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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
Reid, Susan A. Andersen, Josef M. Vicenzino, Bill
Reid, Susan A.
Andersen, Josef M.
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.
Keywords
distal radius fracture, rehabilitation, mobilisation, physical therapy, exercise
Date
2020
Type
Journal article
Journal
Journal of Physiotherapy
Book
Volume
66
Issue
2
Page Range
105-112
Article Number
ACU Department
School of Allied Health
Faculty of Health Sciences
Faculty of Health Sciences
Collections
Relation URI
Source URL
Event URL
Open Access Status
Published as ‘gold’ (paid) open access
License
CC BY-NC-ND 4.0
File Access
Open