Exercise handout and one-on-one hand therapy for management of stiffness after plaster cast immobilization of simple phalangeal and metacarpal fractures in children: A randomized,noninferiority trial |
| |
| Affiliation: | 1. Physiotherapy Department, Perth Children''s Hospital, Perth, Western Australia, Australia;2. Department of Clinical Research and Education, Child Adolescent Health Service, Perth, Western Australia, Australia;3. Department of Plastics and Reconstructive Surgery, Child and Adolescent Health Service, Perth, Western Australia, Australia;1. School of Physical Therapy, Western University, London, ON, Canada;2. Roth-McFarlane Hand and Upper Limb Centre, St. Joseph''s Hospital, London, ON, Canada;3. Department of Surgery, University of Western Ontario, London, ON, Canada;4. Department of Surgery, Western University, London, ON, Canada;1. Orthoklinik Hand Center, Santa Cruz do Sul, Rio Grande do Sul, Brazil;2. Titular Member and Board Member of The Brazilian Society of Hand Therapy and Upper Limb, SBTM, Brazil;3. Hand and Microsurgery Department, Santa Cruz Hospital, Santa Cruz do Sul, Rio Grande do Sul, Brazil;4. Pazin Clinic, Brazil;1. Bolu Physical Therapy and Rehabilitation Hospital, Bolu, Turkey;2. Faculty of Health Science, Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey;3. School of Medicine, Department of Preventive Oncology, Hacettepe University, Ankara, Turkey;4. School of Medicine, Department of Biophysics, Hacettepe University, Ankara, Turkey;1. Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia;2. Faculty of Economics, University of Novi Sad, Subotica, Serbia;3. Department of Physical and Sports Education, PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Faculty of Sport Sciences, University of Granada, Granada, Spain;1. School of Rehabilitation, University of Ottawa, Ottawa, Ontario, Canada;2. Bruyère Research Institute, Ottawa, Ontario, Canada;3. Centre for Hip Health and Mobility Robert H.N. Ho Research Centre, School of Kinesiology, University of British Columbia, Vancouver, Canada;4. Evidence-Based Health Department, Federal University of Sao Paulo, Sao Paulo, Brazil;5. Department of Physical Education and Sport, University of Cadiz, Cadiz, Spain;6. Mary Pack Arthritis Program, Vancouver Coastal Health and Centre for Hip Health and Mobility and Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada |
| |
| Abstract: | Study DesignThis is a noninferior, single-blind, randomized controlled trial.IntroductionJoint stiffness is common after plaster cast immobilization for simple phalanx and metacarpal fractures in children. The limited literature suggests this joint stiffness in children resolves without one-on-one therapy; however, without robust studies confirming that there is no detrimental effect from withdrawing treatment, many children are still referred.Purpose of the StudyThe purpose of this study was to determine if an educational handout for self-management of stiffness is noninferior to one-on-one hand therapy for achieving full range of motion (ROM).MethodsParticipants were randomly assigned to group one who received the handout or group two who received hand therapy in addition to the handout. The ROM was measured by composite flexion and total active motion (TAM). The noninferiority margin was 10% difference between the two groups in the proportion of participants who achieved full ROM at two weeks after cast removal.ResultsSixty participants in each group completed the study. Group difference for composite flexion was 1.7% (95% CI: −3.9% to 7.2%), demonstrating noninferiority. Group difference for TAM was inconclusive at 8.3% (95% CI: −2.1% to 18.7%). Sensitivity analysis adjusting for participants with full composite flexion at the baseline resulted in the group difference for composite flexion of 3.1% (95% CI: −3.6% to 9.8%), maintaining noninferiority, but group difference for TAM at 10.4% (95% CI: 0.0% to 20.9%), was inconclusive with the handout group significantly worse.ConclusionAn educational handout is noninferior to hand therapy for achieving full ROM in composite flexion but not TAM. This needs to be taken into consideration for changing clinical practise. |
| |
| Keywords: | Hand therapy Phalangeal fracture Metacarpal fracture Pediatric hand fractures Stiffness Plaster cast immobilization |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
