Shoulder Proprioceptive Training During Immobilization of the Wrist

Study Overview
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Brief Summary
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The goal of this randomized clinical trial is to compare how a program of proprioceptive exercises for the shoulder could influence in pain, functionality, quality of life and shoulder muscle overload in people that are undergoing a immobilization period after a wrist fracture. The main questions it aims to answer are: Study the relationship between shoulder muscle overload and shoulder pain. Evaluate the effect of a proprioceptive program on pain and patient's satisfaction. Intervention will be: Control group: participants of this group are not going to receive any protocol of exercises during the immobilization period. Experimental group: participants of this group are going to receive a protocol of proprioceptive shoulder exercises to do during the immobilization period. Researchers will compare control and experimental group to see if a implantation of a proprioceptive program for the shoulder has benefits on pain, function, quality of life and muscle overload.

Detailed Description
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Distal radius fracture (DRF) in one of the most frequent injuries in the upper limb, corresponding to 1/6 of the total fractures of the body. It appears mostly in >50 years old women (due to osteoporosis and menopause) but it is also frequent in middle age men as a consequence of a big trauma during sport activities or working. This injury can be treated conservative of surgically, but regardless of the treatment, it always has a period of immobilization between 3 to 6 weeks. During the immobilization period, proximal structures suffer changes in mobility. Shoulder's ROM has to increased in order to compensate the immobilization of the wrist. Previous studies shown that there is a relation between time of immobilization and shoulder pain. Shoulder pain can significantly affect daily living activities as driving, dressing or even eating. Also, pain does not appear only on it's own, but with other psychological factors as catastrophism, lower self-efficacy, fear of movement and avoidance. These factors could be crucial to predict disability in these patients, hence they should not be ignored during the rehabilitation process. Our hypothesis is that the implementation of a proprioceptive shoulder exercise program during the period of immobilization may help and/or prevent shoulder pain secondary to immobilization.

Official Title
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Effects of Proprioceptive Training on Shoulder's Muscle Mass After Distal Radius Fracture. Randomized Clinical Trial.

Conditions
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Wrist Fractures, Shoulder Pain

Intervention / Treatment
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* Other: Proprioceptive exercises


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult (equal or more than 18 y/o). Suffering a distal radius fracture and being in the first week of the immobilization period. Agree and sign informed consent. Exclusion Criteria: Not had suffered a distal radius fracture and/or not being on the immobilization period. Suffer any mental, cognitive, neurological or musculoskeletal disorder. Previous injury or pathology of the shoulder diagnosed as fractures, instability, shoulder pain or capsulitis. Previous shoulder surgery. Have cervical pathology/impairment.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control group<br>Patients that are undergoing immobilization period after a distal radius fracture. | |
| Experimental: Experimental group<br>Patients that are undergoing immobilization period after a distal radius fracture. | Other: Proprioceptive exercises<br>* Specific proprioceptive exercises for the shoulder that the patient has to do during the immobilization period.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in function related with daily living activities | Measured with QuickDash. 11 items, 0= no disability and 100=total disability | Begining of the injury, baseline, 4 weeks and 3 months | 
| Change in disability related with shoulder | Measured with Shoulder Pain and Disability Index (SPADI). 13 items, with 2 subscales (pain and disability). Pain subscale goes from 0-50 points and disability subscale goes from 0 to 80 points. Total punctuation is expressed as a percentage. More points indicates more disability. | Begining of the injury, baseline, 4 weeks and 3 months | 
| Change in perception of Pain, referred to shoulder | Pain measured with Numerical Rating Scale (NRS). 0= no pain and 10=worst pain. | Begining of the injury, baseline, 4 weeks and 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in range of motion of the shoulder | Active range of motion of the shoulder in all planes of motion | Begining of the injury, baseline, 4 weeks and 3 months | 
| Change in Perception of Quality of life | EuroQol-5D. It has 5 dimensions, mobility, self-care, daily activities, pain and anxiety and depression. Patient determines the level of agreement with the affirmations (3 options). | Begining of the injury, baseline, 4 weeks and 3 months | 
| Change in shoulders muscle load | Electromyographic study of the shoulder's muscles | Begining of the injury, baseline, 4 weeks and 3 months | 
| Changes in catastrophizing pain | Measured with Pain Catastrophizing Scale (PCS).13 items. Total punctuation goes from 0 to 52, where more points means more catastrophism level. | Begining of the injury, baseline, 4 weeks and 3 months | 
| Changes in kinesiophobia, fear of movement | Measured with Tampa Scale for Kinesiophobia (TSK). Punctuation goes from 17 to 68, from 36 points means presence of kinesiophobia. | Begining of the injury, baseline, 4 weeks and 3 months | 
| Changes in fear of movement | Measured with Fear Avoidance Beliefs Q questionnarie (FAB). 16 ítems. Punctuation goes from 0 to 96 points. More points means more fear and avoidance. | Begining of the injury, baseline, 4 weeks and 3 months | 
| Changes in self-efficacy related to pain | Measured with Chronic Pain Self-efficacy Scale (CPSES). 19 items. Punctuation goes from 0 to 60 points. High scores indicate greater levels of confidence in dealing with pain. | Begining of the injury, baseline, 4 weeks and 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Proprioceptive exercises, Function