Abstract
BackgroundDistal radius fractures are among the most common fractures and account for approximately one-sixth of all fractures diagnosed. Therapy results after distal radius fracture, especially of elderly patients, are often suboptimal. The inevitable immobilization for several weeks leads to reduction in range of motion, deterioration of muscle strength, malfunction of fine motor skills as well as changes of motor and sensory representations in the brain. Currently, there are no strategies to counteract these immobilization problems. The overall aim of the study is to investigate the therapeutic potential of motor-cognitive approaches (mental practice or mirror therapy) on hand function after wrist fracture.Methods/DesignThis study is a controlled, randomized, longitudinal intervention study with three intervention groups. One experimental group imagines movements of the fractured upper extremity without executing them (mental practice). The second experimental group receives a mirror therapy program consisting of the performance of functional movement synergies using the unaffected forearm, wrist, and hand. The control group completes a relaxation training regime. Additionally, all patients receive usual care by the general practitioner. We include women aged 60 years and older having a distal radius fracture and sufficient cognitive function. All groups are visited at home for therapy sessions 5 times per week for the first 3 weeks and 3 times per week for weeks 4 to 6. Measurements are taken at therapy onset, and after 3, 6 and 12 weeks. The primary outcome measure will assess upper extremity functioning (Patient-Rated Wrist Evaluation [PRWE]), while secondary outcome measures cover subjective wrist function (Disabilities of the Arm and Shoulder; [DASH], objective impairment (range of motion, grip force) and quality of life (EuroQol-5D, [EQ5D]).DiscussionResults from this trial will contribute to the evidence on motor-cognitive approaches in the early therapy of distal radius fractures.Trial registrationThe trial is registered at ClinicalTrials.gov with registration number NCT01394809 and was granted permission by the Medical Ethical Review Committee of the University of Tübingen in June 2011.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-287) contains supplementary material, which is available to authorized users.
Highlights
Distal radius fractures are among the most common fractures and account for approximately one-sixth of all fractures diagnosed
Results from this trial will contribute to the evidence on motor-cognitive approaches in the early therapy of distal radius fractures
Distal radius fractures are among the most common osteoporotic fractures [1] and account for an estimated 17% of fractures treated in US emergency departments [2] with a female–male ratio of about 3:1 [3]
Summary
Distal radius fractures are among the most common fractures and account for approximately one-sixth of all fractures diagnosed. Therapy results after distal radius fracture, especially of elderly patients, are often suboptimal. But especially the long immobilization periods lead to overall complication rates ranging from 6 to 80% and have been associated with poor functional outcomes [7]. These complications include complex and regional pain syndrome, stiffness, nerve injury, tendon and ligament injuries, but a massive reduction in range of motion (ROM), muscular atrophy, and loss of movement representation [8]. Previous studies have indicated that 20% of patients with distal radius fracture had persistent symptoms, and 10% continued to have functional impairments after the typical recovery period [10]. This partly relates to upper extremity dysfunction with activities of daily living such as eating, getting dressed and washed
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