Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Therapies Department, Royal United Hospitals NHS Foundation Trust, Bath, UK.
BMC Musculoskelet Disord. 2023 Sep 18;24(1):741. doi: 10.1186/s12891-023-06711-4.
Distal radius fractures are common fractures in older adults and associated with increased risk of future functional decline and hip fracture. Whether lower limb muscle strength and balance are impaired in this patient population is uncertain. To help inform rehabilitation requirements, this systematic review aimed to compare lower limb muscle strength and balance between older adults with a distal radius fracture with matched controls, and to synthesise lower limb muscle strength and balance outcomes in older adults with a distal radius fracture.
We searched Embase, MEDLINE, and CINAHL (1990 to 25 May 2022) for randomised and non-randomised controlled clinical trials and observational studies that measured lower limb muscle strength and/or balance using instrumented measurements or validated tests, in adults aged ≥ 50 years enrolled within one year after distal radius fracture. We appraised included observational studies using a modified Newcastle-Ottawa Scale and included randomised controlled trials using the Cochrane risk-of-bias tool. Due to the clinical and methodological heterogeneity in included studies, we synthesised results narratively in tables and text.
Nineteen studies (10 case-control studies, five case series, and four randomised controlled trials) of variable methodological quality and including 1835 participants (96% women, mean age 55-73 years, median sample size 82) were included. Twelve included studies (63%) assessed strength using 10 different methods with knee extension strength most commonly assessed (6/12 (50%) studies). Five included case-control studies (50%) assessed lower limb strength. Cases demonstrated impaired strength during functional tests (two studies), but knee extension strength assessment findings were conflicting (three studies). Eighteen included studies (95%) assessed balance using 14 different methods. Single leg balance was most commonly assessed (6/18 (33%) studies). All case-control studies assessed balance with inconsistent findings.
Compared to controls, there is some evidence that older adults with a distal radius fracture have impaired lower limb muscle strength and balance. A cautious interpretation is required due to inconsistent findings across studies and/or outcome measures. Heterogeneity in control participants' characteristics, study design, study quality, and assessment methods limited synthesis of results. Robust case-control and/or prospective observational studies are needed.
International prospective register of systematic reviews (date of registration: 02 July 2020, registration identifier: CRD42020196274).
桡骨远端骨折是老年人常见的骨折，与未来功能下降和髋部骨折的风险增加有关。在这一患者群体中，下肢肌肉力量和平衡是否受损尚不确定。为了帮助确定康复需求，本系统评价旨在比较桡骨远端骨折老年患者与匹配对照组之间的下肢肌肉力量和平衡，并综合桡骨远端骨折老年患者的下肢肌肉力量和平衡结果。
我们检索了 Embase、MEDLINE 和 CINAHL（1990 年至 2022 年 5 月 25 日），以查找使用仪器测量或经过验证的测试测量下肢肌肉力量和/或平衡的随机和非随机对照临床试验和观察性研究，纳入年龄≥50 岁且在桡骨远端骨折后一年内入组的成年人。我们使用改良的纽卡斯尔-渥太华量表评估纳入的观察性研究，并使用 Cochrane 偏倚风险工具评估随机对照试验。由于纳入研究的临床和方法学存在异质性，我们以表格和文本的形式进行了结果综合。
共纳入 19 项研究（10 项病例对照研究、5 项病例系列研究和 4 项随机对照试验），这些研究的方法学质量存在差异，共纳入 1835 名参与者（96%为女性，平均年龄 55-73 岁，中位样本量 82）。12 项纳入研究（63%）使用 10 种不同的方法评估力量，其中最常评估的是膝关节伸展力量（6/12[50%]项研究）。5 项纳入的病例对照研究（50%）评估了下肢力量。病例在功能测试中表现出力量受损（两项研究），但膝关节伸展力量评估结果存在矛盾（三项研究）。18 项纳入研究（95%）使用 14 种不同的方法评估平衡。单腿平衡最常被评估（6/18[33%]项研究）。所有病例对照研究均使用不一致的发现来评估平衡。
与对照组相比，桡骨远端骨折的老年患者下肢肌肉力量和平衡可能受损。由于研究之间和/或结果测量的不一致，需要谨慎解释。对照参与者特征、研究设计、研究质量和评估方法的异质性限制了结果的综合。需要进行强有力的病例对照和/或前瞻性观察性研究。
国际前瞻性系统评价登记处（注册日期：2020 年 7 月 2 日，登记编号：CRD42020196274）。
