There was preliminary evidence from one trial that exercise to the non-injured arm during immobilisation might lead to short-term benefits on increasing grip strength and range of movement following distal radius fracture .
There is emerging evidence that current prescribed exercise regimens may not be effective in reducing impairments and improving activity following an upper limb fracture .
Starting exercise early combined with a shorter immobilisation period is more effective than starting exercise after a longer immobilisation period .
QUESTION What is the effect of exercise on increasing participation and activity levels and reducing impairment in the rehabilitation of people with upper limb fractures ?
Bruder AM , Shields N , Dodd KJ , Taylor NF ( 2017 ) Prescribed exercise programs may not be effective in reducing impairments and improving activity during upper limb fracture rehabilitation : a systematic review .
Rehabilitation After Immobilization for Ankle Fracture: The EXACT Randomized Clinical Trial.
IMPORTANCE The benefits of rehabilitation after immobilization for ankle fracture are unclear . OBJECTIVES To determine the effectiveness of a supervised exercise program and advice ( rehabilitation ) compared with advice alone and to determine if effects are moderated by fracture severity or age and sex . DESIGN , SETTING , AND PARTICIPANTS The EXACT trial was a pragmatic , r and omized clinical trial conducted from December 2010 to June 2014 . Patients with isolated ankle fracture presenting to fracture clinics in 7 Australian hospitals were r and omized on the day of removal of immobilization . Of 571 eligible patients , 357 chose not to participate and 214 were allocated to rehabilitation ( n = 106 ) or advice alone ( n = 108 ) , with 194 ( 91 % ) followed up at 1 month , 173 ( 81 % ) at 3 months , and 170 ( 79 % ) at 6 months . There were no withdrawals attributed to adverse effects . Recruitment terminated early on December 31 , 2013 ( planned enrollment , 342 ; actual , 214 ) , because funding was exhausted . INTERVENTIONS Supervised exercise program and advice about self-management ( rehabilitation ) ( individually tailored , prescribed , monitored , and progressed ) or advice alone , both delivered by a physical therapist . MAIN OUTCOMES AND MEASURES Primary outcomes were activity limitation assessed using the Lower Extremity Functional Scale ( score range , 0 - 80 ; higher scores indicate better activity ) , and quality of life assessed using the Assessment of Quality of Life ( score range , 0 - 1 ; higher scores indicate better quality of life ) , measured at baseline and at 1 , 3 ( primary time point ) , and 6 months . RESULTS Mean activity limitation and quality of life at baseline were 30.1 ( SD , 12.5 ) and 0.51 ( SD , 0.24 ) , respectively , for advice and 30.2 ( SD , 13.2 ) and 0.54 ( SD , 0.24 ) for rehabilitation , increasing to 64.3 ( SD , 13.5 ) and 0.85 ( SD , 0.17 ) for advice vs 64.3 ( SD , 15.1 ) and 0.85 ( SD , 0.20 ) for rehabilitation at 3 months . Rehabilitation was not more effective than advice for activity limitation ( mean effect at 3 months , 0.4 [ 95 % CI , -3.3 to 4.1 ] ) or quality of life ( -0.01 [ 95 % CI , -0.06 to 0.04 ] ) . Treatment effects were not moderated by fracture severity or age and sex . CONCLUSIONS AND RELEVANCE A supervised exercise program and advice did not confer additional benefits in activity limitation or quality of life compared with advice alone for patients with isolated and uncomplicated ankle fracture . These findings do not support the routine use of supervised exercise programs after removal of immobilization for patients with isolated and uncomplicated ankle fracture . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12610000979055
There was preliminary evidence from one trial that exercise to the non-injured arm during immobilisation might lead to short-term benefits on increasing grip strength and range of movement following distal radius fracture .
There is emerging evidence that current prescribed exercise regimens may not be effective in reducing impairments and improving activity following an upper limb fracture .
Starting exercise early combined with a shorter immobilisation period is more effective than starting exercise after a longer immobilisation period .
QUESTION What is the effect of exercise on increasing participation and activity levels and reducing impairment in the rehabilitation of people with upper limb fractures ?
Bruder AM , Shields N , Dodd KJ , Taylor NF ( 2017 ) Prescribed exercise programs may not be effective in reducing impairments and improving activity during upper limb fracture rehabilitation : a systematic review .