The effects of whirlpool bath and contrast bath therapies on pain, disability, function, and hand grip strength in patients with complex regional pain syndrome following distal radius fracture

Objective: This study aims to compare the effectiveness of whirlpool bath and contrast bath therapies in patients with type 1 complex regional pain syndrome following distal radius fracture. Materials and Methods: A total of 38 patients who developed type 1 complex regional pain syndrome following distal radius fracture were included in the study. Patients were randomly assigned to the contrast bath group (n=19) or the whirlpool bath group (n=19). Assessments were conducted at baseline (before treatment), at the 4th week after treatment, and at the 12th week after treatment. The contrast bath group received a total of 20 treatment sessions, administered 5 days per week for 4 weeks. Each session consisted of alternating cycles of 4 minutes in hot water (38°C) and 1 minute in cold water (10°C), repeated to complete a total treatment duration of 20 minutes. The whirlpool bath group also received 20 treatment sessions, 5 days per week for 4 weeks. Each session consisted of 20 minutes of therapy in water maintained at a temperature of 32–38°C. In addition, both groups were given an exercise program and TENS. The evaluations inclueded the Visual Analog Scale (VAS) for pain, a goniometer for wrist joint range of motion, and the Jamar Hydraulic Hand Dynamometer for hand grip strength. Functional and clinical assessments included the Disabilities of the Arm, Shoulder, and Hand Questionnaire (Quick-DASH), the Patient-Rated Wrist Evaluation (PRWE), the Jebsen–Taylor Hand Function Test (JTHFT), and the Short Form-36 (SF-36) Health Survey for quality of life. Results: There were no significant differences between the groups in demographic and clinical characteristics (age, sex, affected side, dominant hand, mechanism of injury) or baseline assessment scores (p>0.05). Intragroup evaluations demonstrated statistically significant improvements in VAS, hand grip strength, range of motion, Quick-DASH, PRWE, JTHFT, and SF-36 scores after treatment and at the 12th week (p<0.05). In intergroup comparisons, no statistically significant differences were found in VAS, range of motion, Quick-DASH, PRWE, JTHFT, and SF-36 scores after treatment and at the 12th week (p>0.05). However, at the 12th week, comparison of the groups in terms of hand grip strength revealed that the contrast bath group demonstrated significantly greater improvement than the whirlpool bath group (p<0.05). Conclusion: This study suggest that whirlpool bath and contrast bant therapies may be effective and safe treatment methods for alleviating symptoms, improving quaşity of life and enhancing functional outcomes in patients with type 1 complex regional pain syndrome following distal radius fracture. İn order to confirm these findings and to evaluate their longterm effects, further large-scale and long-term studies are required. Keywords: Distal radius fracture, Complex regional pain syndrome type 1, Contrast bath, Whirlpool Bath, Rehabilitation, Pain