Does an Imagined Movement Regime Improve Dexterity Following Conservatively Managed Distal Radius Fractures in Older Adults? A Pilot Randomised Controlled Trial
Phase: NA
Conditions: Radius; Fracture, Lower or Distal End
Sponsor: University of Derby

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Does an imagined movement regime improve dexterity 
following conservatively managed distal radius fractures 
in older adults? A pilot randomised controlled trial. 
 
Date: 21st July 2017 
 

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Research Proposal- Thomas Hughes 
 
Title: Does an imagined movement regime improve dexterity following 
conservatively managed distal radius fractures in older adults? A pilot randomised 
controlled trial. 
 
Introduction:  
Distal radius fractures, (DRFs) are common, estimated at 71,000 a year in Britain in a 
prospective, multi-centred survey undertaken in 1997/8, (O’Neill et al., 2001).  A 
recent literature review, (MacIntyre and Dewan, 2016), suggests that DRF frequency 
appears to be increasing worldwide.   
 
A survey undertaken in Nottingham, (Moore and Leonardi-Bee, 2008),  reported that 
at 1 year following DRF 63% of subjects had pain, 11% had moderate to very severe 
pain, (visual analogue scale).  The same study reported 95% of subjects had some 
functional difficulty, 16% moderate to very severe difficulty, as measured with the 
disabilities of the arm shoulder and hand (DASH), outcome measure.  This suggests 
that some patients may encounter some problems in recovery following this injury. 
 
The incidence of complex regional pain syndrome, (CRPS) in the conservatively 
managed DRF population has been reported as 32.2%, (Jellad, Salah and Frih, 2014).  
This study uses recognised criteria for diagnosing CRPS which gives the reader 
increased confidence that the diagnosis is correct, (Laver-Fawcett, 2007). 
 
In a rigorous, systematic Cochrane review, (O’Connell et al., 2013), a graded motor 
imagery programme is suggested to reduce pain and improve function in adults with 
CRPS.  It is further suggested that the somatosensory cortex, (SSC) is negatively 
affected by CRPS, (Di Pietro et al. 2013), and that imagery programmes, (which 
include imagined movements), may positively influence the SSC, (Moseley, 2004 and 
Priganc and Stralka, 2011).   
 

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It has been reported in several non-randomised controlled trials that immobilisation 
of the upper limb in healthy individuals may negatively affect the SSC.  This was 
illustrated by reduced tactile perception and reduced activation of the SSC, (Lissek et 
al., 2009), and impaired laterality recognition, (Toussaint and Meugnot, 2013, 
Meugnot et al., 2015 and Meugnot and Touissaint, 2015).  Decreased cortical 
excitability has been demonstrated using trans-cranial magnetic stimulation and 
electromyography in non-randomised controlled trial, (Kaneko et al., 2003), where 
eight orthopaedic patients, (injuries not recorded), were immobilised in a DRF-type 
cast and compared to healthy individuals.  Changes in intra-cortical inhibition and 
facilitation were demonstrated in a small study investigating 9 immobilised subjects 
with distal radius fractures, (Zanette et al., 2004).  These changes could demonstrate 
a change in the SCC.  A small, pilot randomised controlled trial, (RCT), (Frenkel et al., 
2014), immobilised healthy individuals for three weeks and found that 15 minutes of 
imagined wrist movement each day preserved wrist extension and ulnar deviation 
range of motion.  The authors recommend that imagined movement should be 
studied in orthopaedic rehabilitation. 
 
No studies investigating imagined movements in subjects with distal radius fracture 
were identified in a search using a systematic approach, (appendix 1).  There are two 
current studies, (Broekstra and Stenekes, 2015 and Schott and Korbus, 2014), that 
are investigating imagined movements in the distal radius population but these have 
yet to be published.  The methodology and the exact motor imagery programmes for 
the intervention group are unclear.  One commonality is that both studies are only 
using female subjects.  When examining the local metrics at Aneurin Bevan 
University Health-Board, (ABUHB), approximately 20% of this population are male.  It 
is suggested that although relatively small, this group should be included to more 
closely represent the population of interest.  It is suggested that this could be 
addressed in this proposed study. 
 
