Telerehabilitation in Distal Radius Fracture

NCT05332080 | Completed

• 1 other identifier: R-2020-3201-153
• Study Type: interventional
• Target: 88
• Locations: 1 country
• Sites: 1

Brief Summary

Objective: To determine the effectiveness of telerehabilitation versus supervised therapy in the functional recovery of patients with distal radius fracture. Design: A randomized, controlled, parallel-treatment trial protocol was performed to compare functional recovery after a telerehabilitation program vs supervised rehabilitation in patients with distal radius fracture. Setting: Participants: A total of 91 patients with distal radius fractures grades AO23 A and B. Interventions: the supervised rehabilitation group received for two weeks a 10-session program that included external heat application, stretching, mobilization, strengthening, and occupational therapy. The telerehabilitation group was given instructions to apply hydrotherapy, perform mobility and wrist and hand strengthening exercises for four weeks, using the Moodle application on their cell phone. Main outcomes measures: Outcome measures were measured at the time of admission to rehabilitation and 1, 3, and 6 months; at each follow-up visit, functionality, active range of motion, fist grip strength, quality of life and pain were measured. Results: When the results obtained at the beginning and at six months were compared, both groups presented statistically significant changes in the clinical variables analyzed but with greater functionality in the telerehabilitation group.

Conditions

Distal Radius Fracture

Keywords

Telerehabilitation; physical therapy; distal radius fracture

Outcome Measures

Primary Outcomes (1)

• Outcome of baseline measures of wrist function and changes at 4, 12 and 24 weeks

  The measures physical function and symptoms in people with musculoskeletal disorders of the upper limb, specifically the wrist, was measured with Disabilities of the Arm, Shoulder and Hand questionnaire, a higher scores indicate a greater level of disability and severity, whereas, lower scores indicate a lower level of disability. The score test ranges from 0 (no disability) to 100 (most severe disability)

  At baseline and subsequently at 4, 12, and 24 weeks

Secondary Outcomes (1)

• Outcome of baseline measures of quality of life and changes at 4, 12 and 24 weeks

  At baseline and subsequently at 4, 12, and 24 weeks

Study Arms (2)

Telerehabilitation via application on cell phone

EXPERIMENTAL

The patients in this group had application installed on their cell phones to access the online content, where they received advice on self-care and the type of exercises to be performed. The program consisted of hydrotherapy, mobility exercises, muscle strengthening, and activities to improve wrist and hand function, with planned 4-week objectives. Participants in both groups were provided with written exercise material, training, and advice on how to return to work and leisure activities. Each patient made a weekly record of the therapy he/she performed, including the day, type, and time of development of his/her exercises

Procedure: Telerehabilitation via application on cell phone

In-person rehabilitation

NO INTERVENTION

The patients in this group received an in-person rehabilitation program and was considered the control group, this group received for two weeks a 10-session program for two weeks that included external heat application, stretching, mobilization, strengthening, and occupational therapy. Moreover, it was complemented with occupational therapy focused on improving essential functions and strengthening extrinsic and intrinsic hand musculature, effectiveness in wrist mobility, and simulation of specific activities for reincorporation to work

Interventions

Telerehabilitation via application on cell phone PROCEDURE

Realization of rehabilitation through content in an app they received advice on self-care and the type of exercises to do. The program consisted of hydrotherapy, mobility exercises, muscle strengthening, and activities to improve wrist and hand function, with planned goals.

Telerehabilitation via application on cell phone

Eligibility Criteria

• Age: 15 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Men and women older than 15 years
• With closed distal radius fracture type AO23 A and B
• Immobilization for six weeks (with or without surgical fixation)
• With indication by the orthopedic physician to perform rehabilitation
• Have a cell phone and internet access

You may not qualify if:

• Patients with distal radius fractures with any of the following radiographic findings: volar tilt \>12°, radial tilt \>23° and radial height \>12 mm
• Patients with neurological problems, illiteracy, presence of pressure ulcers in the distal third of the forearm or hand that did not heal, users of orally or intravenously administered steroids, patients with pre-existing and concomitant arthritis or osteoarthritis of the wrist, or history of injury. Subjects with less than 80% adherence to treatment were eliminated.

Sponsors & Collaborators

• Instituto Mexicano del Seguro Social: lead

Study Sites (1)

Instituto Mexicano del Seguro Social, HGR 1

Mérida, Yucatán, 97150, Mexico

Location

Related Publications (28)

• Mauck BM, Swigler CW. Evidence-Based Review of Distal Radius Fractures. Orthop Clin North Am. 2018 Apr;49(2):211-222. doi: 10.1016/j.ocl.2017.12.001.

