Optimizing the Composition and Delivery of Assessment and Treatment Following Distal Radius Fracture

Distal radius fracture (DRF) is the most common fracture.1 The most recent Cochrane review indicated “The available evidence from randomized controlled trials is insufficient to establish the relative effectiveness of the various interventions used in the rehabilitation of adults with fractures of the distal radius”.2 Since the relative effectiveness of the various interventions used for rehabilitation after DRF is unknown, the main goal of this thesis is to focus on one aspect of both assessment and treatment to add to the current literature base. The first paper (Chapter 2) describes a new method using a modified finger goniometer (MFG) for measuring forearm rotation, and suggests some potential benefits for using this technique over the currently accepted method. The second paper (Chapter 3) investigates the inter-rater reliability of the MFG method. The MFG method demonstrated excellent inter-rater reliability and compared favorably to the currently accepted method for measuring the forearm. In addition to investigating a new method to optimize assessment following DRF, this thesis also studies common modalities used for treatment. The third paper (Chapter 4) investigates the volumetric changes that occur in the hand with the use of hot packs and whirlpool, which are often used for preconditioning the wrist prior to treatment. The effect of these modalities for improving range of motion (ROM) of the wrist and forearm are reviewed in Chapter 5. Overall, whirlpool was shown to temporarily increase swelling in the hand more than hot pack, but this difference was not evident at the end of each therapy visit. Whirlpool was shown to be more effective for improving ROM of the wrist than hot pack during therapy. In summary, this thesis provides a valuable contribution to the current literature base for rehabilitation after DRF by proposing a new method for measuring forearm rotation, investigating this method’s reliability, and comparing the volumetric and ROM effects of two heat modalities commonly used for treatment. This information can be used as a building block for future research to determine best practice for the treatment of patients with DRF. References 1. JJ FD. Fractures of the Distal Radius. A Practical Approach to Management. 2nd ed. New York: Springer; 2002. 2. Handoll HH, Madhok R, Howe TE. Rehabilitation for distal radial fractures in adults. Cochrane Database Syst Rev. 2006:CD003324