The aim was to assess the feasibility of conducting a definitive trial comparing a flexibility and resistance exercise programme for the upper limb versus usual care advice after distal radius fracture.
WISE was a multi-centre, parallel-group individually randomised feasibility trial with an embedded qualitative study. Participants were aged ≥50 years with distal radius fracture from six UK hospitals. Participants were allocated 1:1:1 via a central web-based randomisation system to usual care, usual care and independent exercise with a single therapy session or usual care and supervised exercise with three therapy sessions. Feasibility outcomes were recruitment rates, adherence and retention. A qualitative sub-study explored participant and therapist experiences. Registration: ISRCTN12290145.
The proportion of eligible patients recruited was 117/227 (52%), meeting the ≥50% progression criteria. Recruitment rate per month per site was 4.5, meeting the ≥4 progression criteria. At three months, 10% more participants in the supervised group were performing their exercises compared to the independent exercise group. Attendance at the first therapy session was 36/38 (95%) for the independent exercise group and 37/39 (95%) for the supervised exercise group. Follow-up was over 89% (104/117) at three months and 83% (97/117) at six months, meeting the 20% progression criteria.
Our interviews highlighted how the extra sessions provided valued opportunities for collaborative problem-solving between patients and therapists. Therapy sessions were considered useful by patients to demonstrate the exercises, ask questions, and gain confidence. Reviewing goals provided reassurance they were progressing. Therapists helped with specific barriers/concerns during exercise, such as managing pain. Intervention acceptability was high among therapists who participated in focus groups. The main challenge highlighted by therapists was fitting the intervention content into the time-limited appointments. However, it was noted this got easier after gaining experience of delivering the intervention and the content was delivered with a high degree of fidelity according to treatment records.
Feasibility for a definitive trial was established and is now underway. The supervised exercise intervention is being taken forward as the intervention to be compared to usual care advice.
This feasibility trial will support the international efforts to improve the evidence-base for rehabilitation after distal radius fracture. We anticipate these findings from the UK context will support the development and evaluation of rehabilitation interventions for this group in other regions.
Trauma
Feasibility randomised controlled trial