The Purdue pegboard was designed to assess manipulative dexterity, (Tiffin and 
Asher, 1948).  In a systematic review the Parkinson evidence database to guide 

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effectiveness task force, (Kegelmeyer et al., 2014), recommends the Purdue 
pegboard to measure fine motor activity and dexterity in Parkinson’s disease.  Its 
application in assessing the dexterity of neurologically impaired subjects suggests it 
is suitable for use in this trial as a measure of motor control/ SSC function. 
 
In summary, it is suggested that DRFs are common and immobilisation for 
conservative treatment may cause changes in the SSC.  The SSC may be positively 
influenced by imagined movements.  No studies were identified which investigate 
this topic using recognised outcome measures for pain and dexterity. 
 
Study Objectives 
The aim is to undertake a pilot RCT to investigate whether an imagined movement 
regimen improves dexterity in conservatively managed DRFs in adults over 50, when 
compared to control.   
 
Other objectives are: 
1) To assess dexterity using the Purdue pegboard in adults over 50 years old 
with conservatively managed DRFs, following an imagined movement 
regimen when compared to control. 
2) To evaluate pain using a visual analogue scale, (VAS) in adults over 50 years 
old with conservatively managed DRFs, following an imagined movement 
regimen when compared to control.  
3) To evaluate active range of motion using goniometry in adults over 50 years 
old with conservatively managed DRFs, following an imagined movement 
regimen when compared to control.  
4) To test research procedures in the same study, and highlight any specific 
problems. 
 
Study Plan 
 
Design 

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When examining a new treatment, a randomised controlled trial can be considered 
to produce the best level of evidence, (Aveyard, 2014).  Randomising reduces 
selection bias and increases the chances of the control and intervention groups 
being similar to each other, (May, 2011 and Denscombe, 2010).  Controlling the 
extraneous variables, and having a control group attempts to isolate the intervention 
and its relationship on outcome, (Bowling, 2014).  Due to costs the assessor cannot 
be blinded to the group allocation.  This is recognised as a potential source of bias 
but is unavoidable in this pilot study. 
 
 
Sample 
Subjects will be recruited from two of the local Accident and Emergency 
departments on their initial visit with DRF.  The inclusion and exclusion criteria are 
tabulated in appendix 2. 
 
Number of participants: 
It is difficult to predict how many participants will be available that meet the criteria.  
An aim of this pilot study is to test procedure, this includes recruitment.  Generally 
it’s preferable to have more subjects in a study, (Blaxter, Hughes and Tight, 2010), 
however the numbers need to be manageable, (Denscombe 2010).  Metrics from the 
two sites between April and September 2016 shows an average of 33 patients with 
DRF over the age of 50 per month.  There tends to be a higher frequency of DRF due 
to falls in the winter months, (MacIntyre and Dewan, 2016), therefore this may be a 
conservative estimate.  If we allow for subjects declining to participate or not 
meeting criteria, (estimate 25%), and factor in a drop-out rate of 20%,  (drop-out 
rates reported to be over 20% in 18% of RCTs, Wood, White and Thompson, 2004),  
this could result in a sample size of approximately 20 per month.  If recruitment runs 
for 2 months, (see appendix 3), that could lead to approximately 40 subjects, 20 in 
each group. 
 
Procedures: 
See appendix 4 for flow chart of how subjects move through the study. 

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At initial attendance in Accident and Emergency, subjects that meet the inclusion 
criteria will be offered an information sheet, (appendix 5) and will be asked whether 
they want to be included in the trial.  If they agree, a consent form regarding being 
contacted about the study, (appendix 6), and an assessment form, (appendix 7) will 
be completed by the advanced nurse practitioner.  The forms will be given to the 
primary researcher and filed securely to comply with The Data Protection Act, 
(1998).  All patients, including those who do not wish to participate or don’t meet 
the criteria will be given the standard advice and exercise booklet, (appendix 8 
without italic section).  This is usual for this group of patients. 
The lead researcher will contact each subject within 3 days to discuss the study, and 
arrange an appointment at 7-10 days to begin the study.  This is necessary ethically 
in order to provide a ‘cooling-off’ period for the subjects to consider whether they 
wish to participate.  It will also give time for radiology reports to be completed and 
any subjects with discounted radius fracture can be excluded.   
 