  PMID: 29499822 BACKGROUND

• Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am. 2001 Sep;26(5):908-15. doi: 10.1053/jhsu.2001.26322.

  PMID: 11561245 BACKGROUND

• Tubeuf S, Yu G, Achten J, Parsons NR, Rangan A, Lamb SE, Costa ML. Cost effectiveness of treatment with percutaneous Kirschner wires versus volar locking plate for adult patients with a dorsally displaced fracture of the distal radius: analysis from the DRAFFT trial. Bone Joint J. 2015 Aug;97-B(8):1082-9. doi: 10.1302/0301-620X.97B8.35234.

  PMID: 26224825 BACKGROUND

• Shauver MJ, Yin H, Banerjee M, Chung KC. Current and future national costs to medicare for the treatment of distal radius fracture in the elderly. J Hand Surg Am. 2011 Aug;36(8):1282-7. doi: 10.1016/j.jhsa.2011.05.017. Epub 2011 Jun 25.

  PMID: 21705154 BACKGROUND

• Wong JY. Time off work in hand injury patients. J Hand Surg Am. 2008 May-Jun;33(5):718-25. doi: 10.1016/j.jhsa.2008.01.015.

  PMID: 18590855 BACKGROUND

• 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 Apr;90(4):537-44. doi: 10.1016/j.apmr.2008.09.575.

  PMID: 19345766 BACKGROUND

• Maciel JS, Taylor NF, McIlveen C. A randomised clinical trial of activity-focussed physiotherapy on patients with distal radius fractures. Arch Orthop Trauma Surg. 2005 Oct;125(8):515-20. doi: 10.1007/s00402-005-0037-x. Epub 2005 Oct 22.

  PMID: 16136342 BACKGROUND

• Oskarsson GV, Hjall A, Aaser P. Physiotherapy: an overestimated factor in after-treatment of fractures in the distal radius? Arch Orthop Trauma Surg. 1997;116(6-7):373-5. doi: 10.1007/BF00433993.

  PMID: 9266044 BACKGROUND

• Watt CF, Taylor NF, Baskus K. Do Colles' fracture patients benefit from routine referral to physiotherapy following cast removal? Arch Orthop Trauma Surg. 2000;120(7-8):413-5. doi: 10.1007/pl00013772.

  PMID: 10968529 BACKGROUND

• Handoll HH, Elliott J. Rehabilitation for distal radial fractures in adults. Cochrane Database Syst Rev. 2015 Sep 25;2015(9):CD003324. doi: 10.1002/14651858.CD003324.pub3.

  PMID: 26403335 BACKGROUND

• Tenforde AS, Iaccarino MA, Borgstrom H, Hefner JE, Silver J, Ahmed M, Babu AN, Blauwet CA, Elson L, Eng C, Kotler D, Homer S, Makovitch S, McInnis KC, Vora A, Borg-Stein J. Telemedicine During COVID-19 for Outpatient Sports and Musculoskeletal Medicine Physicians. PM R. 2020 Sep;12(9):926-932. doi: 10.1002/pmrj.12422. Epub 2020 Jul 10.

  PMID: 32424977 BACKGROUND

• Turolla A, Rossettini G, Viceconti A, Palese A, Geri T. Musculoskeletal Physical Therapy During the COVID-19 Pandemic: Is Telerehabilitation the Answer? Phys Ther. 2020 Aug 12;100(8):1260-1264. doi: 10.1093/ptj/pzaa093. No abstract available.

  PMID: 32386218 BACKGROUND

• Gunther CM, Burger A, Rickert M, Crispin A, Schulz CU. Grip strength in healthy caucasian adults: reference values. J Hand Surg Am. 2008 Apr;33(4):558-65. doi: 10.1016/j.jhsa.2008.01.008.

  PMID: 18406961 BACKGROUND

• Egund L, Onnby K, Mcguigan F, Akesson K. Disability and Pain are the Best Predictors of Sick Leave After a Distal Radius Fracture in Men. J Occup Rehabil. 2020 Dec;30(4):656-664. doi: 10.1007/s10926-020-09880-4.

  PMID: 32052265 BACKGROUND

• Azad A, Kang HP, Alluri RK, Vakhshori V, Kay HF, Ghiassi A. Epidemiological and Treatment Trends of Distal Radius Fractures across Multiple Age Groups. J Wrist Surg. 2019 Aug;8(4):305-311. doi: 10.1055/s-0039-1685205. Epub 2019 Apr 16.

