Fitted orthosis versus plaster splint in postoperative rehabilitation after DRF fixation .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2015;3(9):10 PLoS One. 2015 Mar 30;10(3):e011772029 patients with displaced distal radius fracture were randomized in this cross-over trial comparing a vacuum-fitted orthosis and a plaster splint in postoperative rehabilitation. Following volar locking plate fixation, patients were randomized to one week orthosis wear followed by 3 weeks splint wear, or to one week splint wear followed by 3 weeks orthosis wear. Patient satisfaction and SF-36 scores were examined at 1 and 2 weeks after surgery, and range of motion and DASH scores were reported at 4 and 12 weeks after surgery. Aesthetics, handling, and hygiene were rated higher for the orthosis than the plaster splint, though no significant differences were noted in range of motion, SF-36 scores, or DASH scores.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
4/4
Randomization
1/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
Distal radius fractures are a commonly sustained injury, with an increasing trend in patients undergoing surgery for treatment, particularly in displaced fractures. While extensive research focus has been placed on different methods of surgical management, by comparison very little research has gone into postoperative management and optimal rehabilitation strategies. More specifically, methods and duration of immobilization remain points of interest. Traditionally, plaster casts have been implemented, but there has been interest in whether removable, dynamic orthoses may also be effective while offering better comfort.
Qual era a principal questão de investigação?
How does patient satisfaction and functional outcomes compare between patients treated with a dynamic orthosis versus a plaster cast following volar locking plate fixation of a displaced distal radius fracture?
- After the first week, patients who received the orthosis rated aesthetics significantly higher than those who received the splint (p<0.001), though difference after the cross-over was nonsignificant (p=0.719). Handling and hygiene were rated significantly higher with the orthosis versus the splint among those who received orthosis in the first week (p<0.001), and those who received the orthosis in the second week (p=0.001).
- No significant differences were noted between groups in the rating of activity limitation, physical resilience, fitting, or postoperative pain items within the patient-satisfaction questionnaire (all p>0.05).
- Preference for the orthosis was expressed in 23/29 patients (p=0.017).
- No statistically significant differences between groups were observed in range of motion, SF-36, or DASH scores.
De que é que me devo lembrar mais?
Following surgical fixation of a displaced distal radius fracture, a vacuum-fitted orthosis was associated with greater patient satisfaction compared to a semicircumferential plaster splint with respect to aesthetics, handling, and hygiene, leading to greater patient preference. Patient-reported and function outcome did not significant differ in the short-term.
Como é que isto afectará o tratamento dos meus doentes?
The results of this study suggest that fitted orthoses, such as the VacoHand dynamic orthosis, may be more appealing to patients, although the increased patient satisfaction does not appear to lead to, or be the result of, improved clinical outcome. The cost-effectiveness of fitted orthoses should be considered in subsequent trials.
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