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Occupational Therapy is not superior to Independent Exercises After Volar Plate Fixation
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April 2013
Occupational Therapy is not superior to Independent Exercises After Volar Plate Fixation
Study Type:Therapy
OE Level Evidence:2
Journal Level of Evidence:N/A
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
Journal of Bone and Joint Surgery; 2011; 93(A): 1761-1766Did you know you're eligible to earn 0.5 CME credits for reading this report? Click Here
OE EXCLUSIVE
Dr. Ring speaking on occupational therapy after volar plate fixation.
Synopsis
94 patients with unstable distal radial fracture treated with open reduction and volar locking plate fixation were randomized to receive exercise therapy under the supervision of an occupational therapist, or surgeon-directed independent exercises. After 6 month follow, up it was found that patients who conducted independent exercises displayed a significantly higher mean arc of wrist flexion, extension, ulnar deviation and mean grip strength in comparison to those in the occupational therapy group. However, it was also found that there were no significant differences in disability scores between the two groups.
Publication Funding Details
+
Funding:
Non-funded
Conflicts:
Royalties
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Yes = 1
Uncertain = 0.5
Not Relevant = 0
No = 0
The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.
4/4
Randomization
4/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.
Why was this study needed now?
We all are aware of the potential benefits of the physical and occupational therapy after most surgical procedures. However, uncertainties exist over the the effects of formal occupational therapy on recovery after open reduction and volar plate fixation of the distal radius fracture. This study evaluates the wrist function and arm-specific disability six months after open reduction and volar plate fixation of a distal radial fracture between patients who received and didn't receive the formal occupational therapy.
What was the principal research question?
Does occupational therapy lead to better outcomes in terms of wrist function and arm specific disability in comparison to independent exercises in patients with unstable distal radial fracture treated with open reduction and volar locking plate fixation?
Study Characteristics
-
Population:
94 patients with unstable distal radial fracture treated with open reduction and volar locking plate fixation
Intervention:
Exercises therapy under the supervision of an occupational therapist - supervised exercises were performed to regain digit, wrist, and forearm motion and hand strengthening (n=47)
Comparison:
Independent exercises - patients received a wrist splint and were instructed to perform wrist motion exercises once finger motion was regained. Patients were instructed to perform the exercises as often as possible. No strengthening program was given (n=47)
Outcomes:
Wrist flexion, wrist extension, wrist motion, grip strength, Gartland and Werley scores, Mayo wrist scores, and DASH (Disabilities of the Arm, Shoulder and Hand)
Methods:
RCT; Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Massachusetts
Time:
3 and 6 month follow-up
What were the important findings?
- patients in the independent exercise group had significantly higher pinch strength, grip strength, and Gartland and Werley scores in comparison to those in the occupational therapy group at 3 month follow up (p<0.05)
- the independent group displayed significantly better wrist flexion and extension at 6 month follow up (118 degrees versus 129 degrees, p<0.05)
- DASH scores favored the independent exercise group, but this was not significant (p=0.42)
What should I remember most?
Occupational therapy does not lead to superior function or disability outcomes in comparison to independent exercises in individuals who have undergone open reduction and volar locking plate fixation.
How will this affect the care of my patients?
Although the results of this study do not find any additional benefits for using occupational therapy, further long term studies need to be conducted.
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