  PMID: 31404224 BACKGROUND

• Rundgren J, Bojan A, Mellstrand Navarro C, Enocson A. Epidemiology, classification, treatment and mortality of distal radius fractures in adults: an observational study of 23,394 fractures from the national Swedish fracture register. BMC Musculoskelet Disord. 2020 Feb 8;21(1):88. doi: 10.1186/s12891-020-3097-8.

  PMID: 32035488 BACKGROUND

• Sander AL, Leiblein M, Sommer K, Marzi I, Schneidmuller D, Frank J. Epidemiology and treatment of distal radius fractures: current concept based on fracture severity and not on age. Eur J Trauma Emerg Surg. 2020 Jun;46(3):585-590. doi: 10.1007/s00068-018-1023-7. Epub 2018 Oct 1.

  PMID: 30276724 BACKGROUND

• 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 Sep;82(7):972-6. doi: 10.1302/0301-620x.82b7.10377.

  PMID: 11041584 BACKGROUND

• Challis MJ, Jull GJ, Stanton WR, Welsh MK. Cyclic pneumatic soft-tissue compression enhances recovery following fracture of the distal radius: a randomised controlled trial. Aust J Physiother. 2007;53(4):247-52. doi: 10.1016/s0004-9514(07)70005-3.

  PMID: 18047459 BACKGROUND

• 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. doi: 10.1016/s0004-9514(14)60317-2.

  PMID: 11676793 BACKGROUND

• Lara TR, Kagan RP, Hiratzka SL, Thompson AR, Nazir OF, Mirarchi AJ. Traditional Versus Digital Media-Based Hand Therapy After Distal Radius Fracture. J Hand Surg Am. 2022 Mar;47(3):291.e1-291.e8. doi: 10.1016/j.jhsa.2021.06.018. Epub 2021 Aug 6.

  PMID: 34366180 BACKGROUND

• Andrade-Silva FB, Rocha JP, Carvalho A, Kojima KE, Silva JS. Influence of postoperative immobilization on pain control of patients with distal radius fracture treated with volar locked plating: A prospective, randomized clinical trial. Injury. 2019 Feb;50(2):386-391. doi: 10.1016/j.injury.2018.12.001. Epub 2018 Dec 4.

  PMID: 30558805 BACKGROUND

• Pasila M, Sundholm A. Mobilization of stiff hands after 104 Colles' fractures: a comparison between the value of the Movelat and its base cream. Rheumatol Rehabil. 1980 Aug;19(3):170-2. doi: 10.1093/rheumatology/19.3.170. No abstract available.

  PMID: 7414186 BACKGROUND

• Lyngcoln A, Taylor N, Pizzari T, Baskus K. The relationship between adherence to hand therapy and short-term outcome after distal radius fracture. J Hand Ther. 2005 Jan-Mar;18(1):2-8; quiz 9. doi: 10.1197/j.jht.2004.10.008.

  PMID: 15674780 BACKGROUND

• Souer JS, Buijze G, Ring D. A prospective randomized controlled trial comparing occupational therapy with independent exercises after volar plate fixation of a fracture of the distal part of the radius. J Bone Joint Surg Am. 2011 Oct 5;93(19):1761-6. doi: 10.2106/JBJS.J.01452.

  PMID: 22005860 BACKGROUND

• Upadhyaya GK, Iyengar K, Jain VK, Vaishya R. Challenges and strategies in management of osteoporosis and fragility fracture care during COVID-19 pandemic. J Orthop. 2020 Jun 2;21:287-290. doi: 10.1016/j.jor.2020.06.001. eCollection 2020 Sep-Oct.

  PMID: 32523258 BACKGROUND

• Moore CM, Leonardi-Bee J. The prevalence of pain and disability one year post fracture of the distal radius in a UK population: a cross sectional survey. BMC Musculoskelet Disord. 2008 Sep 29;9:129. doi: 10.1186/1471-2474-9-129.

  PMID: 18823546 BACKGROUND

• MacIntyre NJ, Dewan N. Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther. 2016 Apr-Jun;29(2):136-45. doi: 10.1016/j.jht.2016.03.003.

  PMID: 27264899 BACKGROUND

MeSH Terms

Conditions

Wrist Fractures

Condition Hierarchy (Ancestors)

Wrist Injuries; Arm Injuries; Wounds and Injuries; Fractures, Bone

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal investigator

Model Details: Randomized, controlled, parallel-treatment trial

Study Record Dates

• First Submitted: April 5, 2022
• First Posted: April 18, 2022
• Study Start: November 1, 2020
• Primary Completion: April 30, 2021
• Study Completion: April 30, 2021
• Last Updated: October 24, 2022

Record last verified: 2022-10

Data Sharing

• IPD Sharing: Will not share

Locations

ME (1)