Skip to main content
Erschienen in: Wiener klinische Wochenschrift 5/2015

01.12.2015 | original article

Efficacy of combined physical and occupational therapy in patients with conservatively treated distal radius fracture: randomized controlled trial

verfasst von: Verica Filipova, MD, Dragan Lonzarić, MD, Breda Jesenšek Papež, MD, PhD

Erschienen in: Wiener klinische Wochenschrift | Sonderheft 5/2015

Einloggen, um Zugang zu erhalten

Summary

Aim

To evaluate the efficacy of combined physical and occupational therapy in comparison with physical therapy alone in patients with conservatively treated distal radius fracture.

Methods

Sixty-one participants, conservatively treated after a distal radius fracture, were included in a randomized and single-blind trial. Group A had physical therapy only (n = 31) and group B had physical and occupational therapy (n = 30). The assessment was performed three times: upon inclusion in the study in the first week after removal of the cast (T1), immediately after the end of the rehabilitation (T2), and 1 month after completing the rehabilitation (T3). The passive wrist range-of-motion, grip strength, and Disabilities of Arm, Shoulder and Hand (DASH) score were used as rehabilitation outcomes.

Results

Rehabilitation outcomes were analyzed using two-way mixed analysis of variance. The effect of time was statistically significant (p < 0.001) for all outcomes. The group (therapy) factor was statistically significant for grip strength only (p = 0.038). The interaction effect was statistically significant for rotation (p = 0.034) and grip strength (p = 0.021). A comparison between time points T3:T1 showed statistically significant difference in grip strength in favor of group B 67 % (95 % CI 60–74 %) versus group A 53 % (95 % CI 45–61 %), p = 0.024.

