Digital media therapy for distal radius fractures may improve functional outcomes
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Patients with distal radius fractures who received digital media therapy after volar open reduction and internal fixation had significant improvements in functional outcomes in the early rehabilitation period compared with patients who underwent traditional therapy, according to results.
Taylor R. Lara, MD, and colleagues randomly assigned 51 patients who underwent volar open reduction and internal fixation for distal radius fractures to receive either face-to-face hand therapy using a 12-week protocol or hand therapy via digital videos performed at home without the aid of a hand therapist. Researchers considered QuickDASH scores collected at 2, 6 and 12 weeks or greater postoperatively as the primary outcome, while VAS scores and Veterans RAND 12-item Health Survey (VR-12) were considered secondary outcomes.
Results of the Wilcoxon Rank Sum analysis showed no differences in postoperative baseline QuickDASH scores between the face-to-face and digital media hand therapy groups. Although patients in the digital media group had a greater median improvement from baseline QuickDASH scores at 6 weeks postoperatively, researchers found no differences in QuickDASH scores or improvement from baseline at 12 weeks or more postoperatively. Results showed patients in the digital media group had significantly better least square mean QuickDASH scores at 6 weeks postoperatively, but there were no differences at baseline and 12 weeks or more postoperatively compared with the face-to-face hand therapy group. Researchers noted no significant differences in VAS or VR-12 scores between the two groups.
“Patients undergoing self-directed hand therapy guided by digital videos after volar plating of distal radius fractures had equal or better patient-reported outcomes and wrist range of motion as patients who underwent traditional, face-to-face therapy,” Lara, a fifth-year orthopedic surgery resident at Oregon Health and Science University, told Healio Orthopedics. “This method of delivering hand therapy has the potential to increase value and access to care.” – by Casey Tingle
Reference:
Lara TR, et al. ePaper 463. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
Disclosure: Lara reports no relevant financial disclosures.
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David Ring, MD, PhD
I once did a trial that found people do well when the surgeon shows them how to do exercises after volar plate fixation of a distal radius fracture. That data fit my sense that recovery of motion and function is fairly straightforward. The key seems to be guiding people through the counterintuitive aspects of recovery. It hurts to use and stretch the hand and wrist, and that tends to feel like it’s doing harm rather than good. Patients with less cognitive bias that “hurt equals harm” find it easier to recover from volar plate fixation of a distal radius fracture.
Taylor R. Lara, MD, and colleagues also found that people do well with independent exercises. They gave people a set of videos for their computer that directed recovery over the first 12 weeks after surgery. People who managed recovery on their own, informed by the videos, had comparable pain intensity and magnitude of self-reported activity limitations. They noted a relative benefit to independent exercises at 6 weeks, but that might be spurious. On the other hand, taking ownership for one’s recovery might neutralize unhelpful cognitive biases regarding pain, which could speed recovery.
If I’m a surgeon, hand therapist or person planning for my future distal radius fracture surgery, I take these collective data to mean that I should get some tips about how to do stretches, that the will be relatively easy to do, and that the difficult part will be to train my mind to see that stretch pain as healthy.
Professor of surgery and psychiatry
The University of Texas at Austin
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Lara TR, et al. ePaper 463. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
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