Efficiency and cost-effectiveness of the rehabilitation management of the VBG in patients after distal radius fracture

Purpose: To investigate the efficiency and cost-effectiveness of the special rehabilitation management as compared with the standard strategy in patients after distal radius fractures. Methods: From the 200 consecutive patients which suffered a distal radius fractures 136 were included in the study to date. They were assigned randomly to the special hand management group or to the control group managed in a standardised way. During the first 24 hours after the injury was reported to the VBG, one of the German statutory accident insurances, a specially selected hand surgeon was consulted for confirming diagnoses, establishing prognoses and proposing a most efficient individually tailored rehabilitation strategy for all patients of the intervention group. All other patients were treated in concordance with the suggestions of the local traumatologist within legal framework of the Workers Compensation Act. All patients filled in the SF-36, the DASH and the EQ-5D at the time of injury report (T1), at the time of return to work (T2) and at 9 months follow-up (T3). Results: From 200 included patients 136 (68%) were evaluated at T1 and T2 and 111 (55.5%) at T3 to date. The patients in both groups showed a substantial burden of disease due to the injury as compared to the reference values for age and gender. The first evaluation showed significant longitudinal improvements in terms of all measured parameters in course of rehabilitation. Furthermore, there were significant differences in favour of the intervention group at T3. The study will continue till achieving the calculated sample size. Conclusion: The rehabilitation management can be concluded as more efficient and cost-effective as compared with the standard strategy in patients after distal radius fractures. The rehabilitation itself as well as rehabilitation management seem to be permanent undervalued in terms of minimising burden of disease and the economic impact for the society. Further analyse are needed to investigate which patients profited to which extend from the modified management strategy and which processes could be optimised in knowledge of these results.