Potential subjects attending the initial appointment at 7-10 days will be offered the 
full consent form, (appendix 9).  Those that do not attend or do not consent will be 
referred back to Accident and Emergency and return to usual care.  Those that 
consent will be randomised into control or intervention group using a computerised 
random number generator.  The control group will continue with maintenance 
exercises.  The intervention group will have the same exercises as the control group 
plus imagined wrist exercises, (appendix 8 including italic section).  The exercises will 
be taught to the subject by reading through the booklet with them, this ensures the 
advice is standardised.  As the intervention is targeting the SSC, high frequency is 
considered important, (Magill and Anderson, 2014).  The imagined movement 
programme, is amalgamated from that described by Moseley (2004) and Frenkel et 
al., (2014), and will consist of imagined wrist movement in all planes.  The frequency 
of 15 minutes every waking hour, (Moseley, 2004), is deemed impractical and, as 
previously mentioned, 15 minutes of mental practice a day preserved range of 
motion, (Frenkel et al., 2014). Therefore approximately 10-15 minutes, four times a 
day has been selected as a pragmatic compromise and mirrors routine advice.   

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An appointment will be arranged as soon as is practically possible, aiming for the 
same day or day after removal of plaster at approximately 4-8 weeks, (varies 
between teams).  This is to reduce the chance of movement out of plaster affecting 
the outcome measures. 
 
Outcome Measures 
The primary outcome measures of dexterity using the Purdue peg-board, and 
secondary outcome measures of pain and active wrist range of motion will be 
measured and recorded, (see appendix 10).  The Purdue peg-board will be used as 
per standardised procedure, (Lafayette, 2002).  It has established reliability and 
validity, (albeit not in this specific population, Yancosek and Howell, 2009), and 
normative data, (Tiffin and Asher, 1948).  It is used in this study to measure fine 
finger-tip dexterity which could be influenced by changes in the SSC.  The Visual 
Analogue Scale for pain is widely used in research and clinical trials to measure pain, 
(Paul-Dauphin, 1999) and has reported reliability in a range of patient groups 
including acute pain, (Bijur, Silver and Gallagher, 2001).  Goniometry is widely used 
in research to measure joint movements and has reported reliability and validity, 
(Gajdosik and Bohannon, 1987, Horger, 1990, and Carter et al., 2009).   
. 
 
Analysis 
Demographic data will be correlated and compared across groups using descriptive 
statistics, (Blaxter, Hughes and Tight, 2010).  The data will be compared using 
inferential statistics to establish whether the groups were similar, (Denscombe, 
2010).  The outcome measures being used produce ordinal/ratio data and inferential 
statistics will be used to see if there is a difference between the control and 
intervention groups.  It is recognised that the sample size will be too small to 
determine statistical significance, (Suresh and Chandrashekara, 2012), but the study 
will collect data and test processes that could be used in a full study. 
 
 

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Ethics 
Benefits and risks are included in the participant information sheet, (appendix 5).  
The subjects will be fully informed of the intervention, their commitment and that 
they can leave at any time.  Subjects who do not consent will be discharged from the 
study and return to usual care through accident and emergency.  Usual care is that 
patients are normally referred to physiotherapy after removal of plaster, (it is worth 
noting that some patients are not referred).  All subjects will have 2 additional 
appointments compared to usual care, one at day 7-10, and one for their final 
assessment.  This will incur time and costs to each subject, but it may benefit them 
as they will see a Physiotherapist and could discuss any concerns and have their 
exercises reinforced.  Subjects will also commence their physiotherapy treatment 
approximately 1 week earlier than usual which may be seen as a benefit.  The 
subject is informed of this in the information sheet. 
 
University of Derby Health and Social Care Research Ethics Committee have 
approved the proposal and this proposal is being submitted as part of the IRAS 
process for NHS REC approval. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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‘Decreased cortical excitability during motor imagery after disuse of an upper limb in 
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Paul-Dauphin, A., Guillemin, F., Virion, J.M and Briancon, S. (1999) ‘Bias and Precision 
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1264-1275. 
 
