遠位橈骨骨折患者における監視下理学療法と自宅運動プログラムの比較：ランダム化比較試験の系統的レビューとメタアナリシス

OBJECTIVE: To compare the effects of supervised physical therapy to home exercise programs on functional outcomes in patients after distal radius fractures. DESIGN: Intervention systematic review with meta-analysis of randomized clinical trials (RCTs). LITERATURE SEARCH: We searched MEDLINE, EMBASE, Web of Science, Scopus, CENTRAL, Epistemonikos, Cumulative Index of Nursing and Allied Health Literature, SPORTDiscus, Physiotherapy Evidence Database, and LILACS databases from inception to April 2025. STUDY SELECTION CRITERIA: We included RCTs comparing supervised physical therapy with a home exercise program on functional outcomes in patients with distal radius fracture. DATA SYNTHESIS: We used a random-effects meta-analysis for clinically homogeneous RCTs. We assessed risk of bias using the Cochrane Risk of Bias 2.0 and applied the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to judge the certainty of evidence. RESULTS: Thirteen RCTs were included. At 6 weeks, there were significant differences for Patient-Rated Wrist Evaluation (mean difference [MD] = -11.64 points, P < .001) with moderate certainty of evidence, for grip strength relative to the unaffected side (MD = 12.85%, P = .03) with low certainty of evidence, and for wrist extension range of motion (MD = 8.99°, P = .03) with moderate certainty of evidence. All results were in favor of the supervised physical therapy group. There were significant differences in favor of supervised physical therapy for wrist function and extension range of motion in patients over 65 years (P < .05). A greater number and frequency of supervised physical therapy sessions were associated with greater pain relief and improved wrist range of motion (P < .05). CONCLUSION: Supervised physical therapy had statistically significant short-term benefits in wrist function, grip strength, and wrist extension range of motion. J Orthop Sports Phys Ther 2026;56(3):158-175. Epub 4 February 2026. doi:10.2519/jospt.2026.13561.