Overall Effects and Moderators of Rehabilitation in Patients With Wrist Fracture: A Systematic Review

Background & Aims: Wrist fractures constitute the most frequently occurring upper limb fracture. Many patients report persistent pain and functional limitations up to 18 months following wrist fracture. Identifying which patients are likely to gain the greatest benefit from rehabilitative treatment is an important research priority. This systematic review aimed to summarise effectiveness of rehabilitation after wrist fracture for pain and functional outcomes and identify potential effect moderators of rehabilitation.
Methods: A comprehensive search of seven databases (including MEDLINE, EMBASE, and PEDRO) was performed for randomised controlled trials involving adults >50years who sustained wrist fracture, and received one or more conservative treatments (e.g., exercise/manual therapy, lifestyle, diet or other advice). Study selection, data extraction and risk of bias assessment were conducted independently by two reviewers. Results of included trials were summarised in a narrative synthesis.
Results: 3225 titles were screened and 21 studies satisfying all eligibility criteria were reviewed. Over half of included studies (n=12) comprised physiotherapy and/or occupational therapy interventions. Rehabilitative exercise/manual therapy was generally found to improve function and reduce pain up to 1 year after wrist fracture. However, effects were small, and home exercises were found to be comparable to physiotherapist-led exercise therapy. Evidence for the effects of other non-exercise therapy (including electrotherapy, whirlpool) was equivocal and limited to the short-term (<3months). Only 2 studies explored potential moderators and did not show evidence of moderation by age, sex, or patient attitude of the effects of rehabilitation.
Conclusion: Effectiveness of current rehabilitation protocols after wrist fracture is limited; and evidence for effect moderators is lacking. Currently available trials are not large enough to produce data on sub-group effects with sufficient precision. To aid clinical practice and optimise effects of rehabilitation after wrist fracture, potential moderators need to be investigated in large trials or meta-analysis using individual participant data.
Prospero ID: CRD4201810776
Key words: Wrist fracture, distal radial fracture, rehabilitation, exercise therapy, moderators