 
 
 
 
 
 
 
 
 

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Appendix 1. Literature search strategy. 
Subject terms: ( ”motor imagery” OR imagined OR mental OR thought OR think) AND 
(hand OR wrist) AND (all text) (immobilisation OR static OR plaster OR splint OR 
fracture) NOT (CRPS OR “complex regional pain”). 
When fracture OR radius was added, no further articles were identified, it was 
therefore omitted from the search and the research question for this review 
became, does motor imagery/imagined movement improve outcome following wrist 
immobilisation? 
Inclusion criteria:  
 Any article that explores the use of motor imagery/imagined movements with 
immobilised hand/s or wrist/s 
 Written in English language. 
 Human. 
 Published in a peer reviewed journal. 
Exclusion criteria: 
 Not English language. 
 Any article not exploring the use of motor imagery/imagined movements with 
immobilised hand/s or wrist/s. 
 Not human. 
Date published 
No date restrictions are applied as all articles identified are published since 1990 and 
as only 49 articles were identified in total it was not deemed necessary to limit by 
date and risk missing key articles. 
 
Databases 
Library plus and Google scholar 
 
 
 
 
 

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References scrutinised and 
authors’ previous work searched, 
2 further articles identified, 
including 1 unpublished, current 
trial, the authors were contacted, 
no information available yet.  
Further Searching 
In addition to the database and journal searches, the reference lists of the identified 
articles and any previous work by the authors were scrutinised using the same 
inclusion and exclusion criteria. 
 
 
 
 
79 articles identified
6 articles
Bassolino et al., (2013), Frenkel et al., (2014), Meugnot et 
al., (2015), Meugnot et al., (2016), Schott and Korbus, 
(2014), Stenekes et al., (2009).
8 articles (those above plus)
Schott et al., (2013), Broekstra and Stenekes, (current 
trial)
Abstracts scrutinised and 
articles not meeting inclusion 
criteria, (n=73), removed. 
 

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Appendix 2. Inclusion and exclusion criteria and justification. 
 
Inclusion Criteria 
Justification/Reason 
 
 
Age > 50 
Used commonly in research, (MacIntyre and 
Dewan, 2016). 
Avoids the variable of relatively high velocity 
injuries sustained by the younger population 
influencing outcome. 
Closed distal radius fracture 
Population of interest. 
Prevents possible impact of other variables 
for example wound, infection, operative 
input.  
Lives within ABUHB geographically 
If subject lives outside of ABUHB 
geographically they may not be funded for 
their care and would normally be referred 
locally for their treatment. 
 
Exclusion Criteria 
Justification/Reason 
 
 
Age < 50 
See inclusion criteria (Age>50). 
Lives outside ABUHB/unable to attend 
appointments 
Would not be able to attend for 
intervention/assessment. 
Open distal radius fracture 
See inclusion criteria (closed distal radius 
fracture). 
Subjects that require surgery 
To prevent a possible impact from this 
variable 
Subjects where a fracture is subsequently 
ruled out 
Subject would no longer be in the population 
of interest. 
Any additional upper limb injury 
To prevent a possible impact from this 
variable and may prevent ability to 
participate in the intervention or control 
group.  
Bilateral wrist fracture 
Would prevent ability to participate in the 
intervention group as contralateral wrist is 
used. 
Unable to consent  
(Subject lacks capacity to consent for 
example due to a mental health condition, 
learning disability, dementia or another 
similar condition using the Mental Capacity 
Act, 2005 as a guide) 
Consent required to participate. 
Unable to follow instructions or speak 
English 
Would prevent ability to participate. 
 
