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Reid SA1, Andersen JM2, Vicenzino B3
1Australian Catholic University, School of Physiotherapy, North Sydney, Australia, 2Priv Practise, Copenhagen, Denmark, 3University of Queensland, Faculty of Health and Behavioural Sciences, Brisbane, Australia
Background: Distal radius fractures are the most common fracture in humans accounting for 18% of all fractures in adults. Very few clinical trials have been undertaken to assess the effectiveness of manual therapy post distal radius fracture.
Purpose: The aim of this study was to evaluate the effects of adding Mobilisation with Movement (MWMs) to range-of-motion exercises and advice in treating patients post-distal radius fracture.
Methods: The primary outcome measure was forearm supination at 4 weeks (immediately post intervention period). Secondary outcomes were forearm pronation, wrist flexion, extension, grip strength and the Quick Dash and Patient Rated Wrist Evaluation (PRWE) questionnaires which measure pain and function. All outcomes were assessed at baseline, 4 and 12 weeks. An intention to treat analysis was performed.
A prospective single-blind randomised clinical trial was undertaken. Participants who had sustained a distal radius fracture and were treated conservatively in a cast, were randomly allocated to receive forearm supination and wrist extension MWM or no MWM. All participants received range-of-motion exercises and advice to return to normal activity. All participants attended a physiotherapist over four sessions to receive the treatments and were asked to self-administer their treatment twice daily at home. All participants performed range of motion exercises twice a day for four weeks while the MWM group also performed self-MWMs.
Results: Thirty-three participants (female N=23, 70%) with mean age 56 years (range 24-79 years) were allocated to the MWM group and 34 (female N=28, 82%) with mean age 63 years (range 23-92) to the no-MWM group. For forearm supination post-treatment the mean difference between the treatments was 14.1° (95% CI 5.0 to 23.3; p=0.003), which was still significant at 12 weeks 8.7° (1.3 to 16.2; p=0.02). Secondary outcomes were also different at 4 and 12 weeks respectively: pronation p=0.007 and p=0.006, wrist flexion p=0.004 and p=0.003, extension p0.001 and p0.001; grip strength p=0.04 and p=0.009; Quick Dash p=0.001 and p=0.008; PRWE-pain p0.001 and p= 0.07; and PRWE-function p=0.001 and p=0.049.
Conclusion(s): Adding MWM to range-of-motion exercises and advice results in substantially more supination at 4 weeks, which is maintained to 12 weeks. All other ranges of motion and grip strength are also larger in the MWM group compared to no-MWM group. There was less pain and better function with the MWM intervention.
Implications: Simple self-applied manual therapy facilitated by four sessions with a therapist to instruct and guide the effective application of the MWM appears to be a valuable adjunct to range-of-motion exercises and advice. This has the potential to improve the quality of outcomes substantially for a large proportion of the community. This finding has a high chance of changing clinical practice.
Keywords: Fractured radius, manual therapy, Mulligan
Funding acknowledgements: Partially funded by Mulligan Concept Teachers Association (MCTA). Reid and Vicenzino are honorary MCTA members. Andersen is a MCTA teacher.
Purpose: The aim of this study was to evaluate the effects of adding Mobilisation with Movement (MWMs) to range-of-motion exercises and advice in treating patients post-distal radius fracture.
Methods: The primary outcome measure was forearm supination at 4 weeks (immediately post intervention period). Secondary outcomes were forearm pronation, wrist flexion, extension, grip strength and the Quick Dash and Patient Rated Wrist Evaluation (PRWE) questionnaires which measure pain and function. All outcomes were assessed at baseline, 4 and 12 weeks. An intention to treat analysis was performed.
A prospective single-blind randomised clinical trial was undertaken. Participants who had sustained a distal radius fracture and were treated conservatively in a cast, were randomly allocated to receive forearm supination and wrist extension MWM or no MWM. All participants received range-of-motion exercises and advice to return to normal activity. All participants attended a physiotherapist over four sessions to receive the treatments and were asked to self-administer their treatment twice daily at home. All participants performed range of motion exercises twice a day for four weeks while the MWM group also performed self-MWMs.
Results: Thirty-three participants (female N=23, 70%) with mean age 56 years (range 24-79 years) were allocated to the MWM group and 34 (female N=28, 82%) with mean age 63 years (range 23-92) to the no-MWM group. For forearm supination post-treatment the mean difference between the treatments was 14.1° (95% CI 5.0 to 23.3; p=0.003), which was still significant at 12 weeks 8.7° (1.3 to 16.2; p=0.02). Secondary outcomes were also different at 4 and 12 weeks respectively: pronation p=0.007 and p=0.006, wrist flexion p=0.004 and p=0.003, extension p0.001 and p0.001; grip strength p=0.04 and p=0.009; Quick Dash p=0.001 and p=0.008; PRWE-pain p0.001 and p= 0.07; and PRWE-function p=0.001 and p=0.049.
Conclusion(s): Adding MWM to range-of-motion exercises and advice results in substantially more supination at 4 weeks, which is maintained to 12 weeks. All other ranges of motion and grip strength are also larger in the MWM group compared to no-MWM group. There was less pain and better function with the MWM intervention.
Implications: Simple self-applied manual therapy facilitated by four sessions with a therapist to instruct and guide the effective application of the MWM appears to be a valuable adjunct to range-of-motion exercises and advice. This has the potential to improve the quality of outcomes substantially for a large proportion of the community. This finding has a high chance of changing clinical practice.
Keywords: Fractured radius, manual therapy, Mulligan
Funding acknowledgements: Partially funded by Mulligan Concept Teachers Association (MCTA). Reid and Vicenzino are honorary MCTA members. Andersen is a MCTA teacher.
Topic: Musculoskeletal: upper limb; Orthopaedics; Disability & rehabilitation
Ethics approval required: Yes
Institution: The Australian Catholic University
Ethics committee: Human Research Ethics Committee
Ethics number: Approval No 2015-314H
All authors, affiliations and abstracts have been published as submitted.
