No added benefit of exercise therapy to structured advice following distal radius fracture

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
Synopsis
33 adult patients with a distal radial fracture were randomized to receive either 6 weeks of structured advice from a physiotherapist supplemented with exercise, or structured advice solely. The purpose of this study was to determine whether a combination of structured advice and exercise yields better outcomes compared to structured advice alone with regards to the rehabilitation of upper limb activity. Outcomes were over Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: Physiotherapy Research Foundation
Conflicts: None disclosed
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Why was this study needed now?
Distal radial fractures are common and in some cases can lead to pain, stiffness, and decreased function. Rehabilitation treatments for these fractures often consist of physical therapy via progressive exercise programs and advice programs. Resulting outcomes of these two treatments in tandem are generally positive, but the spread of efficacy between the two interventions has yet to be determined. Therefore, the present study was conducted to determine the contributing effects of a progressive exercise program when paired with a structured advice program.
What was the principal research question?
In the treatment of distal radial fractures, does a progressive exercise program in adjunct to consultation and advice from a physiotherapist provide significantly greater improvements in upper limb activity compared to consultation and advice from a physiotherapist alone when assessed over a 24-week follow-up period?
Population: 33 adult patients (at least 21 years of age) with a distal radial fracture were included. All patients received a compression sleeve composed of elasticized material to be placed on the wrist and forearm to combat swelling.
Intervention: Exercise+advice group: patients received exercises for physical therapy and advice from a physiotherapist over three visits at week 1, 3, and 5. Seven exercises were implemented on the first visit and outlined in a home diary with instruction on how to complete the exercise. Sets and repetitions were recorded daily in the diary and reported every week via mail. At week 3, sleep, relaxation, and work strategy advice was given to the patient and exercises for physical therapy were progressively increased by adding exercises or increasing resistance on existing exercises. Advice on medium-term goal setting was given at week 5 along with progressively increased weight-bearing in the exercise program. (n=19, 16 completed 24 week follow-up) (Mean age: 51+/-17; 4M/15F)
Comparison: Advice-only group: patients received advice from a physiotherapist over three visits at week 1, 3, and 5 with a procedure identical to the exercise+advice group, but without the adjunct exercise program. (n=14, 13 completed 24 week follow-up) (Mean age: 58+/-18; 4M/10F)
Outcomes: The primary outcome was the Patient-Rated Wrist Evaluation activity subscale (PRWE; 0 to 10 from no difficulty with activity to inability to perform activity) and the abridged version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH; 1 to 5 from no difficulty to inability to perform activity), used to evaluate upper limb activity. Secondary outcomes included the range of movement in the wrist (flexion, extension, and supination) measured with a goniometer (degrees), grip strength measured using a Jamar dynamometer (kg), and pain measured using the PRWE pain subscale (0 to 10 from no pain to most pain). Intervention adherence based on the frequency of entries in the home diary was documented at each consultation visit.
Methods: RCT; multicentre, assessor-blinded
Time: Outcomes were assessed post-intervention (week 7), and at 24 week follow-up.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.