Effectiveness of supervised physiotherapy versus a home exercise program in patients with distal radius fracture: a randomized controlled trial with a 2-year follow-up

Abstract

ObjectiveTo determine in the long term whether supervised physiotherapy is more effective than a home exercise program for functional improvement and pain relief in patients with distal radius fracture (DRF). DesignRandomized controlled trial. SettingRehabilitation hospital. ParticipantsA total of 74 patients older than 60 years with extra-articular DRF were randomly allocated into two groups. InterventionsThe experimental group received 6 weeks of supervised physiotherapy (n = 37) and the control group received 6 weeks of home exercise program (n = 37). Main outcome measuresThe primary outcome was wrist/hand function assessed using the Patient-Rated Wrist Evaluation (PRWE) questionnaire; secondary outcomes were the pain visual analogue scale (VAS), grip strength and wrist flexion–extension active range of motion. ResultsAll patients completed the trial. For the primary outcome, at 6-weeks and 1-year follow-up, the PRWE questionnaire showed a mean difference between groups of 18.6 (CI 95% 12.8 to 24.3) and 18.5 points (CI 95% 12.7 to 24.2) respectively, these differences are clinically important. Conversely, at 2-year follow-up this effect decreases to 3.3 points (CI 95% −2.4 to 9.0). For secondary outcomes, at 6-weeks and 1-year follow-up, in all measurements the effect size range from medium to large. Conversely, at 2-year follow-up only grip strength showed large effect size in favor of supervised physiotherapy, the rest of outcomes did not show difference between groups. ConclusionAt the 6-week and 1-year follow-up, supervised physiotherapy is more effective for functional improvement and pain relief compared with a home exercise program in patients older than 60 years with extra-articular DRF. However, this effect decreases over time, at the 2-year follow-up, only grip strength showed a difference in favor of supervised physiotherapy. Contribution of the Paper•Current evidence has shown controversial results regarding the effectiveness of supervised physiotherapy versus a home exercise program in elderly patients with DRFs.•At the 6-week and 1-year follow-up, supervised physiotherapy is more effective for functional improvement and pain relief.•However, at the 2-year follow-up, only grip strength showed a difference in favor of supervised physiotherapy in these patients.