Adding mobilisation with movement to exercise and advice hastens the improvement in range, pain and function after non-operative cast immobilisation for distal radius fracture : A multicentre, randomised trial

Journal article

Reid, Susan A., Andersen, Josef M. and Vicenzino, Bill. (2020). Adding mobilisation with movement to exercise and advice hastens the improvement in range, pain and function after non-operative cast immobilisation for distal radius fracture : A multicentre, randomised trial. Journal of Physiotherapy. 66(2), pp. 105-112. https://doi.org/10.1016/j.jphys.2020.03.010
AuthorsReid, Susan A., Andersen, Josef M. and Vicenzino, Bill
Abstract

Question
Does adding mobilisation with movement (MWM) to usual care (ie, exercises plus advice) improve outcomes after immobilisation for a distal radius fracture?

Design
A prospective, multicentre, randomised, clinical trial with concealed allocation, blinding and intention-to-treat analysis.

Participants
Sixty-seven adults (76% female, mean age 60 years) treated with casting after distal radius fracture.

Intervention
The control group received exercises and advice. The experimental group received the same exercises and advice, plus supination and wrist extension MWM.

Outcome measures
The primary outcome was forearm supination at 4 weeks (immediately post-intervention). Secondary outcomes included wrist extension, flexion, pronation, grip strength, QuickDASH (Disabilities of Arm, Shoulder and Hand), Patient-Rated Wrist Evaluation (PRWE) and global rating of change. Follow-up time points were 4 and 12 weeks, with patient-rated measures at 26 and 52 weeks.

Results
Compared with the control group, supination was greater in the experimental group by 12 deg (95% CI 5 to 20) at 4 weeks and 8 deg (95% CI 1 to 15) at 12 weeks. Various secondary outcomes were better in the experimental group at 4 weeks: extension (14 deg, 95% CI 7 to 20), flexion (9 deg, 95% CI 4 to 15), QuickDASH (−11, 95% CI −18 to −3) and PRWE (−13, 95% CI −23 to −4). Benefits were still evident at 12 weeks for supination, extension, flexion and QuickDASH. The experimental group were more likely to rate their global change as ‘improved’ (risk difference 22%, 95% CI 5 to 39). There were no clear benefits in any of the participant-rated measures at 26 and 52 weeks, and no adverse effects.

Conclusion
Adding MWM to exercise and advice gives a faster and greater improvement in motion impairments for non-operative management of distal radius fracture.

Registration
ACTRN12615001330538.

Keywordsdistal radius fracture; rehabilitation; mobilisation; physical therapy; exercise
Year2020
JournalJournal of Physiotherapy
Journal citation66 (2), pp. 105-112
PublisherAustralian Physiotherapy Association
ISSN1836-9553
Digital Object Identifier (DOI)https://doi.org/10.1016/j.jphys.2020.03.010
Scopus EID2-s2.0-85083065018
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range105-112
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online2020
Publication process dates
Deposited28 Jun 2021
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