Conclusion

The combined therapy resulted in a statistically significant increase of grip strength in comparison with isolated physical therapy in the period of 12–16 weeks after the fracture. This effectiveness was not confirmed with DASH score results.
Literatur
1.
Zurück zum Zitat Bengnér U, Johnell O. Increasing incidence of forearm fractures. A comparison of epidemiologic patterns 25 years apart. Acta Orthop Scand. 1985;56:158–60.CrossRefPubMed Bengnér U, Johnell O. Increasing incidence of forearm fractures. A comparison of epidemiologic patterns 25 years apart. Acta Orthop Scand. 1985;56:158–60.CrossRefPubMed
2.
Zurück zum Zitat Black WS, Becker JA. Common forearm fractures in adults. Am Fam Physician. 2009;80(10):1096–102.PubMed Black WS, Becker JA. Common forearm fractures in adults. Am Fam Physician. 2009;80(10):1096–102.PubMed
3.
Zurück zum Zitat Thompson PW, Taylor J, Dawson A. The annual incidence and seasonal variation of fractures of the distal radius in men and women over 25 years in Dorset, UK. Int J Care Injured. 2004;35:462–6.CrossRef Thompson PW, Taylor J, Dawson A. The annual incidence and seasonal variation of fractures of the distal radius in men and women over 25 years in Dorset, UK. Int J Care Injured. 2004;35:462–6.CrossRef
4.
Zurück zum Zitat McQueen MM, Court-Brown CM. Increasing age and fractures of the distal radius. Curr Orthopaed. 2003;17:360–8.CrossRef McQueen MM, Court-Brown CM. Increasing age and fractures of the distal radius. Curr Orthopaed. 2003;17:360–8.CrossRef
5.
Zurück zum Zitat Cummings SR, Melton LJ, III. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359:1761–7.CrossRefPubMed Cummings SR, Melton LJ, III. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359:1761–7.CrossRefPubMed
6.
Zurück zum Zitat Oyen J, Gjesdal CG, Brudvik C, Hove LM, Apalset EM, Gulseth, HC, et al. Low-energy distal radius fractures in middle-aged and elderly men and women—the burden of osteoporosis and fracture risk: a study of 1794 consecutive patients. Osteoporos Int. 2010;21:1257–67.CrossRefPubMed Oyen J, Gjesdal CG, Brudvik C, Hove LM, Apalset EM, Gulseth, HC, et al. Low-energy distal radius fractures in middle-aged and elderly men and women—the burden of osteoporosis and fracture risk: a study of 1794 consecutive patients. Osteoporos Int. 2010;21:1257–67.CrossRefPubMed
8.
Zurück zum Zitat Figl M, Mayer M, Lederer S, Bogne R, Leixnering M. Extensor pollicis longus rupture after distal radius fracture: results of reconstruction by transposition of the extensor indicis tendon and postoperative dynamic splinting. Wien Klin Wochenschr. 2011;123(15–16):485–7.CrossRefPubMed Figl M, Mayer M, Lederer S, Bogne R, Leixnering M. Extensor pollicis longus rupture after distal radius fracture: results of reconstruction by transposition of the extensor indicis tendon and postoperative dynamic splinting. Wien Klin Wochenschr. 2011;123(15–16):485–7.CrossRefPubMed
9.
Zurück zum Zitat Foldhazy Z, Tornkvist H, Elmstedt E, Andersson G, Hagsten B, Ahrengart L. Long-term outcome of nonsurgically treated distal radius fractures. J Hand Surg Am. 2007;32(9):1374–84.CrossRefPubMed Foldhazy Z, Tornkvist H, Elmstedt E, Andersson G, Hagsten B, Ahrengart L. Long-term outcome of nonsurgically treated distal radius fractures. J Hand Surg Am. 2007;32(9):1374–84.CrossRefPubMed
10.
Zurück zum Zitat Handoll HH, Mathok R. Conservative interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2002;(2):CD000314. Handoll HH, Mathok R. Conservative interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2002;(2):CD000314.
11.
Zurück zum Zitat Schulte LM, Meals CG, Neviaser RJ. Management of adult diaphyseal both-bone forearm fractures. J Am Acad Orthop Surg. 2014;22(7):437–46. doi:10.5435/JAAOS-22-07-437.CrossRefPubMed Schulte LM, Meals CG, Neviaser RJ. Management of adult diaphyseal both-bone forearm fractures. J Am Acad Orthop Surg. 2014;22(7):437–46. doi:10.5435/JAAOS-22-07-437.CrossRefPubMed
12.
Zurück zum Zitat Weninger P, Dall’Ara E, Drobetz H, et al. Multidirectional volar fixed-angle plating using cancellous locking screws for distal radius fractures—evaluation of three screw configurations in an extra-articular fracture model. Wien Klin Wochenschr. 2011;123(1–2):4–10.CrossRefPubMed Weninger P, Dall’Ara E, Drobetz H, et al. Multidirectional volar fixed-angle plating using cancellous locking screws for distal radius fractures—evaluation of three screw configurations in an extra-articular fracture model. Wien Klin Wochenschr. 2011;123(1–2):4–10.CrossRefPubMed
