Maciel J S, Taylor N F, McIlveen C
Western Hospital Physiotherapy Department, Gordon St, 3011 Footscray, VIC, Australia.
Arch Orthop Trauma Surg. 2005 Oct;125(8):515-20. doi: 10.1007/s00402-005-0037-x. Epub 2005 Oct 22.
Physiotherapy is considered by some authorities to be an important aspect of management in patients following distal radius fractures. There is evidence of improvement in impairment with physiotherapy; however, there is no evidence to support early return of functional activity. Traditional physiotherapy management has focussed on improving impairment; however, there are no trials with emphasis on skill acquisition via motor re-learning principles.
Forty-one participants with conservatively managed distal radius fractures were studied in a randomised, single-blinded, prospective trial. Two treatment options were compared: exercise and advice versus activity-focussed physiotherapy with measurement periods of 6 weeks after removal of cast and follow-up at 24 weeks.
Participants allocated to the exercise and advice group consulted a physiotherapist an average of 0.9 (SD 0.4) times, while the participants allocated to the more intensive activity-focussed group consulted with physiotherapy a mean of 4.4 (SD 2.3) times. At both 6 and 24 weeks there were no significant differences between the groups for change in impairment (as measured by grip strength, range of motion of wrist flexion and extension and pain intensity), activity limitation and participation restriction, as measured by the Patient-Rated Wrist Evaluation (PRWE). Exercise and advice given by a physiotherapist were equally as effective as activity-focussed physiotherapy in recovery both at 6 and 24 weeks.
The results suggest that after removal of cast from fracture of distal radius, patients may routinely require no more than a single session of advice and exercise provided by a physiotherapist.
一些权威机构认为物理治疗是桡骨远端骨折患者治疗管理的一个重要方面。有证据表明物理治疗可改善功能障碍；然而，尚无证据支持早期恢复功能活动。传统的物理治疗管理侧重于改善功能障碍；然而，尚无强调通过运动再学习原则获取技能的试验。
在一项随机、单盲、前瞻性试验中，对41例采用保守治疗的桡骨远端骨折患者进行了研究。比较了两种治疗方案：运动与建议组和以活动为重点的物理治疗组，测量时间为拆除石膏后6周以及24周时的随访。
分配到运动与建议组的参与者平均咨询物理治疗师0.9（标准差0.4）次，而分配到更强化的以活动为重点组的参与者平均咨询物理治疗师4.4（标准差2.3）次。在6周和24周时，两组在功能障碍变化（通过握力、腕关节屈伸活动范围和疼痛强度测量）、活动受限和参与限制方面均无显著差异，活动受限和参与限制通过患者自评腕关节评估（PRWE）进行测量。在6周和24周的恢复过程中，物理治疗师给予的运动与建议与以活动为重点的物理治疗同样有效。
结果表明，桡骨远端骨折拆除石膏后，患者通常可能只需接受物理治疗师提供的一次建议和运动指导。
