Prism Adaptation Therapy for CRPS Type 1

Range of motion was assessed using a goniometer for the wrist (flexion/extension, radial/ulnar deviation) and the forearm (supination/pronation). Each measurement was performed three times, and the mean value was calculated and recorded.

Light touch sensation was evaluated using Semmes-Weinstein monofilaments (SWM). The assessment was conducted at seven sites corresponding to the dermatomal distribution of the median, radial, and ulnar nerves. During the procedure, patients were instructed to avert their gaze from the tested area. Each filament was applied perpendicularly for 1.5 seconds until it bent. Patients were asked to indicate when they perceived the stimulus. Filaments within the 1.65-4.08 range were applied three times, whereas those within the 4.17-6.65 range were applied once, and the patient's response was recorded. Values between 1.65 and 2.83 (green) were classified as normal; 3.22-3.61 (blue) indicated diminished light touch; 3.84-4.31 (purple) signified diminished protective sensation; and 4.56-6.65 (red) represented loss of protective sensation. In cases where there was no response to the 6.65 filament, this was documented as no response, and deep pressure sensation was subsequently assessed.

Grip strength and lateral pinch strength were assessed using a Lafayette digital hand dynamometer. Grip strength measurements were conducted in the seated position as recommended by the American Society of Hand Therapists (ASHT), with the wrist maintained in a neutral position, the forearm supported in mid-rotation, the elbow flexed at 90°, and the shoulder positioned neutrally with adduction. Each measurement was performed three times per patient, and the mean value was calculated.

For lateral pinch strength, the dynamometer was pressed using the distal phalanx of the thumb, supported against the lateral aspect of the second phalanx of the index finger. Patients were instructed to exert maximal force during the measurement. Each measurement was repeated three times per patient, and the average value was recorded.

Wrist circumference was measured in all patients using a measuring tape, carefully positioned to fit precisely over the styloid processes of the radius and ulna. To ensure measurement reliability, each assessment was conducted three times, and the mean value was recorded. Measurements were reported in centimeters.

The assessment of extremity volume is considered the gold standard for volumetric measurements. For each patient, the volumeter was filled with water until it overflowed, and the extremity to be measured was immersed such that the thumb faced the opening of the volumeter and the web space between the second and third fingers aligned with the marked midpoint of the volumeter. The volume of the displaced water was measured using a graduated container for both the healthy and affected extremities of each patient. Measurements were repeated three times separately, recorded individually, and the average value was determined in milliliters (ml).

Upper-extremity function was evaluated using the Nine-Hole Peg Test. Participants were instructed to sequentially pick up nine pegs from the side compartment, insert them one by one into the nine holes on the board, and then remove them as quickly as possible. The time taken to complete the task was recorded using a stopwatch. Completion times were standardized based on participants' age, sex, and dominant hand. The test was administered three times per participant, and the mean completion time was calculated.

The hand function of the patients included in the study was assessed using the Duruöz Hand Index (DHI), an 18-item questionnaire that does not require prior training or specialized equipment. The questionnaire evaluates activities of daily living categorized into domains such as kitchen tasks, dressing, hygiene and cleaning, work-related activities, and other routine daily functions. Each item is scored on a Likert scale, resulting in a total score ranging from 0 to 90, where lower scores correspond to better functional ability.

Disability in all participants was evaluated using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire to assess limitations in activity and participation.

To evaluate quality of life, all participants completed the Short Form-36 Health Survey (SF-36). Initially comprising 149 items in 1999, the instrument was subsequently refined to the SF-20. To expand the assessment's scope and improve its psychometric robustness, the 36-item version was developed. The SF-36 consists of 36 items categorized into eight subscales.

Respondents are instructed to consider their experiences over the preceding four weeks. An alternative version assessing the prior one week is also available to capture acute changes. Items 4 and 5 are answered with binary (yes/no) responses, while the remaining items utilize Likert-type scales with three to six response options. Each subscale is scored independently on a scale from 0 to 100, where higher scores denote better health status.

Patients were evaluated using the Tampa Scale for Kinesiophobia (TSK), a 17-item questionnaire designed to assess fear of movement and/or re-injury. The total score ranges from 17 (lowest) to 68 (highest), with elevated scores indicating greater kinesiophobia, which corresponds to an increased fear of movement and falling.

Ultrasonographic measurements of all patients included in the study were conducted using a G.E. LOGIQ P5 ultrasound system. The device frequency was set between 7 and 12 MHz, and measurements were obtained by positioning a linear transducer over the third metacarpophalangeal joint of the affected limb. Echogenicity, subcutaneous tissue structure, and edema characteristics were assessed, and the findings were classified according to the Ultrasonographic Subcutaneous Edema Grading (USEG) scale.