Collis Julie M, Mayland Elizabeth C, Wright-St Clair Valerie, Rashid Usman, Kayes Nicola, Signal Nada
Auckland University of Technology, School of Clinical Sciences, Auckland, New Zealand.
Western Sydney University, School of Health Sciences, Campbelltown, New South Wales, Australia.
J Hand Ther. 2023 Jul-Sep;36(3):593-605. doi: 10.1016/j.jht.2022.07.009. Epub 2022 Aug 8.
Following surgical repair of distal radius fractures, range of movement (ROM) exercises are the primary approach for restoring movement during early rehabilitation. Specified purposeful activities can also be used, but the movement produced by activities is not well-understood. The study aimed to evaluate and compare movement during purposeful activity and ROM exercises METHODS: Thirty-five adults with a surgically repaired distal radius facture undertook two 10-minutes interventions: purposeful activity (PA) and active ROM exercises (AE), separated by a 60 minute washout, in random order. Data collection occurred during a single session on the same day. Electrogoniometry was used to measure time-accumulated position (TAP), a global metric of movement range and amount, maximum active end range, movement repetitions, excursions >75% of available ROM, and active time. Data were analyzed using linear mixed and generalized linear mixed regression models.
Purposeful activities selected were predominantly household or food preparation. TAP was significantly higher during AE than PA: -1878 [-2388, -1367], p ≤.001, for wrist extension/flexion. PA produced significantly greater movement repetitions for wrist extension/flexion and deviation, excursions beyond 75% of available ROM, and active time, than AE. During PA the wrist was extending/flexing a mean of 97% [92, 101], of the time, compared with 43% [40, 47], during AE. There were no significant differences in maximum end range for wrist extension between PA, 33.7° [29.8, 37.5] and AE, 34.5° [30.7, 38.4], or for ulnar deviation.
ROM exercises produced higher volumes of sustained joint position than purposeful activity but activities, selected for importance and challenge, produced significantly higher volumes of continuous, repetitious motion in equivalent ranges of movement as exercise repetitions. The study challenges therapists to consider the rehabilitative potential of movement produced by activity for restoring movement and function in the early postoperative weeks.
在桡骨远端骨折手术修复后，活动范围（ROM）练习是早期康复期间恢复活动的主要方法。也可采用特定的有目的活动，但这些活动所产生的运动尚不为人所熟知。本研究旨在评估和比较有目的活动与ROM练习期间的运动情况。
35例接受桡骨远端骨折手术修复的成年人进行了两项10分钟的干预：有目的活动（PA）和主动ROM练习（AE），中间间隔60分钟的洗脱期，顺序随机。数据收集在同一天的单个时段进行。使用电子测角仪测量时间累积位置（TAP），这是一个衡量运动范围和量的整体指标、最大主动终末范围、运动重复次数、超过可用ROM 75%的偏移以及主动时间。使用线性混合和广义线性混合回归模型分析数据。
所选的有目的活动主要是家务或食物准备。对于腕关节伸展/屈曲，AE期间的TAP显著高于PA：-1878[-2388，-1367]，p≤.001。PA在腕关节伸展/屈曲和偏斜、超过可用ROM 75%的偏移以及主动时间方面产生的运动重复次数显著多于AE。在PA期间，腕关节伸展/屈曲的平均时间为97%[92，101]，而在AE期间为43%[40，47]。PA（33.7°[29.8，37.5]）和AE（34.5°[30.7，38.4]）之间腕关节伸展的最大终末范围或尺侧偏斜方面无显著差异。
ROM练习比有目的活动产生更高的持续关节位置量，但为重要性和挑战性而选择的活动在与练习重复相同的运动范围内产生了显著更高的连续、重复运动量。该研究促使治疗师考虑活动所产生的运动在术后早期恢复运动和功能方面的康复潜力。
