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Zhou Z, Li X, Wu X, Wang X. Impact of early rehabilitation therapy on functional outcomes in patients post distal radius fracture surgery: a systematic review and meta-analysis. BMC Musculoskelet Disord 2024; 25:198. [PMID: 38443916 PMCID: PMC10913665 DOI: 10.1186/s12891-024-07317-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND This meta-analysis aims to investigate the efficacy of early rehabilitation on patients who have undergone surgery for distal radius fractures (DRFs) with palmar plating, focusing on multiple outcome measures including upper limb function, wrist function, back extension mobility, pain levels, and complications. METHODS A rigorous search strategy adhering to the PRISMA guidelines was employed across four major databases, including PubMed, Embase, Web of Science, and the Cochrane Library. Studies were included based on stringent criteria, and data extraction was performed independently by two reviewers. Meta-analysis was conducted employing both fixed-effect and random-effects models as dictated by heterogeneity, assessed by the I2 statistic and chi-square tests. A total of 7 studies, encompassing diverse demographic groups and timelines, were included for the final analysis. RESULTS The meta-analysis disclosed that early rehabilitation yielded a statistically significant improvement in upper limb function (SMD -0.27; 95% CI -0.48 to -0.07; P < 0.0001) and back extension mobility (SMD 0.26; 95% CI 0.04 to 0.48; P = 0.021). A notable reduction in pain levels was observed in the early rehabilitation group (SMD -0.28; 95% CI -0.53 to -0.02; P = 0.03). However, there were no significant differences in wrist function (SMD -0.13; 95% CI -0.38 to 0.12; P = 0.36) and complications (OR 0.99; 95% CI 0.61 to 1.61; P = 0.96). CONCLUSIONS Early rehabilitation post-DRF surgery with palmar plating has been found to be beneficial in enhancing upper limb functionality and back extension mobility, and in reducing pain levels. Nevertheless, no significant impact was observed regarding wrist function and complications.
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Affiliation(s)
- Zhihui Zhou
- Department of Emergency, Dongguan Hospital of Traditional Chinese Medicine, No. 3 Dongcheng Section, Songshan Lake Avenue, Dongcheng Street, Dongguan, Guangdong, 523000, China
| | - Xiuying Li
- Traditional Chinese Medicine Department, Dongguan Songshan Lake Community Health Service Center, Lanxin Garden, Science and Technology, 9Th Road, Dongguan, Guangdong, 523000, China
| | - Xiaoyan Wu
- Traditional Chinese Medicine Department, Dongguan Songshan Lake Community Health Service Center, Lanxin Garden, Science and Technology, 9Th Road, Dongguan, Guangdong, 523000, China
| | - Xiaotian Wang
- Department of Hand Surgery, Dongguan Hospital of Traditional Chinese Medicine, No. 3 Dongcheng Section, Songshan Lake Avenue, Dongcheng Street, Dongguan, Guangdong, 523000, China.
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Ceylan İ, Büyükturan Ö, Aykanat Ö, Büyükturan B, Şaş S, Ceylan MF. The effectiveness of mobilization with movement on patients with mild and moderate carpal tunnel syndrome: A single-blinded, randomized controlled study. J Hand Ther 2023; 36:773-785. [PMID: 37573157 DOI: 10.1016/j.jht.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 08/14/2023]
Abstract
STUDY DESIGN Single-blinded, randomized controlled study. INTRODUCTION Carpal Tunnel Syndrome (CTS) causes pain and loss of function in the affected hand. The mobilization with movement (MWM) technique is a manual therapy method applied to correct joint movement limitation and to relieve pain and functional disorders. PURPOSE OF THE STUDY This study aimed to examine the effectiveness of MWM technique on pain, grip strength, range of motion, edema, hand reaction, nerve conduction, and functional status in patients with CTS. METHODS A total of 45 patients enrolled in the study. The MWM group (n = 18) completed a 4-week combined conservative physiotherapy and MWM program, whereas the control group (n = 18) received only the 4 weeks of conservative physiotherapy. Pain severity according to the numerical rating scale was used as primary outcome. RESULTS We found an improvement within the subjects in resting pain (MWMG:5.1 ± 3.6 vs 1.1 ± 2.4, Effect Size (ES)=1.3; CG:4.5 ± 3.3 vs 1.0 ± 2.2, ES=1.1), in activity pain (MWMG:6.5 ± 3.7 vs 1.1 ± 2.4, ES=1.5; CG:4.8 ± 3.4 vs 2.2 ± 2.3, ES=1) and in night pain (MWMG:5.9 ± 3.2 vs 1.8 ± 2.5, ES=1.2; CG:5.3 ± 4.2 vs ± 2.3 ± 3.5, ES=0.9). For between the groups, a statistical difference was found for the activity pain, Disabilities of the Arm Shoulder and Hand Questionnaire score (MWMG:52.2 ± 23.8 vs 27 ± 24.7, ES=1.3; CG:47.0 ± 24.8 vs 41.5 ± 22.1, ES=0.2), Michigan Hand Outcomes Questionnaire (MHQ-1), (MWMG:44.4 ± 23.7 vs 74.7 ± 24.5, ES=1.3; CG:44.8 ± 17.4 vs 57.4 ± 21.7, ES=0.9) and MHQ-5 (MWMG:68.8 ± 13.1 vs 82.5 ± 11.5, ES=0.9; CG:63.4 ± 26.7 vs 59.3 ± 25.8, ES=0.1) parameters in favour of MWM group. DISCUSSION This study showed that MWM compared to conservative physiotherapy might be more effective in reducing perceived symptoms in mild and moderate CTS patients. CONCLUSIONS MWM produced a small benefit to recovery of activity pain and upper extremity functionality level outcomes of patients with mild to moderate CTS when added to a traditional CTS physical therapy program.