Pre-existing wrist injury, deformity or 
neurological impairment of either upper 
limb 
To prevent a possible impact from this 
variable.  Subject may not be able to 
participate. 
Subject describes significant emotional 
and/or psychological trauma at time of 
injury 
To reduce the subject experiencing undue 
stress and reduce the incidence of additional 
debriefing with these subjects which would 

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add time to the assessments and potentially 
add a confounding variable to the study 
 
 
 

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Appendix 3. Planned time line for study, (adjusted due to extension granted) 
 
 
 
July 
August 
Sep 
Oct 
Nov 
Dec 
Jan 
Feb 
March 
Continue literature search and review 
 
 
 
 
 
 
 
 
 
Pilot (dependent on ethics) 
 
 
 
 
 
 
 
 
 
Recruitment 
 
 
 
 
 
 
 
 
 
Main data collection 
 
 
 
 
 
 
 
 
 
Write method section 
 
 
 
 
 
 
 
 
 
 
Data collation and analysis 
 
 
 
 
 
 
 
 
 
Write results section 
 
 
 
 
 
 
 
 
 
Write discussion and conclusion 
 
 
 
 
 
 
 
 
 
 
Complete typing, editing, binding 
 
 
 
 
 
 
 
 
 
 
 
 
May require deferring/expediting dependent on ethical approval but time scales would remain similar. 
 
 
 

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Appendix 4. Flow diagram of progress through study. 
Day 0 
Potential subject attends Accident and Emergency with a distal radius fracture. 
All patients are provided with an advice and exercise sheet, (appendix 8 without 
italic section).  Advanced Practice Nurse ensures suitability with inclusion and 
exclusion criteria and an information sheet, (appendix 5), and a consent to be 
contacted form (appendix 6) are completed. 
 
 
 
 
Day 2-3 
Potential subject telephoned by primary researcher. 
Any questions or concerns are able to be discussed. 
An appointment is arranged for the subject to commence the study. 
 
 
Day 7-10 
Subject attends initial appointment and is offered full consent form, (appendix 9). 
 
 
Subject randomised into control or treatment group. 
Control group continue with same exercises, treatment group given additional 
imagined movement exercises (appendix 8 with italics) issued. 
Assessment appointment arranged to correlate with removal of plaster cast. 
 
 
 
Day 28-56 (dependent on length of immobilisation) 
Assessment of primary and secondary outcome measures, (appendix 10). 
Study terminates, standard physiotherapy begins. 
If consent is given then 
demographic data is 
collected using form, 
(appendix 7).  
If consent 
not given 
Patient 
discharged 
from study and 
returned to 
usual care 

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Participant information sheet 
 
 
 
PARTICIPANT INFORMATION SHEET 
 
 
STUDY TITLE 
Does 
an 
imagined 
movement 
regime 
improve 
dexterity 
following 
conservatively managed distal radius fractures in older adults? A pilot 
randomised controlled trial. 
 
You are being invited to take part in a research study.  Please take time to 
read the following information carefully as it is important that you understand 
why the research is being done and what is involved.  Feel free to discuss this 
with your friends and family and take your time to decide.  You can then 
decide whether or not you wish to take part. 
 
WHO IS ORGANISING AND FUNDING THE RESEARCH? 
I am conducting this research as part of my MSc in Hand Therapy as a 
student of Derby University, College of Health and Social Care. Aneurin 
Bevan University Health Board is supporting me in terms of my time.  There is 
no direct funding. 
 
 
WHAT IS THE PURPOSE OF THE STUDY? 
Patients with a broken/fractured wrist can have problems with stiffness, pain 
and use of their hand and arm for several months following removal of plaster.  
This study is investigating whether imagined movements whilst in the plaster 
improves your dexterity and/or reduces pain and/or improves movement.  It is 
a randomised control trial; this means that you will be placed in either a 
control or experimental group.   
You have been asked to participate because you have a distal radius fracture, 
(wrist fracture) that has been treated in plaster and you are over 50 years of 
age. 
 
DO I HAVE TO TAKE PART? 
Taking part in this study is entirely optional.  If you do decide to take part you 
will be given this information sheet to keep and be asked to sign a consent 
form to be contacted by phone to arrange an appointment. If you decide to 
take part you are free to withdraw at any time and without giving a reason.  
Any information collected up to the point of withdrawal will be retained.  This 
study will not prevent you from attending any hospital or physiotherapy 
appointments.   
 

