title: The value of early mobilisation in the treatment of Colles' fractures. Early mobilisation of Colles' fractures. A prospective trial. Do Colles’ fracture patients benefit from routine referral to physiotherapy following cast removal? Independent exercises versus physiotherapy in nondisplaced proximal humeral fractures. Physiotherapy after volar plating of wrist fractures is effective using a home exercise program. Physiotherapy after fracture of the proximal end of the humerus. Comparison between two methods. Early mobilization in the treatment of Colles' fracture: a 3 year prospective study. [The importance of early exercise therapy in the treatment of Colles' fracture. A clinically controlled study]. Immediate mobilization compared with conventional immobilization for the impacted nonoperatively treated proximal humeral fracture. A randomized controlled trial. Occupational therapy and Colles' fractures Reliability of the PEDro scale for rating quality of randomized controlled trials. Risk factors for fractures of the distal forearm and proximal humerus. The Study of Osteoporotic Fractures Research Group. The role of physiotherapy and clinical predictors of outcome after fracture of the distal radius. Rehabilitation of two-part fractures of the neck of the humerus (two-year follow-up). An advice and exercise program has some benefits over natural recovery after distal radius fracture: a randomised trial. Early mobilisation for minimally displaced radial head fractures is desirable. A prospective randomised study of two protocols. A randomised clinical trial of activity-focussed physiotherapy on patients with distal radius fractures Early active mobilisation of volar plate avulsion fractures. Early versus late mobilization after hemiarthroplasty for proximal humeral fractures. Rehabilitation after two-part fractures of the neck of the humerus. The epidemiology of proximal humeral fractures
abstract: Unilateral Colles ' fractures in 187 patients over the age of 55 years were studied in a r and omised prospect i ve trial : 97 fractures were minimally displaced and were treated either conventionally or in a crêpe b and age ; 90 displaced Colles ' fractures were reduced and of these 47 were treated conventionally while 43 were encouraged to mobilise the wrist in a cast which restricted extension . Early wrist movement hastened functional recovery and led to earlier resolution of wrist swelling . Discomfort was no greater than in patients who were treated conventionally . The bony deformity , which recurred irrespective of the method of treatment , was not adversely affected by early mobilisation The results of a prospect i ve controlled trial of early mobilisation of Colles ' fractures in the elderly are presented . Early mobilisation produced less pain and a stronger grip . It did not lead to any greater loss of reduction of the fracture . However , there was no significant improvement in the final range of movement of the wrist .  Immobilisation of the wrist for six weeks in plaster is extremely inconvenient for the elderly living alone and the patients greatly appreciated the reduction of this period of time to a minimum Abstract Colles ’ fracture patients who received physiotherapy  immediately following cast removal were compared with patients who received no active therapy following cast removal in a prospect i ve r and omised study . Patients who attended physiotherapy achieved significantly greater increases in wrist extension and grip strength after 6 weeks compared to patients who received no active therapy 42 patients with undisplaced , proximal humeral fractures were r and omly assigned into two groups in order to compare the results of instruction to the patient for independent exercises and conventional physiotherapy . No differences appeared between the groups subjectively or as regards functional parameters at 1 as well as at 3 months after the fracture and at a follow up more than 1 year later . As no disadvantage could be found instructions to the patients should in these cases be regarded as a satisfactory after-treatment OBJECTIVE To determine the effect of 2 different postoperative therapy approaches after operative stabilization of the wrist fractures :  treatment by a physical therapist with 12 sessions and an unassisted home exercise program . DESIGN R and omized controlled cohort study . SETTING Hospital-based care , primary center of orthopedic surgery . PARTICIPANTS Volunteers ( N=48 ) with fractures of the distal radius after internal fixation with locking plates . There were 46 patients available for follow-up after exclusion of 2 participants due to physiotherapy sessions in excess of the study protocol . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Evaluation of grip strength using a Jamar dynamometer , range of motion ( ROM ) , and Patient Related Wrist Evaluation ( PRWE ) . RESULTS After a 6-week period of postoperative treatment , the patients ( n=23 ) performing an independent home exercise program using a training diary showed a significantly greater improvement of the functionality of the wrist . Grip strength reached 54 % ( P=.003 ) , and ROM in extension and flexion 79 % ( P<.001 ) of the uninjured side . Ulnar and radial abduction was also higher in this group . In contrast , patients who were treated by a physical therapist achieved grip strength equal to 32 % , and ROM in extension and flexion of 52 % of the uninjured side . Patients who were performing the home training after operation recorded an improved wrist function with a nearly 50 % lower value ( P<.001 ) in the PRWE score . CONCLUSIONS In the postoperative rehabilitation of wrist fractures , instructions in a home exercise program are an effective alternative to prescribed physical therapy treatment Two methods of physiotherapy after fracture of the proximal end of the humerus were compared . The study was design ed as a r and omized , controlled and single-blind trial . Twenty patients were assigned to two groups 10 - 12 days after the injury . One group was treated conventionally , the other received instructions in self-training with follow-up control of results .  Objective examination and subjective assessment were made at five intervals , up to one year after the injury . The greatest improvement in function was shown in both groups between 3 and 8 weeks . The patients deemed their daily life functions to be normal 8 weeks after the injury . The objective assessment was normal at later stages . No significant differences were found between the two groups in any of the tests . Instruction in self-training with control of results including objective assessment s are therefore an adequate method in the rehabilitation of these patients Ninety consecutive women with unilateral Colles ' fractures were r and omized into two different treatment groups . The control group was treated for 5 weeks in conventional short-arm , below the elbow plaster of Paris casts . The other group ( N = 45 ) was treated similarly in plaster casts for 3 weeks and then had flexible casting applied for the remaining 2 weeks which allowed for early joint mobilization . Functional recovery was assessed by measuring grip strength and joint mobility at intervals over the 3 years . Radiographic and overall assessment s were also made during 3 year course of study . Virtually all patients reported greater comfort after switching to the flexible casting . Mean grip scores and joint mobilities were higher at all time points with early mobilization , reaching levels of statistical significance at 6 months for grip score and at 3 months for joint mobility . By 3 years most differences between treatment groups had resolved . We found no evidence that early mobilization was detrimental to recovery . We conclude that early mobilization is a satisfactory treatment option for Colles ' fracture , and may , in fact , hasten functional recovery Forty patients participated in a study of the importance of early occupational therapy for the prognosis in stable Colles ' fractures . Seventeen patients were treated by an occupational therapist 1 - 3 days after the injury , and the need for appliances and home-care was estimated . Twenty-three patients completed the usual treatment . Five weeks after the injury , we found significantly ( p less than 0.05 ) better function of the h and in the 17 patients with early occupational therapy . This difference in function could not be found after 13 weeks . The rate of complications was the same in the two groups . The results indicate that contact with the occupational therapist shortly after the injury is valuable in patients with stable Colles ' fractures BACKGROUND There have been few r and omized controlled trials evaluating nonoperative treatment of proximal humeral fractures . To investigate shortening the period of dependence , we assessed the feasibility and efficacy of early mobilization of the shoulder ( within three days after the fracture ) in comparison with those of conventional three-week immobilization followed by physiotherapy . METHODS We r and omly assigned seventy-four patients with an impacted proximal humeral fracture to receive early passive mobilization or conventional treatment . The primary outcome was the overall shoulder functional status ( as measured with the Constant score ) at three months . The secondary outcomes were the Constant score at six weeks and at six months , the change in pain ( on a visual analog scale ) , and the active and passive range of motion . RESULTS At three months and at six weeks , the early mobilization group had a significantly better Constant score than did the conventional-treatment group ( between-group difference , 9.9 [ 95 % confidence interval , 1.9 to 17.8 ] [ p = 0.02 ] and 10.1 [ 95 % confidence interval , 2.0 to 18.1 ] [ p = 0.02 ] , respectively ) and better active mobility in