Home Exercise Program
A home exercise program is an option for patients prescribed therapy after distal radius fracture.
LIMITED RECOMMENDATION Rationale
We were interested in determining the role of formal therapy compared to non-formal therapy after distal radius fracture. Five randomized controlled trials compared a directed home exercise program against various forms of supervised therapy.78-82 All had at least one methodological flaw and were considered level II evidence.
In 4 of the 5 studies, patients were treated with casting (with or without addition of pins) and therapy was started after removal of fixation (cast or external fixator). In one study, all patients were treated by volar plating and therapy was commenced 1 week postoperatively.
In studies comparing directed home exercise program to supervised therapy started after removal of fixation there was no difference in pain or function. We questioned the applicability of these studies because of the timing of therapy. In the remaining study where patients were mobilized 1 week after plating, the home exercise group had significantly better functional (PRWE) scores than the group that received formal therapy. The strength of recommendation was graded as “limited” based on the possibly clinically important effects identified by this study.
The above studies excluded, by design, patients with complications (finger stiffness, CRPS) and the data above reflect the effect of therapy in radius fractures that were healing without any adverse events.
In 4 of the 5 studies, patients were treated with casting (with or without addition of pins) and therapy was started after removal of fixation (cast or external fixator). In one study, all patients were treated by volar plating and therapy was commenced 1 week postoperatively.
In studies comparing directed home exercise program to supervised therapy started after removal of fixation there was no difference in pain or function. We questioned the applicability of these studies because of the timing of therapy. In the remaining study where patients were mobilized 1 week after plating, the home exercise group had significantly better functional (PRWE) scores than the group that received formal therapy. The strength of recommendation was graded as “limited” based on the possibly clinically important effects identified by this study.
The above studies excluded, by design, patients with complications (finger stiffness, CRPS) and the data above reflect the effect of therapy in radius fractures that were healing without any adverse events.
- (78) Krischak GD, Krasteva A, Schneider F, Gulkin D, Gebhard F, Kramer M. Physiotherapy after volar plating of wrist fractures is effective using a home exercise program. Arch Phys Med Rehabil 2009;90(4):537-544.
- (79) Maciel JS, Taylor NF, McIlveen C. A randomised clinical trial of activityfocussed physiotherapy on patients with distal radius fractures. Arch Orthop Trauma Surg 2005;125(8):515-520.
- (80) Kay S, Haensel N, Stiller K. The effect of passive mobilisation following fractures involving the distal radius: a randomised study. Aust J Physiother 2000;46(2):93-101.
- (81) Wakefield AE, McQueen MM. The role of physiotherapy and clinical predictors of outcome after fracture of the distal radius. J Bone Joint Surg Br 2000;82(7):972-976.
- (82) Taylor NF, Bennell KL. The effectiveness of passive joint mobilisation on the return of active wrist extension following Colles' fracture: a clinical trial. New Zealand Journal of Physiotherapy 1994;22(1):24-28.