Cryotherapy

The Cryotherapy recommendation has been downgraded two levels because of inconsistent evidence.

Nine high (Levy 1993, Schinsky 2016, Ivey 1994, Li 2016, Thijs 2019, Kullenberg 2006, Smith 2002, Sadoghi 2018, Park 2019) and seven moderate quality articles (Gibbons 2002, Karaduman 2019, Thienpont 2014, Bech 2015, Leegwater 2017, Dervin 1998, Su 2012, Pan 2015) were reviewed regarding cryotherapy.  Of the five studies evaluating pain, three showed improved pain with cryotherapy and one of these also showed decreased opioid consumption.  Of the seven studies evaluating function after cryotherapy, five showed improved range of motion with cryotherapy. 

Benefits/Harms of Implementation

Prolonged cryotherapy could potentially harm the patient with skin contact damage in certain sensitive population, but overall low risk intervention.

Cost Effectiveness/Resource Utilization

Use of a cryotherapy machine would be a large cost if a treating facility had not already invested in these devices.  In addition, large cost for patient to take this device home if indicated.  Potentially large resource utilization in donning/doffing if needing assistance from nursing.

Acceptability

Would require increased resource utilization which may have some concerns with acceptability.

Feasibility

For an extended use of cryotherapy (after discharge), feasibility would be more challenging to gain resources from payers to distribute portable devices.

Future Research

Increased studies with larger patient populations evaluating cryotherapy with better examination of pain and opioid consumption after these interventions, better examination of functional scores and outcomes after this intervention.