TRAUMA
A Prospective Randomized Controlled Trial Comparing Occupational Therapy with Independent Exercises After Volar Plate Fixation of a Fracture of the Distal Part of the Radius
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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)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
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
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
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.
主な研究課題は何ですか？
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?
重要な知見は？
- 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)
最も覚えておくべきことは？
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.
それが私の患者ケアにどのように影響するか？
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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