School of Allied Health, La Trobe University.
School of Allied Health, La Trobe University; Department of Allied Health, Northern Health.
J Physiother. 2016 Jul;62(3):145-52. doi: 10.1016/j.jphys.2016.05.011. Epub 2016 Jun 18.
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?
A phase I/II, multi-centre, randomised, controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis.
Thirty-three adults (25 female, mean age 54 years) following distal radial fracture managed in a cast.
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.
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).
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.
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.
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].
在桡骨远端骨折康复阶段实施运动方案和结构化建议是否比仅实施结构化建议能更好地恢复上肢活动？
Ⅰ/Ⅱ期、多中心、随机、对照试验，设盲评估，意向治疗分析。
33 名成人（25 名女性，平均年龄 54 岁），桡骨远端骨折，管型固定。
实验组为 6 周的渐进性运动和结构化建议方案，由物理治疗师进行 3 次咨询。对照组为仅实施结构化建议方案，由物理治疗师进行 3 次咨询。
主要结局是上肢活动受限，采用患者腕关节评估和上肢功能障碍问卷（DASH）简表进行测量。次要结局是腕关节活动范围、握力和疼痛。所有测量均在基线（第 0 周）、干预后（第 7 周）和 6 个月（第 24 周）进行。
第 7 周和第 24 周时，患者腕关节评估和 DASH 评分均未见组间差异有统计学意义（第 7 周时，平均差值 -4 分，95%CI -10 至 2 分；第 24 周时，平均差值 0 分，95%CI -3 至 3 分）。第 7 周和第 24 周时，次要结局也未见组间差异有统计学意义。
在接受管型固定的桡骨远端骨折患者中，除了接受 3 次物理治疗咨询的结构化建议方案外，再开具运动处方可能不会带来额外益处。
ACTRN12612000118808。[Bruder AM, Shields N, Dodd KJ, Hau R, Taylor NF（2016）在桡骨远端骨折康复阶段实施运动方案和结构化建议并不比仅实施结构化建议能更好地恢复上肢活动：一项多中心随机试验。J Physiother 62: 145-152]。
