An evaluation of wrist and forearm movement during purposeful activities and range of movement exercises after surgical repair of a distal radius fracture: A randomized crossover study

Julie M Collis; Elizabeth C Mayland; Valerie Wright-St Clair; Usman Rashid; Nicola Kayes; Nada Signal

doi:10.1016/j.jht.2022.07.009

An evaluation of wrist and forearm movement during purposeful activities and range of movement exercises after surgical repair of a distal radius fracture: A randomized crossover study

J Hand Ther. 2023 Jul-Sep;36(3):593-605. doi: 10.1016/j.jht.2022.07.009. Epub 2022 Aug 8.

Authors

Julie M Collis¹, Elizabeth C Mayland², Valerie Wright-St Clair³, Usman Rashid⁴, Nicola Kayes⁵, Nada Signal⁵

Affiliations

¹ Auckland University of Technology, School of Clinical Sciences, Auckland, New Zealand. Electronic address: Julie.collis@aut.ac.nz.
² Western Sydney University, School of Health Sciences, Campbelltown, New South Wales, Australia.
³ Auckland University of Technology, School of Clinical Sciences, Auckland, New Zealand.
⁴ Auckland University of Technology, Health & Rehabilitation Research Institue, Auckland, New Zealand.
⁵ Auckland University of Technology, Centre for Person Centred Research, Auckland, New Zealand.

PMID: 35953335
DOI: 10.1016/j.jht.2022.07.009

Abstract

Purpose: Following surgical repair of distal radius fractures, range of movement (ROM) exercises are the primary approach for restoring movement during early rehabilitation. Specified purposeful activities can also be used, but the movement produced by activities is not well-understood. The study aimed to evaluate and compare movement during purposeful activity and ROM exercises METHODS: Thirty-five adults with a surgically repaired distal radius facture undertook two 10-minutes interventions: purposeful activity (PA) and active ROM exercises (AE), separated by a 60 minute washout, in random order. Data collection occurred during a single session on the same day. Electrogoniometry was used to measure time-accumulated position (TAP), a global metric of movement range and amount, maximum active end range, movement repetitions, excursions >75% of available ROM, and active time. Data were analyzed using linear mixed and generalized linear mixed regression models.

Results: Purposeful activities selected were predominantly household or food preparation. TAP was significantly higher during AE than PA: -1878 [-2388, -1367], p ≤.001, for wrist extension/flexion. PA produced significantly greater movement repetitions for wrist extension/flexion and deviation, excursions beyond 75% of available ROM, and active time, than AE. During PA the wrist was extending/flexing a mean of 97% [92, 101], of the time, compared with 43% [40, 47], during AE. There were no significant differences in maximum end range for wrist extension between PA, 33.7° [29.8, 37.5] and AE, 34.5° [30.7, 38.4], or for ulnar deviation.

Conclusions: ROM exercises produced higher volumes of sustained joint position than purposeful activity but activities, selected for importance and challenge, produced significantly higher volumes of continuous, repetitious motion in equivalent ranges of movement as exercise repetitions. The study challenges therapists to consider the rehabilitative potential of movement produced by activity for restoring movement and function in the early postoperative weeks.

Keywords: Distal Radius Fracture; Hand Therapy; Purposeful activity; crossover study; occupation; rehabilitation.