Influence of postoperative immobilization on pain control of patients with distal radius fracture treated with volar locked plating: A prospective, randomized clinical trial

Andrade-Silva, Fernando Brandão; Rocha, José Antonio; Carvalho, Adriana Lelis; Kojima, Kodi Edson; Silva, Jorge Santos

doi:10.1016/j.injury.2018.12.001

Cited by 31 publications

(43 citation statements)

References 18 publications

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“…Further information on postoperative interventions was requested from authors of all studies, particularly to clarify instructions given about daily activities. Additional information was received from five authors [15][16][17][18][19] and there was no reply from three. [20][21][22] Activity and exercise data were tabulated and reported descriptively.…”

Section: Data Extractionmentioning

confidence: 99%

“…Two studies included only AO 32 type A fractures; in the remaining six studies 72% had AO types B or C. Across all 519 participants 52% had AO type B or C fractures. Of the eight included studies, five were level II Oxford CEBM levels of evidence 27 randomised controlled trials (RCTs) [16][17][18][19]22 with the remaining three being level four retrospective chart reviews. 15,20,21 The studies all compared early and delayed mobilisation (< or !2 weeks) but varied with respect to purpose.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Four studies aimed to determine the optimal period of immobilisation. 16,19,21,22 The purpose of the remaining studies was to evaluate use of analgesia, 18 compare home and outpatient rehabilitation, 17 achievement of minimal clinically important differences for the DASH score 20 or compare numbers of hand therapy appointments. 15 In the early groups, mobilisation was commenced at an average of 4 days (range 1-8) and delayed until an average of 30 days (weeks two, 17,18,20,21 three, 16 five 22 or six 15,16,19 ) in the immobilised groups (see Table 3).…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Five studies [16][17][18]20,21 compared mobilisation that commenced prior to two weeks with mobilisation that was delayed until two to three weeks. Of these, three were of good or excellent quality.…”

Section: Studies Comparing <2 Weeks With Two To Three Weeks Immobilismentioning

confidence: 99%

“…[16][17][18] Range of movement. At the six-to eight-week follow-up, greater wrist movement was observed with small effect sizes for forearm or wrist range of movement in three studies, in favour of early mobilisation, 17,18,20 whereas no differences were observed in the study with the lowest risk of bias. 16 In two low-quality studies, small or medium effects were seen at 10 to 12 weeks for some ROM measures.…”

Section: Studies Comparing <2 Weeks With Two To Three Weeks Immobilismentioning

confidence: 99%

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A systematic review of how daily activities and exercises are recommended following volar plating of distal radius fractures and the efficacy and safety of early versus late mobilisation

et al. 2020

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Introduction Following surgical repair of distal radius fractures, mobilisation timeframes and interventions vary. Early mobilisation (<2 weeks postoperatively) usually includes range of motion exercises and may include recommendations to perform daily activities. The review investigated (i) how early mobilisation was recommended, particularly with respect to wrist use during daily activities and (ii) the efficacy and safety of early versus delayed mobilisation (< or ≥2 weeks). Methods The study protocol was registered on PROSPERO (CRD42019136490). Five databases were searched for studies that compared early and delayed mobilisation in adults with volar plating of distal radius fractures. The Downs and Black Quality Index and the Template for Intervention Description and Replication checklist were used for quality evaluation. Effect sizes were calculated for range of movement, function and pain at 6–8, 10–12 and 26 weeks. A descriptive analysis of outcomes and mobilisation regimes was conducted. Results Eight studies with a mean Quality Index score of 20 out of 28 (SD=5.6) were included. Performing daily activities was commonly recommended as part of early mobilisation. Commencing mobilisation prior to two weeks resulted in greater range of movement, function and less pain at up to eight weeks postoperatively than delaying mobilisation until two weeks or later. Discussion Performance of daily activities was used alongside exercise to promote recovery but without clearly specifying the type, duration or intensity of activities. In combination with exercise, early daily activity was safe and beneficial. Performing daily activities may have discrete advantages. Hand therapists are challenged to incorporate activity-approaches into early mobilisation regimes.

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