An advice and exercise program has some benefits over natural recovery after distal radius fracture: a randomised trial

Question: Does an advice and exercise program improve outcome for adults following distal radius fracture? Design: Randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Participants: Fifty-six patients whose fracture had been managed with pins and/or cast. Intervention: The experimental group received a physiotherapist-directed program of advice and exercises. The control group did not receive any physiotherapy intervention. Outcome measures: The primary outcome was wrist extension (measured with a goniometer). Secondary outcomes were the other wrist ranges of motion (measured with a goniometer), grip strength (measured with a dynamometer), pain, and activity limitations (measured with questionnaires). These outcomes were measured initially, then three and six weeks later. Participants also rated their satisfaction with physiotherapy intervention at Week 6. Results: No difference was found between groups for the primary outcome of wrist extension (mean difference 6 deg, 95% CI -3 to 14), nor for the secondary outcomes of other range of motion data and grip strength. The difference between groups for pain was -16 points out of 100 (95% CI -27 to -5) at Week 3, and -14 points (95% CI -25 to -3) points at Week 6, and for activity was -13 points out of 100 (95% CI -24 to -2) at Week 3; in favour of the experimental group. The experimental group was also more satisfied with the amount of physiotherapy intervention. Conclusion: An advice and exercise program provided some additional benefits over no intervention for adults following distal radius fracture. Trial registration: ACTRN012607000204448. [Kay S, McMahon M, Stiller K (2008) An advice and exercise program has some benefits over natural recovery after distal radius fracture: a randomised trial. Australian Journal of Physiotherapy 54: 253-259]