Implementation of the Dart-throwing Motion Plane in Hand Therapy After Distal Radius Fractures
Condition: Distal Radius Fracture
MeSH terms: Fractures, Bone; Radius Fractures; Wrist Fractures
Study type: Interventional

Summary: 
      Rehabilitation following wrist fractures often includes exercising flexion-extension.
      However, during daily functions, our wrist moves through an oblique plane, named the Dart
      Throwing Motion (DTM) plane. This plane might be a more stable plane in cases of wrist
      injuries, since the proximal carpal row remains relatively immobile. However, rehabilitation
      programs that incorporate exercising in the DTM plane have yet to be explored.

      The researchers aimed to evaluate the rehabilitation outcomes following treatment in the DTM
      plane compared with outcomes following treatment in the sagittal plane after Distal Radius
      Fracture (DRFs).

      Twenty four subjects following internal fixation of DRFs were randomly assigned into a
      research group . The range of motion, pain levels and functional tests were measured before
      and after an intervention of 12 treatment sessions. The control group activated the wrist in
      the sagittal plane while the research group activated the wrist in the DTM plane, via a DTM
      orthosis.
    

Detailed description: 
      Twenty four subjects were recruited after Open Reduction Internal Fixation (ORIF) of DRFs.
      Inclusion criteria were: individuals aged 18 to 65 years. Individuals with previous
      orthopedic or neurological impairments of the upper limb or a cognitive impairment were
      excluded from the study. Subjects were enrolled from the department of hand surgery at the
      Sheba medical center.

      Each subject read and signed an informed consent form pretrial. Each subject went through an
      intake session documenting personal information, upper limb ROM, pain levels and functional
      tests recorded by a certified occupational therapist (OT), hand therapist. The Sagittal group
      activated the wrist mostly in the sagittal plane while the research group activated the wrist
      also in the DTM plane, via the Modified Dart Splint (MDS).

      All of the subjects in both groups received 12 therapy sessions, 30 minutes each one, 2-3
      times a week, during 6-8 weeks following the removal of the cast. Certified hand therapists
      used several different treatment techniques during the sessions, to achieve the primary goals
      of edema control, increased Range of Motion (ROM), and decreased stiffness. Compressive wrap
      with retrograde massage, scar management, soft-tissue mobilization, joint mobilization,
      active motion and ROM exercises were practice patterns used in this study for all subjects,
      regardless their group. Both groups were instructed to exercise at home, 3 times a day, 10
      minutes per exercise session. The MDS was fitted to the subjects in the DTM group on their
      first evaluation session. They received oral and written instructions regarding the donning
      and manner of exercise. Specifically, they were instructed to use the MDS at home. For each
      10-minute exercise session, they were asked to perform 5 minutes of radial-extension under
      resistance and then 5 minutes ulnar-flexion under resistance. In addition, this group was
      required to fill in a chart at the end of each practice session (morning, noon and evening),
      throughout the intervention period. The researcher performed weekly phone calls to remind the
      DTM group to fill these out. The Sagittal group was instructed to perform at home active
      wrist motion similar to that practiced during the supervised therapy sessions. The prescribed
      instructions were similar to the exercises performed during the sessions.

      At the completion of the treatment, the subjects were reexamined by the same evaluator that
      performed the baseline evaluation.
    

Intervention name(s): Dart splint orthosis; Conventional treatment
Intervention type(s): Device; Other
Intervention description(s): The Dart Splint orthosis was fitted to the subjects in the research group on their first evaluation session. They received oral and written instructions regarding the donning and manner of exercise. Specifically, they were instructed to use the Dart splint orthosis at home. For each 10-minute exercise session, they were asked to perform 5 minutes of radial-extension under resistance and then 5 minutes ulnar-flexion under resistance. In addition, this group was required to fill in a chart at the end of each practice session (morning, noon and evening), throughout the intervention period.; The control group activated the wrist mostly in the sagittal plane. This group was instructed to perform at home active wrist motion similar to that practiced during the supervised therapy sessions. The prescribed instructions were similar to the exercises performed during the sessions. Specifically, they were instructed to exercise at home for 10-minute in each session, three times a day (morning, noon and evening), throughout the intervention period.
Other intervention name(s): Conventional treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: After enrollment, subjects were randomly divided into the research group and into the control group. Both groups went through the same intake evaluation. On completion of the intervention, both groups were reevaluated and filled out a satisfaction questionnaire.
The research group alone filled out the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) questionnaire, to measure the level of satisfaction attribute to assistive technologies, e.g., the innovative dart splint they exercised with.
Masking: None (Open Label)
Primary purpose: Treatment