil Rehabil 2019;41(7):847-853. doi:10.1080/09638288.2017.1407968

Presenting Author: Akira Mibu
Submitting Author: Akira Mibu

Senior Author: Akira Mibu

IASP 2026 Global Year theme of Neuropathic Pain: No

• Tomohiko Nishigami: Ph.D. - Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima
• Michihiro Osumi: Ph.D. - Graduate School of Health Science, Kio University
• So Tanaka: Ph.D. - Department of Clinical Research Center, Fukuoka Orthopaedic Hospital
• Ryota Imai: Ph.D. - Graduate School of Rehabilitation, Osaka Kawasaki Rehabilitation University