forward elevation ( between-group difference , 12.0 [ 95 % confidence interval , 1.7 to 22.4 ] [ p = 0.02 ] and 28.1 [ 95 % confidence interval , 7.1 to 49.1 ] [ p = 0.01 ] , respectively ) . At three months , the early mobilization group had significantly reduced pain compared with the conventional-treatment group ( between-group difference , 15.7 [ 95 % confidence interval , 0.52 to 30.8 ] [ p = 0.04 ] ) . No complications in displacement or nonhealing were noted . CONCLUSIONS Early mobilization for impacted nonoperatively treated proximal humeral fractures is safe and is more effective for quickly restoring the physical capability and performance of the injured arm than is conventional immobilization followed by physiotherapy Abstract . In this r and omized trial , we enrolled 30 patients treated for a distal radius Colles ' type fracture . The fractures were reduced if necessary and fixed in a below-elbow plaster cast for 5 weeks . One group consisting of 14 patients received instructions for shoulder ; elbow and finger exercise and the other group consisting of 16 patients had occupational therapy . At 5 weeks , 3 and 9 months we measured the functional scores . There were no statistically significant differences between the groups at any time . It seems that for non-surgically treated patients with a distal radius fracture only instructions are necessary . Résumé . Etude r and omisée de 30 patients traités d'une fracture distale du radius de type Pouteaux-Colles . Les fractures furent réduites si nécessaire et fixées dans une manchette plâtrée durant 5 semaines . L'un des groupes était constitué de 14 patients qui avaient reçu des instructions d'exercices pour l'épaule , le coude et les doigts . L'autre groupe était constitué de 16 patients qui ont bénéficié d'une ergothérapie  . Une évaluation a été faite après 5 semaines , 3 et 9 mois . Il n'avait aucune différence significative entre les 2 groupes en aucune période . Il semble ainsi suffisant , dans les fractures distales du radius traitées orthopédiquement , d'instruire les patients en vue d'une autoréeducation BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . The Study of Osteoporotic Fractures is a prospect i ve cohort study begun in 1986 that includes 9,704 women aged 65 years and older from Maryl and , Minnesota , Oregon , and Pennsylvania . A total of 171 women suffered fractures of the distal forearm , and 79 women had fractures of the proximal humerus during the first 2.2 years of follow-up . Most fractures at both sites occurred as a result of a fall . Low bone mineral density was a strong predictor of these fractures ; comparing those in the lowest quintile of bone mineral density in the distal radius with those in the highest quintile , the rate ratio was 4.1 for fractures of the distal forearm and 7.5 for fractures of the proximal humerus . Other factors associated with an increased rate of distal forearm fracture independently of low bone mineral density included poor visual acuity , number of falls in the year before baseline , and frequent walking . Factors that appeared to be independently associated with an increased rate of fracture of the proximal humerus included a recent decline in health status , insulin-dependent diabetes mellitus , infrequent walking , and several indicators of neuromuscular weakness such as inability to st and with feet in a t and em position for more than a few seconds . These data support the hypothesis that distal forearm fractures often occur as a result of a fall in women with low bone mineral density who are relatively healthy and active and have good neuromuscular function , while fractures of the proximal humerus tend to occur as a result of a fall in women with low bone mineral density who are less healthy and less active than average and who have poor neuromuscular function The capacity for physiotherapy to improve the outcome after fracture of the distal radius is unproven . We carried out a r and omised controlled trial on 96 patients , comparing conventional physiotherapy with a regime of home exercises .  The function of the upper limb was assessed at the time of removal of the plaster cast and at three and six months after injury . Factors which may predict poor outcome in these patients were sought . Grip strength and h and function did not significantly differ between the two groups . Flexion and extension of the wrist were the only movements to improve with physiotherapy at six months ( p = 0.001 ) . Predictors of poor functional outcome were malunion and impaired function before the fracture . These patients presented with pain , decreased rotation of the forearm and low functional scores at six weeks . Our study has shown that home exercises are adequate rehabilitation after uncomplicated fracture of the distal radius , and routine referral for a course of physiotherapy should be discouraged . The role of physiotherapy in patients at high risk of a poor