The Effect of Passive Mobilisation Following Fractures Involving the Distal Radius: A Randomised Study.

The Effect of Passive Mobilisation Following Fractures Involving the Distal Radius: A Randomised Study Kay S, Haensel N, Stiller K (Physical Therapy Department, Royal Adelaide Hospital, Adelaide, South Australia), Australian Journal of Physiotherapy. 2000;46:93-101.

The purpose of this study was to determine whether the addition of passive mobilization to a program of advice and exercise provided better outcomes in patients following a distal radial fracture.

Over a 1-year period, patients who were treated by the Royal Adelaide Hospital for fractures of the distal radius were selected for this study, after their pins or plaster were removed. All patients were included unless they expressed an unwillingness to participate in the study, were not able to understand spoken or written English, or had sustained a wrist fracture of the affected side in the last 20 years or a fracture at any time that caused a residual loss of range of motion or function. Patients also were excluded if they had concurrent ipsilateral or bilateral upper-extremity fractures, pre-existing inflammatory joint conditions, external fixation, or open reduction and internal fixation. If a patient failed to attend 3 consecutive treatments, they were eliminated from this study.

Forty patients were randomly assigned to 2 groups. The first group (n = 20; 8 men, 12 women; mean age = 51.6 [+ or -] 18.8 years) received advice and exercise, whereas the second group (n = 19; 4 men, 15 women; mean age = 54.7 [+ or -] 13.1 years) received a 6-week course of passive mobilization in addition to advice and exercise. The advice and exercises were standardized for the 2 groups.

All of the patients were examined by a physical therapist who was unaware of the group assignments. The examinations were done prior to starting the treatment regimen and at 3 and 6 weeks later. Pain and functional disability were assessed using a visual analog scale. A functional assessment tool that tested 6 different functions (cylindrical grip, grip with pronation, pronation, supination, weightbearing through wrist extension, wrist flexion) was developed for use in this study. Each test in the tool was rated using an ordinal scale (0 = unable to perform task, 3 = able to complete task without difficulty). Range of motion of the wrist and thumb, grip strength, deficits in finger flexion and extension, and thumb opposition were measured.

One patient in the mobilization group withdrew his consent prior to the 3-week data collection; therefore, his data were not used. One patient in the nonmobilization group missed the 3-week assessment but was present for the 6-week assessment; therefore, her data were included. The groups were considered homogeneous. Members of both groups experienced complications that were noted at the initial assessment or in subsequent follow-up appointments.

The nonmobilization group attended physical therapy for a mean of 3.2 treatments (SD = 0.9). The mobilization group was treated a mean of 9.1 times (SD = 0.7). Both groups improved significantly on all of the outcome measures. However, no significant difference existed in the VAS scores or the functional task scores at any of the measurement times. A repeated measures ANOVA likewise failed to reveal any significant group x time interactions in any of the measurements, with the exception of wrist flexion ROM. The authors, however, felt that the difference in wrist flexion between the groups was not large enough to be considered clinically important.

The authors concluded that passive mobilization did not increase the effectiveness of advice and exercises in managing patients with fractures of the distal radius. They argued that the study results did not support the routine use of passive mobilization for this patient group. They stated that further studies are needed to verify these conclusions.

Jeff Yaver, PT Kaiser Permanente Sacramento, Calif