13.
Zurück zum Zitat Watt CF, Taylor NF, Baskus K. Do Colles’ fracture patients benefit from routine referral to physiotherapy following cast removal? Arch Orthop Trauma Surg. 2000;120(7–8):413–5.CrossRefPubMed Watt CF, Taylor NF, Baskus K. Do Colles’ fracture patients benefit from routine referral to physiotherapy following cast removal? Arch Orthop Trauma Surg. 2000;120(7–8):413–5.CrossRefPubMed
14.
Zurück zum Zitat Wakefield AE, McQueen MM. The role of physiotherapy and clinical predictors of outcome after fracture of the distal radius. J Bone Joint Surg Br. 2000;82(7):972–6.CrossRefPubMed Wakefield AE, McQueen MM. The role of physiotherapy and clinical predictors of outcome after fracture of the distal radius. J Bone Joint Surg Br. 2000;82(7):972–6.CrossRefPubMed
15.
Zurück zum Zitat Nielsen TL, Dekkers MK. Progress and prediction of occupational performance in women with distal radius fractures: a one-year follow-up. Scand J Occup Ther. 2013;20(2):143–51.CrossRefPubMed Nielsen TL, Dekkers MK. Progress and prediction of occupational performance in women with distal radius fractures: a one-year follow-up. Scand J Occup Ther. 2013;20(2):143–51.CrossRefPubMed
16.
Zurück zum Zitat Christensen OM, Kunov A, Hansen FF, Christiansen TC, Krasheninnikoff M. Occupational therapy and Colles’ fractures. Int Orthop. 2001;25(1):43–5.CrossRefPubMedPubMedCentral Christensen OM, Kunov A, Hansen FF, Christiansen TC, Krasheninnikoff M. Occupational therapy and Colles’ fractures. Int Orthop. 2001;25(1):43–5.CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Valdes K, Naughton N, Michlovitz S. Therapist supervised clinic-based therapy versus instruction in a home program following distal radius fracture: a systematic review. Hand Ther. 2014;27(3):165–73.CrossRef Valdes K, Naughton N, Michlovitz S. Therapist supervised clinic-based therapy versus instruction in a home program following distal radius fracture: a systematic review. Hand Ther. 2014;27(3):165–73.CrossRef
18.
Zurück zum Zitat Norkin CC, White DJ, eds. Techniques and procedures in measurement of joint motion: a guide to goniometry. Philadelphia: FA Davis; 1988. pp. 9–24. Norkin CC, White DJ, eds. Techniques and procedures in measurement of joint motion: a guide to goniometry. Philadelphia: FA Davis; 1988. pp. 9–24.
19.
Zurück zum Zitat Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1984;66(2):69–74. Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1984;66(2):69–74.
20.
Zurück zum Zitat Bohannon RW, Peolsson A, Massy-Westropp N, Desrosiers J, Bear-Lehmane J. Reference values for adult grip strength measured with a Jamar dynamometer: a descriptive meta-analysis. Physio. 2006;92:11–5.CrossRef Bohannon RW, Peolsson A, Massy-Westropp N, Desrosiers J, Bear-Lehmane J. Reference values for adult grip strength measured with a Jamar dynamometer: a descriptive meta-analysis. Physio. 2006;92:11–5.CrossRef
21.
Zurück zum Zitat Westphal T, Piatek S, Schubert S, Schuschke T, Winckler S. Reliability and validity of the upper limb DASH questionnaire in patients with distal radius fractures. Z Orthop Ihre Grenzgeb. 2002;140(4):447–51.CrossRefPubMed Westphal T, Piatek S, Schubert S, Schuschke T, Winckler S. Reliability and validity of the upper limb DASH questionnaire in patients with distal radius fractures. Z Orthop Ihre Grenzgeb. 2002;140(4):447–51.CrossRefPubMed
22.
Zurück zum Zitat Green D, Hotchkiss R, Pederson W, eds. et al. Green’s operative hand surgery. 5th ed. Philadelphia: Churchill Livingstone; 2005. pp. 2015–44 (Chapter 59, Complex regional pain syndrome). Green D, Hotchkiss R, Pederson W, eds. et al. Green’s operative hand surgery. 5th ed. Philadelphia: Churchill Livingstone; 2005. pp. 2015–44 (Chapter 59, Complex regional pain syndrome).
23.
Zurück zum Zitat Harden RN, Bruehl SP. Diagnosis of complex regional pain syndrome: signs, symptoms, and new empirically derived diagnostic criteria. Clin J Pain. 2006;22(5):415–9.CrossRefPubMed Harden RN, Bruehl SP. Diagnosis of complex regional pain syndrome: signs, symptoms, and new empirically derived diagnostic criteria. Clin J Pain. 2006;22(5):415–9.CrossRefPubMed