outcome requires further investigation The 2-year results of a r and omized , prospect i ve , controlled trial of minimally displaced proximal humeral fractures treated either by immediate physiotherapy ( group A ) or after 3 weeks of immobilization ( group B ) are reported . At 1 year shoulder disability , as measured with the Croft shoulder disability question naire , was found in 42.8 % of patients in group A and 72.5 % in group B ( P < .01 ) . By 2 years , shoulder disability in group A remained unchanged ( 43.2 % ) but had reduced in group B ( 59.5 % ) . This difference was not statistically significant . Immediate physiotherapy after a minimally displaced proximal humeral fracture results in faster recovery , with maximal functional benefit being achieved at 1 year . Delayed rehabilitation by 3 weeks of shoulder immobilization produces a slower recovery , which continues for at least 2 years after the time of injury QUESTION Does an advice and exercise program improve outcome for adults following distal radius fracture ? DESIGN R and omised trial with concealed allocation , assessor blinding , and intention-to-treat analysis . PARTICIPANTS Fifty-six patients whose fracture had been managed with pins and /or cast . INTERVENTION The experimental group received a physiotherapist-directed program of advice and exercises . The control group did not receive any physiotherapy intervention . OUTCOME MEASURES The primary outcome was wrist extension ( measured with a goniometer ) . Secondary outcomes were the other wrist ranges of motion ( measured with a goniometer ) , grip strength ( measured with a dynamometer ) , pain , and activity limitations ( measured with question naires ) . These outcomes were measured initially , then three and six weeks later . Participants also rated their satisfaction with physiotherapy intervention at Week 6 . RESULTS No difference was found between groups for the primary outcome of wrist extension ( mean difference 6 deg , 95 % CI -3 to 14 ) , nor for the secondary outcomes of other range of motion data and grip strength . The difference between groups for pain was -16 points out of 100 ( 95 % CI -27 to -5 ) at Week 3 , and -14 points ( 95 % CI -25 to -3 ) points at Week 6 , and for activity was -13 points out of 100 ( 95 % CI -24 to -2 ) at Week 3 ; in favour of the experimental group . The experimental group was also more satisfied with the amount of physiotherapy intervention . CONCLUSION An advice and exercise program provided some additional benefits over no intervention for adults following distal radius fracture We compared two protocol s of early mobilisation for minimally displaced radial head fractures through a single-blinded , prospect i ve r and omised trial . Sixty patients were r and omly allocated to either immediate active mobilisation or 5-day delay before active mobilisation was commenced . Patients were review ed at 7 days , 4 weeks and 3 months after injuries . A blinded observer assessed each patient . All fractures united by the third month . At the end of 7 days , the mobilisation group had less pain ( visual analogue scale ( VAS ) 6 versus 7.6 , P=0.002 ) ; greater flexion ( mean 112 versus 98 degrees , P=0.0004 ) ; greater strength in supination ( P<0.001 ) and better elbow function ( Morrey Score : 54 versus 43 , P=0.005 ) . By the fourth week , both groups were comparable in all parameters and improvement continued into the third month . Mean limit of extension at the third month were 2.3 degrees in the immediate mobilisation group and 1.8 degrees in the delayed group ( NS ) . All had excellent function on the basis of the Morrey Score . Immediate mobilisation did not adversely affect the outcome ; the patients had less pain and better elbow function at 1-week post-injury . Pain , ranges of movement and function were similar by the fourth week post-injury Introduction : Physiotherapy is considered by some authorities to be an important aspect of management in patients following distal radius fractures . There is evidence of improvement in impairment with physiotherapy ; however , there is no evidence to support early return of functional activity . Traditional physiotherapy management has focussed on improving impairment ; however , there are no trials with emphasis on skill acquisition via motor re-learning principles . Material s and methods : Forty-one participants with conservatively managed distal radius fractures were studied in a r and omised , single-blinded , prospect i ve trial . Two treatment options were compared : exercise and advice versus activity-focussed physiotherapy with measurement periods of 6 weeks after removal of cast and follow-up at 24 weeks . Results : Participants allocated to the exercise and advice group consulted a physiotherapist an average of 0.9 ( SD 0.4 ) times , while the participants allocated to the more intensive activity-focussed group consulted with physiotherapy a mean of 4.4 ( SD 2.3 ) times . At both 6 and 24 weeks there were no significant differences between the groups for change in impairment ( as measured by grip strength , range of motion of wrist flexion and extension and pain intensity ) , activity limitation and participation restriction , as measured by the Patient-Rated Wrist Evaluation ( PRWE ) .  