Pradhan, S, Chiu, S, Burton, CL, Forsyth, J, Corp, N, Paskins, Z, van der Windt, DA and Babatunde, OO (2022) Overall Effects and Moderators of Rehabilitation in Patients With Wrist Fracture: A Systematic Review. Physical Therapy, 102 (6). ISSN 1538-6724

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Abstract

OBJECTIVE: Wrist fractures constitute the most frequently occurring upper limb fracture. Many patients report persistent pain and functional limitations up to 18 months following wrist fracture. Identifying which patients 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 [PEDro]) 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 half of 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 to 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 patients who are likely to benefit most. However, evidence for effect moderators is lacking within currently available literature. To aid clinical practice and optimize effects of rehabilitation, investigating potential moderators of rehabilitation in patients with wrist fracture via large trials or meta-analysis of individual participant data is research and policy imperative.

Item Type: Article
Additional Information: © The Author(s) 2022. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
Uncontrolled Keywords: Distal Radial Fracture; Exercise Therapy; Moderators; Rehabilitation; Wrist Fracture
Subjects: R Medicine > RA Public aspects of medicine
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RM Therapeutics. Pharmacology > Physical medicine. Physical therapy. Including massage, exercise, occupational therapy, hydrotherapy, phototherapy, radiotherapy, thermotherapy, electrotherapy
Divisions: Faculty of Medicine and Health Sciences > School of Medicine
Related URLs:
Depositing User: Symplectic
Date Deposited: 09 May 2022 14:41
Last Modified: 13 Oct 2022 11:46
URI: https://eprints.keele.ac.uk/id/eprint/10889

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