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Affiliation(s)
- İsmail Ceylan
- School of Physical Therapy and Rehabilitation, Kirsehir Ahi Evran University, Kirsehir, Turkey.
| | - Öznur Büyükturan
- School of Physical Therapy and Rehabilitation, Kirsehir Ahi Evran University, Kirsehir, Turkey
| | - Ömer Aykanat
- Department of Neurosurgery, Kirsehir Ahi Evran University School of Medicine, Kirsehir, Turkey
| | - Buket Büyükturan
- School of Physical Therapy and Rehabilitation, Kirsehir Ahi Evran University, Kirsehir, Turkey
| | - Senem Şaş
- Erciyes University, Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Kayseri, Turkey
| | - Mehmet Fethi Ceylan
- Department of Orthopaedics and Traumatology, İnönü University School of Medicine, Malatya, Turkey
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Physical therapy after distal radius fracture. HAND SURGERY & REHABILITATION 2022; 42:168-169. [PMID: 36567011 DOI: 10.1016/j.hansur.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
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Pradhan S, Chiu S, Burton C, Forsyth J, Corp N, Paskins Z, van der Windt DA, Babatunde OO. Overall Effects and Moderators of Rehabilitation in Patients With Wrist Fracture: A Systematic Review. Phys Ther 2022; 102:6566429. [PMID: 35421234 DOI: 10.1093/ptj/pzac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 11/05/2021] [Accepted: 04/05/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Wrist fractures constitute the most frequently occurring upper limb fracture. Many individuals report persistent pain and functional limitations up to 18 months following wrist fracture. Identifying which individuals are likely to gain the greatest benefit from rehabilitative treatment is an important research priority. This systematic review aimed to summarize effectiveness of rehabilitation after wrist fracture for pain and functional outcomes and identify potential effect moderators of rehabilitation. METHODS A comprehensive search of 7 databases (including MEDLINE, EMBASE, and the Physiotherapy Evidence Database) was performed for randomized controlled trials involving adults >50 years of age who sustained wrist fracture and had received 1 or more conservative treatments (eg, exercise/manual therapy, lifestyle, diet, or other advice). Study selection, data extraction, and risk-of-bias assessment were conducted independently by 2 reviewers. Results of included trials were summarized in a narrative synthesis. RESULTS A total of 3225 titles were screened, and 21 studies satisfying all eligibility criteria were reviewed. Over one-half of the included studies (n = 12) comprised physical therapist and/or occupational therapist interventions. Rehabilitative exercise/manual therapy was generally found to improve function and reduce pain up to 1 year after wrist fracture. However, effects were small, and home exercises were found to be comparable with physical therapist-led exercise therapy. Evidence for the effects of other nonexercised therapy (including electrotherapy, whirlpool) was equivocal and limited to the short term (<3 months). Only 2 studies explored potential moderators, and they did not show evidence of moderation by age, sex, or patient attitude of the effects of rehabilitation. CONCLUSION Effectiveness of current rehabilitation protocols after wrist fracture is limited, and evidence for effect moderators is lacking. Currently available trials are not large enough to produce data on subgroup effects with sufficient precision. To aid clinical practice and optimize effects of rehabilitation after wrist fracture, potential moderators need to be investigated in large trials or meta-analyses using individual participant data. IMPACT Many patients report persistent pain and functional limitations up to 18 months following wrist fracture. Effectiveness of current rehabilitation protocols after wrist fracture is limited and may be due to insufficient targeting of specific rehabilitation to individuals who are likely to benefit most. However, evidence for effect moderators is lacking within the currently available literature. To aid clinical practice and optimize effects of rehabilitation, investigating potential moderators of rehabilitation in individuals with wrist fracture via large trials or meta-analysis of individual participant data is research and policy imperative.
