Effectiveness of supervised physiotherapy versus a home exercise program in patients with distal radius fracture: a randomized controlled trial with a 2-year follow-up

• Published in: Physiotherapy Vol. 124; pp. 93 - 100
• Main Authors: Gutiérrez-Espinoza, Héctor, Gutiérrez-Monclus, Rodrigo, Román-Veas, Javier, Valenzuela-Fuenzalida, Juan, Hagert, Elisabet, Araya-Quintanilla, Felipe
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-09-2024
• Subjects: Aged; Distal radius fracture; Elderly; Exercise Therapy - methods; Female; Follow-Up Studies; Hand Strength; Home Care Services; Home exercise program; Humans; Male; Medicin och hälsovetenskap; Middle Aged; Pain Measurement; Physical Therapy Modalities; Radius Fractures - rehabilitation; Randomized controlled trial; Range of Motion, Articular; Supervised physiotherapy; Wrist Fractures; Home exercise program; Supervised physiotherapy; Elderly; Randomized controlled trial; Distal radius fracture
• ISSN: 0031-9406; 1873-1465; 1873-1465
• DOI: 10.1016/j.physio.2024.03.005

To determine in the long term whether supervised physiotherapy is more effective than a home exercise program for functional improvement and pain relief in patients with distal radius fracture (DRF).
Randomized controlled trial.
Rehabilitation hospital.
A total of 74 patients older than 60 years with extra-articular DRF were randomly allocated into two groups.
The experimental group received 6 weeks of supervised physiotherapy (n = 37) and the control group received 6 weeks of home exercise program (n = 37).
The primary outcome was wrist/hand function assessed using the Patient-Rated Wrist Evaluation (PRWE) questionnaire; secondary outcomes were the pain visual analogue scale (VAS), grip strength and wrist flexion–extension active range of motion.
All patients completed the trial. For the primary outcome, at 6-weeks and 1-year follow-up, the PRWE questionnaire showed a mean difference between groups of 18.6 (95% CI 12.8 to 24.3) and 18.5 points (95% CI 12.7 to 24.2) respectively, these differences are clinically important. Conversely, at 2-year follow-up this effect decreases to 3.3 points (95% CI −2.4 to 9.0). For secondary outcomes, at 6-weeks and 1-year follow-up, in all measurements the effect size range from medium to large. Conversely, at 2-year follow-up only grip strength showed large effect size in favor of supervised physiotherapy, the rest of outcomes did not show difference between groups.
At the 6-week and 1-year follow-up, supervised physiotherapy was more effective for functional improvement and pain relief compared with a home exercise program in patients older than 60 years with extra-articular DRF. However, this effect decreases over time, at the 2-year follow-up, only grip strength showed a difference in favor of supervised physiotherapy.
Brazilian registry of clinical trials UTN no. U1111- 1249-2492. Registered 17 March 2020.
•Current evidence has shown controversial results regarding the effectiveness of supervised physiotherapy versus a home exercise program in elderly patients with DRFs.•At the 6-week and 1-year follow-up, supervised physiotherapy is more effective for functional improvement and pain relief.
•However, at the 2-year follow-up, only grip strength showed a difference in favor of supervised physiotherapy in these patients.