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

• Published in: Journal of hand therapy Vol. 36; no. 3; pp. 593 - 605
• Main Authors: Collis, Julie M., Mayland, Elizabeth C., Wright-St Clair, Valerie, Rashid, Usman, Kayes, Nicola, Signal, Nada
• Format: Journal Article
• Language: English
• Published: Philadelphia Elsevier Inc 01.07.2023; Elsevier Limited
• Subjects: Activities of daily living; Biometrics; crossover study; Data collection; Deviation; Distal Radius Fracture; Fractures; Hand Therapy; Intervention; Movement; occupation; Pain; Position measurement; Purposeful activity; Qualitative research; Recording equipment; Regression analysis; Regression models; rehabilitation; Surgery; Time measurement; Wrist; New Zealand; crossover study; rehabilitation; Purposeful activity; occupation; Distal Radius Fracture; Hand Therapy
• ISSN: 0894-1130; 1545-004X
• DOI: 10.1016/j.jht.2022.07.009

•Purposeful activity produces substantial wrist and forearm movement.•Wrist active end ROM is similar during purposeful activity and ROM exercises.•Movement is more continuous and repetitious during purposeful activity than ROM exercises.•Purposeful activity is a valuable source of postoperative therapeutic movement. 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 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. 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. 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.