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WHAT WILL HAPPEN TO ME IF I TAKE PART? 
All participants will be contacted by telephone within 3 days of joining the 
study to ask if you want to be involved in the study.  If you do not want to be 
involved you will be referred back to Accident and Emergency and return to 
usual care which will normally involve a physiotherapy referral after removal of 
your plaster. If you want to be involved an appointment will be arranged for 
you about 1 week after you first attended Accident and Emergency.  This is an 
extra appointment that you would not normally have.  At this appointment you 
will see the lead researcher who is a Clinical Specialist Physiotherapist and be 
asked to fill in a consent form.  If you do not want to be involved you will be 
referred back to Accident and Emergency and return to usual care, (as 
described earlier).  If you agree to take part you will be put into one of two 
groups. One group, the control group, will be taught the usual exercises to 
maintain the shoulder, elbow and finger movements whilst in plaster.  The 
other group, the experimental group, will have the same exercises and some 
additional exercises where you imagine moving your wrist whilst it is still in 
plaster.  Both groups will be asked to do these exercises 4 times a day.  It is 
anticipated they will take you no more than 15 minutes each time. 
 
A final assessment appointment will be arranged soon after your plaster is 
removed.  At this appointment the lead researcher will measure your wrist 
movements, (as an angle), your pain level, (using a line scale), and your 
ability to manipulate small objects using a pegboard, which involves placing 
small pegs into holes.  This should take no more than 30 minutes.  These 
appointments can only be arranged at the Royal Gwent Hospital, Newport.  
This will be the end of the trial for you but you will continue to attend 
physiotherapy as necessary. 
 
WHAT ARE THE POSSIBLE DISADVANTAGES AND RISKS OF TAKING PART?  
As mentioned previously, you will need to attend two appointments, each 
lasting no more than 30 minutes.  These appointments are extra compared to 
usual care.  Unfortunately there is no funding available for your travel or time. 
There is no cost to park at the hospital but parking is limited. 
You may be randomised to the control group; this means that you will receive 
the usual exercises rather than the treatment being investigated.   
There are no known risks associated with the two exercise plans. 
Measuring your wrist movements and dexterity may be uncomfortable but will 
not be harmful as we would normally encourage early movement when the 
plaster is removed. 
 
WHAT ARE THE POSSIBLE BENEFITS OF TAKING PART? 
There are no intended clinical benefits to taking part in the study however you 
will attend physiotherapy slightly earlier than normal, this may give you the 
chance to ask any questions and raise any concerns you may have. 
If you are in the control group you will still receive the usual exercises to 
ensure you are not penalised for participating.   
Research is essential in ensuring we use evidence to guide our treatment.  By 
participating you may help to improve our understanding of this topic and 
possibly improve future patient care. 
 

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WILL MY DETAILS BE KEPT CONFIDENTIAL? 
All information collected will be kept strictly confidential, (subject to legal 
limitations).  
Your G.P. and/or consultant will be informed if you decide to participate. Your 
details will be anonymised and all data will be securely stored either in locked 
cabinets or on a password protected computer.  No personal information will 
be included in the writing of this study. 
 
WHAT SHOULD I DO IF I WANT TO TAKE PART? 
If you want to take part please sign the consent form so that I can contact you 
by phone.  I will phone you within three days of your plaster being applied and 
you will be asked again if you are happy to take part.  At the first appointment 
you will be asked to complete a full consent form. 
 
WHAT WILL HAPPEN TO THE RESULTS OF THE RESEARCH STUDY? 
The results of this study will be used as my dissertation for an MSc in Hand 
Therapy at the University of Derby.  The results of this study may be 
published in the form of a poster at scientific conferences, no confidential 
information will be used.  The findings may be used to guide further study 
which could be published in a scientific journal, if you wish to view the results 
please contact me using the details below. 
 
WHO HAS REVIEWED THE STUDY? 
The research has been approved by the University of Derby and NHS ethics 
boards. 
 
CONTACT FOR FURTHER INFORMATION 
Researcher: Tom Hughes Clinical Specialist Physiotherapist, Royal Gwent 
Hospital, Cardiff Road, Newport NP20 2UB (01633 234491) Email 
tom.hughes@wales.nhs.uk 
 
If you have any concerns about how this research is being undertaken please 
contact my supervisor, Sue Kennedy, Lecturer, University of Derby, College of 
Health and Social Care, Kedleston Road, Derby. DE22 1GB Email 
S.Kennedy@derby.ac.uk 
  
THANK YOU FOR TAKING THE TIME TO READ THIS INFORMATION SHEET. 
 
