Physiotherapy in Conservatively Managed Distal Radius Fractures
Research type
Research Study
Full title
Outcomes and Cost Effectiveness of Physiotherapy, Self Directed Therapy and Advice Sheets Following Conservatively Managed Distal Radius Fractures : A Prospective Randomised Controlled Trial
IRAS ID
143108
Contact name
BJ Ollivere
Contact email
Sponsor organisation
Nottingham Health Science Partners
Duration of Study in the UK
0 years, 4 months, 29 days
Research summary
Summary of Research
There remains no consensus on the most appropriate rehabilitation for patients who are treated in plaster without surgery after distal radius (wrist) fractures.
Many centres refer these patients to a physiotherapist after cast removal, adding to the overall cost of patient management. This can be justified if the patient's return to function is hastened by physiotherapy. If no significant benefit can be shown then a change in the management of these patients should be recommended.
The study will be a prospective randomised control trial with two intervention groups and a control group;
Referral to a physiotherapist.
Self directed exercises at home with a teaching video.
Advice sheet (control group).Summary of Result
Access to face-to-face physiotherapy after injury has increasingly had challenges, particularly during the COVID-19 pandemic. We set out to investigate whether, following cast removal for nonoperatively treated distal radius fractures, rehabilitation facilitated by alternatives to face-to-face therapy sessions were comparable to a course of face-to-face therapy in terms of efficacy using patient-reported outcome measures (PROMs).1 Included in this study were adult participants with an isolated, nonoperatively treated distal radius fracture. They entered the study after cast removal. Participants were randomized to delivery of rehabilitation interventions in one of three ways: 1) an advice leaflet; 2) an advice video; or 3) face-to-face therapy session(s). The primary outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score at six weeks, and secondary outcome measures included DASH at one year, DASH work sub-scale, grip strength, and range of motion at six weeks and one year.
We found that 116 (97%) of 120 enrolled participants commenced treatment. Of those, 21 were lost to follow-up, resulting in 30 participants in the advice leaflet, 32 in the advice video, and 33 in the face-to-face therapy arms. There was no significant difference between the treatment groups in the DASH at six weeks or one year (advice leaflet vs face-to-face therapy; p = 0.69; advice video vs face-to-face therapy; p = 0.56; advice leaflet vs advice video; p = 0.37; advice leaflet vs advice video vs face-to-face therapy; p = 0.63, analysis of variance). At six weeks, there were no differences in any secondary outcome measures, except for the DASH work sub-scale, where face-to-face therapy conferred benefit over advice leaflet (p = 0.01, independent-samples t-test).
We concluded that this study demonstrated that following cast removal for nonoperatively treated distal radius fractures, offering a patient an advice leaflet or advice video for rehabilitation gives equivalent PROMs to a course of face-to-face therapy.https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fu2790089.ct.sendgrid.net%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbUh5lmQToAEIyw-2Fd2PznX8uhtNMj4iDJgPqnS3gou6PxvJXlaOSABiBhIsUTIPJMKx2qL4HHp56DB-2F0KfHs0B0-2BNmyI05fYznuBlFstLb7Ut5Jox_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YKBI5FClbor6M-2FtrDBANsut0p3-2Bs0oFlBXnf2A8nx12ABYWRFrp5aKHkw5iB-2B-2BlS-2BoUnnkh3gvH71ZgIEUZgMrbJs0BvYww0DtRLSUbO8JA1282obKXEClL6AzMqOGt2FTWVkvdBKpigus85BaH2slpd1rH00b8P3bsfsvfbMppvg-3D-3D&data=05%7C01%7Capprovals%40hra.nhs.uk%7Cf9ba1e08503f410dc6e808da34dd11fc%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C637880421331041193%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=UpWYrTjTt37WXZp6fwzQTvo9CNIzReeCZO3KxWXJvMs%3D&reserved=0
REC name
East Midlands - Nottingham 2 Research Ethics Committee
REC reference
15/EM/0297
Date of REC Opinion
30 Jul 2015
REC opinion
Favourable Opinion