Occupational Therapy is not superior to Independent Exercises After Volar Plate Fixation .
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by one or more authors of the
original publication.
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(3):112 Journal of Bone and Joint Surgery; 2011; 93(A): 1761-1766Exclusive Author Interview
Dr. Ring speaking on occupational therapy after volar plate fixation.
94 patients with unstable distal radial fracture treated with open reduction and volar locking plate fixation were randomized to receive exercise therapy under the supervision of an occupational therapist, or surgeon-directed independent exercises. After 6 month follow, up it was found that patients who conducted independent exercises displayed a significantly higher mean arc of wrist flexion, extension, ulnar deviation and mean grip strength in comparison to those in the occupational therapy group. However, it was also found that there were no significant differences in disability scores between the two groups.
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)?
Sì = 1
Incerto = 0,5
Non rilevante = 0
No = 0
La valutazione dei criteri di segnalazione valuta la trasparenza con cui gli autori riportano le caratteristiche metodologiche e sperimentali dello studio all'interno della pubblicazione. La valutazione è suddivisa in cinque categorie che vengono presentate di seguito.
4/4
Randomization
4/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
L'Indice di Fragilità è uno strumento che aiuta l'interpretazione dei risultati significativi, fornendo una misura della forza di un risultato. L'Indice di Fragilità rappresenta il numero di eventi consecutivi che devono essere aggiunti a un risultato dicotomico per rendere il risultato non più significativo. Un numero piccolo rappresenta un risultato più debole, mentre un numero grande rappresenta un risultato più forte.
Perché questo studio era necessario ora?
We all are aware of the potential benefits of the physical and occupational therapy after most surgical procedures. However, uncertainties exist over the the effects of formal occupational therapy on recovery after open reduction and volar plate fixation of the distal radius fracture. This study evaluates the wrist function and arm-specific disability six months after open reduction and volar plate fixation of a distal radial fracture between patients who received and didn't receive the formal occupational therapy.
Qual era la domanda di ricerca principale?
Does occupational therapy lead to better outcomes in terms of wrist function and arm specific disability in comparison to independent exercises in patients with unstable distal radial fracture treated with open reduction and volar locking plate fixation?
- patients in the independent exercise group had significantly higher pinch strength, grip strength, and Gartland and Werley scores in comparison to those in the occupational therapy group at 3 month follow up (p<0.05)
- the independent group displayed significantly better wrist flexion and extension at 6 month follow up (118 degrees versus 129 degrees, p<0.05)
- DASH scores favored the independent exercise group, but this was not significant (p=0.42)
Che cosa devo ricordare di più?
Occupational therapy does not lead to superior function or disability outcomes in comparison to independent exercises in individuals who have undergone open reduction and volar locking plate fixation.
Come influenzerà l'assistenza ai miei pazienti?
Although the results of this study do not find any additional benefits for using occupational therapy, further long term studies need to be conducted.
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