Adding mobilisation with movement to exercise and advice hastens the improvement in range, pain and function after non-operative cast immobilisation for distal radius fracture: a multicentre, randomised trial
Susan A. Reid, Josef M Andersen, Bill Vicenzino
Abstract
QUESTION: Does adding mobilisation with movement (MWM) to usual care (ie, exercises plus advice) improve outcomes after immobilisation for a distal radius fracture? DESIGN: A prospective, multicentre, randomised, clinical trial with concealed allocation, blinding and intention-to-treat analysis. PARTICIPANTS: Sixty-seven adults (76% female, mean age 60 years) treated with casting after distal radius fracture. INTERVENTION: The control group received exercises and advice. The experimental group received the same exercises and advice, plus supination and wrist extension MWM. OUTCOME MEASURES: The primary outcome was forearm supination at 4 weeks (immediately post-intervention). Secondary outcomes included wrist extension, flexion, pronation, grip strength, QuickDASH (Disabilities of Arm, Shoulder and Hand), Patient-Rated Wrist Evaluation (PRWE) and global rating of change. Follow-up time points were 4 and 12 weeks, with patient-rated measures at 26 and 52 weeks. RESULTS: Compared with the control group, supination was greater in the experimental group by 12 deg (95% CI 5 to 20) at 4 weeks and 8 deg (95% CI 1 to 15) at 12 weeks. Various secondary outcomes were better in the experimental group at 4 weeks: extension (14 deg, 95% CI 7 to 20), flexion (9 deg, 95% CI 4 to 15), QuickDASH (-11, 95% CI -18 to -3) and PRWE (-13, 95% CI -23 to -4). Benefits were still evident at 12 weeks for supination, extension, flexion and QuickDASH. The experimental group were more likely to rate their global change as 'improved' (risk difference 22%, 95% CI 5 to 39). There were no clear benefits in any of the participant-rated measures at 26 and 52 weeks, and no adverse effects. CONCLUSION: Adding MWM to exercise and advice gives a faster and greater improvement in motion impairments for non-operative management of distal radius fracture. REGISTRATION: ACTRN12615001330538.