24.
Zurück zum Zitat Harden RN, Swan M, King A, Costa B, Barthel J. Treatment of complex regional pain syndrome: functional restoration. Clin J Pain. 2006;22(5):420–4.CrossRefPubMed Harden RN, Swan M, King A, Costa B, Barthel J. Treatment of complex regional pain syndrome: functional restoration. Clin J Pain. 2006;22(5):420–4.CrossRefPubMed
25.
Zurück zum Zitat Hoang-Kim A, Pegreffi F, Moroni A, Ladd A. Measuring wrist and hand function: common scales and checklists. Injury. 2011;42(3):253–8.CrossRefPubMed Hoang-Kim A, Pegreffi F, Moroni A, Ladd A. Measuring wrist and hand function: common scales and checklists. Injury. 2011;42(3):253–8.CrossRefPubMed
26.
Zurück zum Zitat Changulani M, Okonkwo U, Keswani T, Kalairajah Y. Outcome evaluation measures for wrist and hand—which one to choose? Int Orthop. 2008;32(1):1–6.CrossRefPubMedPubMedCentral Changulani M, Okonkwo U, Keswani T, Kalairajah Y. Outcome evaluation measures for wrist and hand—which one to choose? Int Orthop. 2008;32(1):1–6.CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Srinivasan RC, Jain D, Richard MJ, Leversedge FJ, Mithani SK, Ruch DS. Isolated ulnar shortening osteotomy for the treatment of extra-articular distal radius malunion. J Hand Surg Am. 2013;38(6):1106–10.CrossRefPubMed Srinivasan RC, Jain D, Richard MJ, Leversedge FJ, Mithani SK, Ruch DS. Isolated ulnar shortening osteotomy for the treatment of extra-articular distal radius malunion. J Hand Surg Am. 2013;38(6):1106–10.CrossRefPubMed
28.
Zurück zum Zitat Ketiš-Klemenc Z, Kersnik J. One month prevalence of self–reported musculoskeletal pain syndromes and correlates. Acta Medico–Biotechnica AMB. 2012;5(2):40–6. Ketiš-Klemenc Z, Kersnik J. One month prevalence of self–reported musculoskeletal pain syndromes and correlates. Acta Medico–Biotechnica AMB. 2012;5(2):40–6.
29.
Zurück zum Zitat Swart E, Nellans K, Rosenwasser M. The effects of pain, supination, and grip strength on patient-rated disability after operatively treated distal radius fractures. J Hand Surg Am. 2012;37(5):957–62.CrossRefPubMed Swart E, Nellans K, Rosenwasser M. The effects of pain, supination, and grip strength on patient-rated disability after operatively treated distal radius fractures. J Hand Surg Am. 2012;37(5):957–62.CrossRefPubMed
30.
Zurück zum Zitat Wilcke MK, Abbaszadegan H, Adolphson PY. Patient-perceived outcome after displaced distal radius fractures. A comparison between radiological parameters, objective physical variables, and the DASH score. J Hand Ther. 2007;20(4):290–8.CrossRefPubMed Wilcke MK, Abbaszadegan H, Adolphson PY. Patient-perceived outcome after displaced distal radius fractures. A comparison between radiological parameters, objective physical variables, and the DASH score. J Hand Ther. 2007;20(4):290–8.CrossRefPubMed
31.
Zurück zum Zitat Ring D, Kadzielski J, Fabian L, Zurakowski D, Malhotra LR, Jupiter JB. Self-reported upper extremity health status correlates with depression. J Bone Joint Surg Am. 2006;88(9):1983–8.CrossRefPubMed Ring D, Kadzielski J, Fabian L, Zurakowski D, Malhotra LR, Jupiter JB. Self-reported upper extremity health status correlates with depression. J Bone Joint Surg Am. 2006;88(9):1983–8.CrossRefPubMed
32.
Zurück zum Zitat Magnus CR, Arnold CM, Johnston G, et al. Cross-education for improving strength and mobility after distal radius fractures: a randomized controlled trial. Arch Phys Med Rehabil. 2013;94(7):1247–55.CrossRefPubMed Magnus CR, Arnold CM, Johnston G, et al. Cross-education for improving strength and mobility after distal radius fractures: a randomized controlled trial. Arch Phys Med Rehabil. 2013;94(7):1247–55.CrossRefPubMed
Metadaten
Titel
Efficacy of combined physical and occupational therapy in patients with conservatively treated distal radius fracture: randomized controlled trial
verfasst von
Verica Filipova, MD
Dragan Lonzarić, MD
Breda Jesenšek Papež, MD, PhD
Publikationsdatum
01.12.2015
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe Sonderheft 5/2015
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-015-0812-9

Weitere Artikel der Sonderheft 5/2015

Wiener klinische Wochenschrift 5/2015 Zur Ausgabe