Exercise and advice given by a physiotherapist were equally as effective as  activity-focussed physiotherapy  in recovery both at 6 and 24 weeks . Conclusion : The results suggest that after removal of cast from fracture of distal radius , patients may routinely require no more than a single session of advice and exercise provided by a physiotherapist This is a prospect i ve follow up of 190 consecutive cases of volar plate avulsion fractures . A st and ard management regimen of immediate , active movement was followed in all cases and physiotherapy was rarely required . Of the 190 patients , 162 were followed up for at least one year . An excellent or good outcome was achieved in 98 per cent . Patients presenting more than three weeks from injury had a worse outcome . The size and displacement of the avulsed fragment did not affect the outcome . For the stable joint , early active mobilisation with minimal or no splintage provides a good result This r and omized controlled trial compares 2 mobilization regimens after  shoulder hemiarthroplasty for acute 3- and 4-part fractures . The aim was to establish whether the length of immobilization plays a role in the functional outcome , tuberosity healing , and subsequent range of motion . The same prosthesis and surgical technique were used . We recruited 59 patients into the study ; 31 were r and omized to early ( 2 weeks ) mobilization and 28 to late ( 6 weeks ) mobilization .  Greater tuberosity migration was assessed with a series of radiographs , and the functional outcome was assessed with the Constant Shoulder Assessment and Oxford shoulder scores . Of the patients , 49 ( mean age , 70 years ) met the inclusion criteria and were followed up for 12 months . Greater tuberosity migration occurred in 3 cases in the early mobilization group and once in the late mobilization group ( P > .10 ) . There was no significant difference in the Constant Shoulder Assessment and Oxford scores between the 2 groups . Although there was a decreased incidence of tuberosity migration in the group undergoing late mobilization , this was not statistically significant We undertook a prospect i ve , controlled trial which compared two rehabilitation programmes for 86 patients who sustained two-part fractures of the proximal humerus . Patients were r and omised either to receive immediate physiotherapy within one week ( group A ) or delayed physiotherapy after three weeks of immobilisation in a collar and cuff sling ( group B ) . At 16 weeks after the fracture , patients in group A had less pain ( p < 0.01 ) and had greater shoulder function ( p < 0.001 ) than those in group B. At 52 weeks , the differences between the groups had reduced . Although group A still had greater shoulder function and less pain , there was no statistical difference when compared with group B. By analysis of the area under the curve , an overall measure up to the 52-week period , group A experienced less pain as measured by the SF36 general health question naire and had improved shoulder function . Our results show that patients with two-part fractures of the proximal humerus who begin immediate physiotherapy , experience less pain . The gains in shoulder function persist at 52 weeks which suggests that patients do not benefit from immobilisation before beginning physiotherapy We present a 5-year prospect i ve study of the epidemiology of 1,027 proximal humeral fractures . These fractures , which tend to occur in fit elderly persons , have a unipolar age distribution and the highest age-specific incidence occurs in women between 80 and 89 years of age . The commonest was the B1.1 impacted valgus fracture , found in one-fifth of the cases in this series , a type that is not included in the Neer classification . We used both Neer and AO classifications . The AO classification proved to be more comprehensive because in the Neer classification , half of the fractures are minimally displaced and almost nine-tenths fall into only three categories . In the AO classification , the B1.1 , A2.2 , A3.2 and A1.2 sub-groups comprise over half of all proximal humeral fractures , while the AO type C fractures occur in only 6 % . We suggest that the literature does not adequately reflect the spectrum of proximal humeral fractures
target: There is evidence to support the role of specific exercise regimens in reducing impairments and improving upper limb function following specific upper limb fractures
background: QUESTION What is the effect of exercise on reducing impairment and increasing activity in the rehabilitation of people with upper limb fractures ?