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A progressive exercise and structured advice program does not improve activity more than structured advice alone
Andrea M Bruder1, Nora Shields2, Karen J Dodd3
1School of Allied Health, La Trobe University.
Question:
Does a program of exercise and structured advice implemented during the rehabilitation phase following a distal radial fracture achieve better recovery of upper limb activity than structured advice alone?
Design:
A phase I/II, multi-centre, randomised, controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis.
Participants:
Thirty-three adults (25 female, mean age 54 years) following distal radial fracture managed in a cast.
Intervention:
The experimental intervention was a 6-week program of progressive exercise and structured advice implemented over three consultations by a physiotherapist. The control intervention was a program of structured advice only, delivered by a physiotherapist over three consultations.
Outcome Measures:
The primary outcome was upper limb activity limitations, assessed by the Patient-Rated Wrist Evaluation and the shortened version of the Disabilities of the Arm, Shoulder and Hand outcome measure (QuickDASH). The secondary outcomes were wrist range of movement, grip strength and pain. All measures were completed at baseline (week 0), after the intervention (week 7) and at 6 months (week 24).
Results:
There were no significant between-group differences in upper limb activity as measured by the Patient-Rated Wrist Evaluation at week 7 and week 24 assessments (mean difference -4 units, 95% CI -10 to 2; mean difference 0 units, 95% CI -3 to 3, respectively), or QuickDASH at week 7 and week 24 assessments (mean difference -5 units, 95% CI -16 to 6; mean difference 0.3 units, 95% CI -6 to 7, respectively). The secondary outcomes did not demonstrate any significant between-group effects.
Conclusion:
The prescription of exercise in addition to a structured advice program over three physiotherapy consultations may convey no extra benefit following distal radial fracture managed in a cast.
Trial Registration:
ACTRN12612000118808. [Bruder AM, Shields N, Dodd KJ, Hau R, Taylor NF (2016) A progressive exercise and structured advice program does not improve activity more than structured advice alone following a distal radial fracture: a multi-centre, randomised trial.Journal of Physiotherapy62: 145-152].
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