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Hydrotherapy for Complex Regional Pain Syndrome (CRPS) of the foot and ankle

Three Part Question

IN [adults with CRPS] DOES [hydrotherapy on it's own or as an adjunct to 'dry-land' therapy] IMPROVE [pain and function]

Clinical Scenario

A middle aged patient is referred to physiotherapy with a 6 months history of CRPS following an innocuous trauma. You usually try hydrotherapy with such a condition but want to know if this is more beneficial than 'dry-land' treatment.

Search Strategy

MEDLINE 1966-01/05, CINAHL 1982 –01/05, AMED 1985-01/05, SPORTDiscus 1830-01/05, EMBASE 1996-01/05, via the OVID interface. In addition the Cochrane database and PEDro database were also searched
Medline, CINAHL, AMED, SPORTDiscus, EMBASE, (Sudeck OR Sudeck's atrophy OR reflex sympathetic dystrophy OR complex regional pain syndrome OR algodystrophy) AND (Hydrotherapy OR Physiotherapy OR physical therapy). LIMIT to Human AND English Language

Search Outcome

32 papers were retrieved, none of which answered the 3 part question.


There have been 7 RCTs published since 1999, including trials on children with CRPS and CRPS of the upper limb. None of these compared hydrotherapy to 'dry land' physiotherapy. Some did not have a control group and combined several interventions hindering any inferences regarding efficacy of physiotherapy and hydrotherapy. One additional paper in 2002 was an 'expert panel report' that described 'swimming' as part of a care continuum for CRPS patients.

Clinical Bottom Line

Presently, although 'dry land' physiotherapy seems to be regarded as an important component for the care of CRPS patients, there is no evidence of the efficacy of hydrotherapy for this condition.

Level of Evidence

Level 3 - Small numbers of small studies or great heterogeneity or very different population.