Adding mobilisation with movement to exercise and advice hastens the improvement in range, pain and function after non-operative cast immobilisation for distal radius fracture: a multicentre, randomised trial

Question: Does adding mobilisation with movement (MWM) to usual care (ie, exercises plus advice) improve outcomes after immobilisation for a distal radius fracture? Design: A prospective, multicentre, randomised, clinical trial with concealed allocation, blinding and intention-to-treat analysis. Participants: Sixty-seven adults (76% female, mean age 60 years) treated with casting after distal radius fracture. Intervention: The control group received exercises and advice. The experimental group received the same exercises and advice, plus supination and wrist extension MWM. Outcome measures: The primary outcome was forearm supination at 4 weeks (immediately post-intervention). Secondary outcomes included wrist extension, flexion, pronation, grip strength, QuickDASH (Disabilities of Arm, Shoulder and Hand), Patient-Rated Wrist Evaluation (PRWE) and global rating of change. Follow-up time points were 4 and 12 weeks, with patient-rated measures at 26 and 52 weeks. Results: Compared with the control group, supination was greater in the experimental group by 12 deg (95% CI 5 to 20) at 4 weeks and 8 deg (95% CI 1 to 15) at 12 weeks. Various secondary outcomes were better in the experimental group at 4 weeks: extension (14 deg, 95% CI 7 to 20), flexion (9 deg, 95% CI 4 to 15), QuickDASH (211, 95% CI 218 to 23) and PRWE (213, 95% CI 223 to 24). Benefits were still evident at 12 weeks for supination, extension, flexion and QuickDASH. The experimental group were more likely to rate their global change as ‘improved’ (risk difference 22%, 95% CI 5 to 39). There were no clear benefits in any of the participant-rated measures at 26 and 52 weeks, and no adverse effects. Conclusion: Adding MWM to exercise and advice gives a faster and greater improvement in motion impairments for non-operative management of distal radius fracture