DATE 
Version 2-17 
 
 
 
 
 
 
 
 
 
 
 

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Appendix 6. Consent to be contacted form. 
 
 
RESEARCH ETHICS: CONSENT TO BE CONTACTED FORM  
 
 
 
 
 
 
 
 
 
 
 
 
Does an imagined movement regime improve dexterity following conservatively 
managed distal radius fractures in older adults? A pilot randomised controlled trial. 
 
 
Name, position and contact address of Researcher: 
Mr Tom Hughes, Clinical Specialist Physiotherapist, (hands). 
Physiotherapy hand unit, physiotherapy department. 
Royal Gwent Hospital 
Cardiff Road 
Newport  
NP20 2UB 
 
Email: tom.hughes@wales.nhs.uk 
 
 
 
 
Please Initial Box 
 
1. 
I confirm that I have read and understand the information 
sheet for the above study and have had the opportunity to 
ask questions. 
 
 
 
 
 
 
2. 
I agree to be telephoned to discuss my involvement in the 
study and to arrange an appointment. 
 
 
 
 
 
 
Name of Participant  
 
 
Date 
 
 
 
Signature 
 
 
 
 
Name of Researcher/Staff 
 
 
Date 
 
 
 
Signature 
 
 
 
 
 
 
 
 
 

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Appendix 7. Baseline demographic data form. 
 
 
Subject Name 
 
 
 
Subject Hospital number 
 
 
 
Date of A&E attendance 
 
 
 
Subject Date of Birth 
 
 
 
Subject Contact Telephone number/s 
 
 
 
 
This provides enough information to ensure the correct subject is identifiable whilst 
not collecting unnecessary data. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Appendix 8. Patient advice booklet. 
 
 
 
 
 
Aneurin Bevan University Health Board 
Physiotherapy Directorate 
 
 
Physiotherapy advice and 
exercise booklet: 
 
Wrist fractures. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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This booklet gives you advice on helping your wrist to 
recover following a wrist fracture/break.  Whilst in your 
plaster there are some exercises you can do which may 
reduce stiffness and pain. 
 
Swelling and pain 
When you break your wrist it is normal to have swelling 
and pain.  You should keep your hand elevated as much 
as possible.  This should help with the swelling. 
 
You may have been prescribed pain killers by a member 
of staff in accident and emergency.  If you have any 
concerns or feel your pain is not under control, speak to 
your G.P. or pharmacist. 
 
Exercises 
 
It is very important to exercise, even when your wrist is 
immobilised in a plaster cast.  It is suggested that all of 
these exercises are performed 4 times a day.  There is a 
diary at the back of this booklet for you to record when 
you exercise.  You may also wish to set an alarm to 
remind you when to exercise through the day. 
 
1) Make a fist and then straighten your      
fingers. Repeat 10 times. 
 
 
 
 
 

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2) Make a hook/claw grip (the main 
knuckle joints straight with the smaller 
finger joints bent).  Then straighten 
your fingers. Repeat 10 times. 
 
 
 
 
 
3) Bring your arm forwards so that 
your hand goes above your head, 
then lower your hand. Repeat 10 
times. 
 
 
 
 
 
4) Leading with your thumb, bring 
your arm out to the side and above 
your head, then lower. Repeat 10 
times. 
 
 
 
 
 
 

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5) Keep you elbows tucked into your 
side.  Rotate your shoulders so that 
your hands move away from your 
body.  
 
 
 
 
The next three exercises involve you imagining that you 
are moving the wrist that is in plaster.  We recommend 
that you perform each of the exercises 3 times with your 
un-injured wrist so that you can see and feel how your 
‘normal’ wrist moves. Then try to think about doing the 
same thing with your other wrist.  You do not need to 
actually move your wrist in the plaster, you just need to 
imagine the wrist is moving.  We think this may help to 
maintain the movement control part of your brain whilst 
your wrist is unable to move in the plaster cast.  
 
Move your un-injured wrist slowly 
backwards and forwards 3 times.  
Concentrate on how the wrist 
moves and how it feels when it 
moves.  Now, imagine doing the 
same exercise with your injured 
wrist 20 times. 
 