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Affiliation(s)
- Sara Pradhan
- University Hospital North Midlands NHS Trust, Newcastle Rd, Stoke-on-Trent, UK
| | - Sarah Chiu
- School of Medicine, Keele University, Staffordshire, Keele, UK
| | - Claire Burton
- School of Medicine, Keele University, Staffordshire, Keele, UK
| | - Jacky Forsyth
- Staffordshire University, Leek Road, Stoke-on-Trent UK
| | - Nadia Corp
- School of Medicine, Keele University, Staffordshire, Keele, UK
| | - Zoe Paskins
- School of Medicine, Keele University, Staffordshire, Keele, UK.,Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UK
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Gutiérrez-Espinoza H, Araya-Quintanilla F, Olguín-Huerta C, Valenzuela-Fuenzalida J, Gutiérrez-Monclus R, Moncada-Ramírez V. Effectiveness of manual therapy in patients with distal radius fracture: a systematic review and meta-analysis. J Man Manip Ther 2021; 30:33-45. [PMID: 34668847 DOI: 10.1080/10669817.2021.1992090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To determine the effectiveness of manual therapy (MT) for functional outcomes in patients with distal radius fracture (DRF). METHODS An electronic search was performed in the Medline, Central, Embase, PEDro, Lilacs, CINAHL, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that included MT techniques with or without other therapeutic interventions in functional outcomes, such as wrist or upper limb function, pain, grip strength, and wrist range of motion in patients older than 18 years with DRF. RESULTS Eight clinical trials met the eligibility criteria; for the quantitative synthesis, six studies were included. For supervised physiotherapy plus joint mobilization versus home exercise program at 6 weeks follow-up, the mean difference (MD) for wrist flexion was 7.1 degrees (p = 0.20), and extension was 11.99 degrees (p = 0.16). For exercise program plus mobilization with movement versus exercise program at 12 weeks follow-up, the PRWE was -10.2 points (p = 0.02), the DASH was -9.86 points (p = 0.0001), and grip strength was 3.9 percent (p = 0.25). For conventional treatment plus manual lymph drainage versus conventional treatment, for edema the MD at 3-7 days was -14.58 ml (p = 0.03), at 17-21 days -17.96 ml (p = 0.009), at 33-42 days -15.34 ml (p = 0.003), and at 63-68 days -13.97 ml (p = 0.002). CONCLUSION There was very low to high evidence according to the GRADE rating. Adding mobilization with movement and manual lymphatic drainage showed statistically significant differences in wrist, upper limb function, and hand edema in patients with DRF.
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Affiliation(s)
- Héctor Gutiérrez-Espinoza
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | | | - Cristian Olguín-Huerta
- School of Health Sciences, Kinesiology Career, Universidad Gabriela Mistral, Santiago, Chile
| | - Juan Valenzuela-Fuenzalida
- Departamento de Ciencias Químicas y Biológicas, Facultad de Ciencias de la Salud, Universidad Bernardo O´Higgins, Santiago, Chile
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Erinç S, Uygur E, Akkaya M, Akpınar F. Metacarpal squeezing reduces grip strength. HAND SURGERY & REHABILITATION 2021; 41:37-41. [PMID: 34600131 DOI: 10.1016/j.hansur.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/28/2021] [Accepted: 09/05/2021] [Indexed: 11/25/2022]
Abstract
Unduly tight plaster hand casts may narrow the metacarpal joint space, hindering rehabilitation. This study investigated how metacarpal narrowing affects grip strength. Forty-two adult volunteers with no other pathology were included. Dominant and non-dominant hand grip strength was measured with a digital hand dynamometer (Jamar plus, China). Metacarpal width was measured with a metal caliper, and the caliper was then fixed at 10% narrowing of the joint space, and a second measurement of grip strength was taken. The measurements were thus taken twice each in the dominant and non-dominant hand, and the average of the two was recorded. A total 336 measurements were taken in the dominant and non-dominant hands of 42 individuals at two time points. There was no significant difference in grip strength between dominant and non-dominant hands (p = 0.183). After 10% narrowing, both the dominant and the non-dominant hand showed a mean 33.4% reduction in grip strength: i.e., squeezing the metacarpus with a caliper significantly reduced grip strength in both dominant and non-dominant hands (p = 0.01). The study thus showed that grip strength will decrease significantly when the metacarpus is squeezed by a tight cast. Although the patient does not feel the 10% narrowing of the metacarpus, it is clear that hand muscle mass may be adversely affected in the long term.
