Acute Effects of Dual Task on Physical Function in Patients With Elbow Joint Fracture
Condition: Elbow Fracture
MeSH terms: Fractures, Bone; Elbow Fractures
Study type: Observational [Patient Registry]

Summary: 
      Elbow injuries account for up to 15% of emergency consultations. The complexity of this joint
      and the subtle imaging findings present even in severe injuries make diagnosis difficult and
      can delay treatment, causing pain and functional impotence. Appropriate deterioration
      mitigation strategies include, but are not limited to, strengthening programs of sufficient
      intensity to stimulate anabolism and limit muscle loss and increase strength. The general
      recommendation for increasing muscle strength and neural adaptations in healthy subjects
      after sustaining an elbow fracture is moderate to heavy load resistance training with loads
      approximating 60%-80% of the one repetition maximum ( 1RM). However, high joint stress would
      be challenging and increase the risk of adverse consequences in such patients, so strategies
      are still needed to meet the challenges of effectively and safely adapting training loads to
      safely enable improvement. without requiring high joint stress. Resistance band work, coupled
      with the use of dual tasks, is a novel approach used during resistance training, especially
      among healthy populations, with promising results. The purpose of the study is to evaluate
      acute neuromuscular responses, pain intensity and RPE in patients with elbow joint fracture,
      with or without surgical approach, with different strategies to strengthen the upper limb.

      Candidates for this study will be men and women over 18 years of age who have been diagnosed
      with a fracture of the elbow joint (types 1-3 and types 2-1 according to Müller's OA fracture
      classification), with or without a surgical approach and with date of injury and completion
      of their physiotherapy program in 2022-2023, and who begin their physiotherapy treatment
      between weeks 7 to 9 post-fracture.
    

Detailed description: 
      Elbow injuries account for up to 15% of emergency consultations. The complexity of this joint
      and the subtle imaging findings present even in severe injuries make diagnosis difficult and
      can delay treatment, causing pain and functional impotence. Appropriate deterioration
      mitigation strategies include, but are not limited to, strengthening programs of sufficient
      intensity to stimulate anabolism and limit muscle loss and increase strength. The general
      recommendation for increasing muscle strength and neural adaptations in healthy subjects
      after sustaining an elbow fracture is moderate to heavy load resistance training with loads
      approximating 60%-80% of the one repetition maximum (1RM). However, high joint stress would
      be challenging and increase the risk of adverse consequences in such patients, so strategies
      are still needed to meet the challenges of effectively and safely adapting training loads to
      safely enable improvement. without requiring high joint stress. Resistance band work, coupled
      with the use of dual tasks, is a novel approach used during resistance training, especially
      among healthy populations, with promising results. The purpose of the study is to evaluate
      acute neuromuscular responses, pain intensity and RPE in patients with elbow joint fracture,
      with or without surgical approach, with different strategies to strengthen the upper limb.

      Candidates for this study will be men and women over 18 years of age who have been diagnosed
      with a fracture of the elbow joint (types 1-3 and types 2-1 according to Müller's OA fracture
      classification), with or without a surgical approach and with date of injury and completion
      of their physiotherapy program in 2022-2023, and who begin their physiotherapy treatment
      between weeks 7 to 9 post-fracture. The patients will voluntarily participate in the study,
      which will be carried out at the Hospital Clínico Universitario de Valencia, during the
      months of May 2022 to May 2023. All participants will be informed about the objectives and
      content of the research and information will be obtained. written informed consent. The study
      will conform to the Declaration of Helsinki and will be approved by the local ethics
      committee. Participants will be excluded if they have any involvement in the contralateral
      upper limb, if they have already had/have any other injury to the elbow or other anatomical
      part of the affected MS (in the last year), and if they have any other condition or disease
      in the which there is a contraindication to physical exercise.

      Also if they participate in physiotherapy programs external to the one carried out by us or
      in other research studies. In addition, if there is evidence of a severe failure in bone
      consolidation (separation greater than 5 mm), if there is neural injury, CRPS (Complex
      Regional Pain Syndrome), severe open fracture with muscle and periosteal loss, clinical
      picture not competent for physiotherapy by diagnosis doubtful and severe congenital
      instability of MMSS. The study consists of observational session will be held. The
      experimental protocol begins with the evaluation of neuromuscular responses, self-perceived
      pain intensity and RPE from the use of different intensities of elastic resistance, during
      elbow flexion and extension, at a controlled speed of 1.5 sec/phase. For this purpose, 1.5 m
      long elastic bands will be available, which will be previously stretched to approximately 25%
      of their initial length. This intensity is selected because it appears to correspond to the
      appropriate weight which is equivalent to 30% of 1RM and is considered a light intensity. At
      the end of each set of the exercise, you will be asked about RPE (Borg CR10) and pain in the
      joint. The exercises must be performed with the available range of movement of the subject.
      Participants are asked to move their body and trunk as little as possible and to perform the
      exercise smoothly, without stopping or accelerating. Elbow flexion will be performed in a
      sitting position and extension in the supine position, both stable positions, with exact
      fastening of the bands on the panel of the Rocher Cage, located in the therapeutic room.

      The subjects, in a counterbalanced way, will perform 4 different conditions, with 10 minutes
      of rest between them: the possibilities are 1) perform all possible repetitions of elbow
      flexion with the appropriate band; 2) perform all possible repetitions of elbow flexion with
      the appropriate band, and following a dual task; 3) perform as many elbow extension reps as
      possible with the appropriate band; 4) perform as many elbow extension repetitions as
      possible with the appropriate band, and following a dual task.
    

Observational model: Case-Crossover
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Candidates for this study will be men and women over 18 years of age who have been
        diagnosed with a fracture of the elbow joint (types 1-3 and types 2-1 according to Müller's
        OA fracture classification), with or without a surgical approach and with date of injury
        and completion of their physiotherapy program in 2022-2023, and who begin their
        physiotherapy treatment between weeks 7 to 9 post-fracture.