 
 
 
 
 
 

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Move your un-injured wrist slowly 
from side to side 3 times.  
Concentrate on how the wrist moves 
and how it feels when it moves.  
Now, imagine doing the same 
exercise with your injured wrist 20 
times.  
 
 
Keep your elbow tucked into your 
side.  Move your un-injured wrist 
slowly so that the palm faces up and 
then down, 3 times.  Concentrate on 
how the wrist moves and how it feels 
when it moves.  Now, imagine doing 
the same exercise with your injured 
wrist 20 times. 
 
(The section in italics is not included for the control 
group). 

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Exercise diary 
Please use this chart to help you remember to exercise.  Tick the relevant box each time you 
complete your exercises. 
Monday 
Tuesday 
Wednesday 
Thursday 
morning midday afternoon evening morning midday afternoon evening morning midday afternoon evening morning midday afternoon evening 
Week 1 
Week 2 
Week 3 
Week 4 
Week 5 
Week 6 
 
Friday 
Saturday 
Sunday 
morning midday afternoon evening morning midday afternoon evening morning midday afternoon evening 
Week 1 
Week 2 
Week 3 
Week 4 
Week 5 
Week 6 
  
  
  
  
  
  
  
  
  
  
  
  

 
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If you have any questions about your 
exercises or have any concerns please 
contact the physiotherapy team using 
the details below.   
 
 
Physiotherapy Hand Unit 
Physiotherapy Outpatients 
Royal Gwent Hospital 
Cardiff Road 
Newport 
NP20 2UB 
Tel: 01633 234491 
 
 
 
 
 
 
 
 
 
 
 
 

 
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Appendix 9. Full consent form. 
 
 
RESEARCH ETHICS: CONSENT FORM  
 
 
 
 
 
 
 
 
 
 
 
 
Does an imagined movement regime improve dexterity following conservatively 
managed distal radius fractures in older adults? A pilot randomised controlled trial. 
 
 
Name, position and contact address of Researcher: 
Mr Tom Hughes, Clinical Specialist Physiotherapist, (hands). 
Physiotherapy hand unit, physiotherapy department. 
Royal Gwent Hospital 
Cardiff Road 
Newport  
NP20 2UB 
 
Email: tom.hughes@wales.nhs.uk 
 
 
 
 
Please Initial Box 
 
1. 
I confirm that I have read and understand the information 
sheet for the above study and have had the opportunity to 
ask questions. 
 
 
 
2. 
I understand that my participation is voluntary and that I am 
free to withdraw at any time, without giving reason. However, 
if my data has been analysed and written up, I realise I will 
no longer be able to withdraw. 
 
3. 
I understand my information will be anonymised and held 
securely 
 
 
4. 
I agree that my GP and the orthopaedic team responsible for 
my care will be informed of my participation in the study. 
 
 
 
 
5. 
I agree to take part in the above study. 
 
 
 
 
 
 
 
Name of Participant  
 
 
Date 
 
 
 
Signature 
 
 
 
Name of Researcher  
 
 
Date 
 
 
 
Signature 
 
 
 
 

 
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Appendix 10. Assessment data form. 
 
 
Subject Name 
 
 
Hospital number 
 
 
Subject Date of Birth 
 
 
Date  
 
 
Group allocation 
 
Intervention 
Control 
Days since removal of plaster 
 
Days 
Hand dominance 
 
LEFT 
RIGHT 
Injured Hand 
 
LEFT 
RIGHT 
 
Length of time in plaster 
 
Weeks 
Wrist active ROM 
Flexion 
 
 
 
Extension 
 
 
 
Radial Deviation 
 
 
 
Ulnar Deviation 
 
 
 
Supination 
 
 
 
Pronation 
 
 
Purdue peg board score 
Left 
 
 
 
Right 
 
 
 
Both hands 
 
 
 
Left+Right+Both 
 
 
 
Assembly 
 
 
 
 
 

 
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Pain score 
 
 
 
 
 
No pain at all  
 
 
 
 
 
Worst pain imaginable 
 
(It will be checked that this line measures 10cm when printed/photocopied) 
 
Current medication