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Affiliation(s)
- S Erinç
- Şişli Hamidiye Etfal Research and Training Hospital, Halaskargazi Caddesi, Etfal Sokak, 34371 Şişli, İstanbul, Turkey.
| | - E Uygur
- Orthopedics and Traumatology, İstanbul Medeniyet University, Faculty of Medicine, Ünalan Mahallesi, D100 Karayolu Yanyol, 34700 Üsküdar, İstanbul, Turkey; Göztepe Prof. Dr. Süleyman Yalçın State Hospital, Eğitim Mahallesi, Dr. Erkin Caddesi, 34722 Kadıköy, İstanbul, Turkey.
| | - M Akkaya
- Gaziosmanpaşa Research and Training Hospital, Karayolları, Osmanbey Caddesi, 621 Sokak, 34255 Gaziosmanpaşa, İstanbul, Turkey.
| | - F Akpınar
- Orthopedics and Traumatology, İstanbul Medeniyet University, Faculty of Medicine, Ünalan Mahallesi, D100 Karayolu Yanyol, 34700 Üsküdar, İstanbul, Turkey; Göztepe Prof. Dr. Süleyman Yalçın State Hospital, Eğitim Mahallesi, Dr. Erkin Caddesi, 34722 Kadıköy, İstanbul, Turkey.
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Ghaddaf AA, Abdulhamid AS, Alomari MS, Alquhaibi MS, Alshehri AA, Alshehri MS. Comparison of immobilization periods following open reduction and internal fixation of distal radius fracture: A systematic review and meta-analysis. J Hand Ther 2021; 36:23-32. [PMID: 34304976 DOI: 10.1016/j.jht.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/18/2021] [Accepted: 06/17/2021] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. INTRODUCTION The use of volar locking plate (VLP) in the fixation of fracture fragments promised a new era in the management of distal radius fracture (DRF). PURPOSE OF THE STUDY To compare the patient-reported outcomes, functional outcomes, pain, and adverse events between the different periods of immobilization following open reduction and internal fixation of DRFs with VLP. METHODS We searched Medline/Pubmed, Web of Science, Ovid, and CINAHL. The inclusion criteria was randomized controlled trials that compared different immobilization periods after open reduction and internal fixation of DRFs with VLP. The last search was performed on 2 June 2020. The different immobilization periods were divided into the following 3 groups: ≤1-week group, 2-3-week group, and 5-6-week group. RESULTS Seven eligible randomized controlled trials provided data on 509 patients. We found that compared to 5-6-week group, ≤1-week and 2-3-week groups showed a reduction in overall Patient-Reported Wrist Evaluation score (SMD = -0.48, 95% CI -0.73 to -0.22, P < .001; SMD = -0.69, 95% CI -0.97 to -0.41, P < .001, respectively). We also found that there were improvements in the other patient-reported outcomes including overall Disabilities of the Arm, Shoulder, and Hand score and pain; and functional outcomes including overall grip strength and range of motion measures in favor of ≤1-week and 2-3-week groups. CONCLUSION This systematic review and meta-analysis showed that compared to immobilization for 5 to 6 weeks after DRF repair, immobilization for ≤1 week or 2-3 weeks showed improvements in the patients-reported outcomes and functional outcomes. The differences between the 3 immobilization groups may not be clinically important considering the small changes as follow up progresses.
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Affiliation(s)
- Abdullah A Ghaddaf
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
| | - Ahmed S Abdulhamid
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Mohammed S Alomari
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Mohammed S Alquhaibi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | | | - Mohammed S Alshehri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; Department of Orthopedic Surgery, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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