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Meta-Analysis
. 2015 Sep 25;2015(9):CD003324.
doi: 10.1002/14651858.CD003324.pub3.

Rehabilitation for distal radial fractures in adults

Helen H G Handoll  1 , Joanne Elliott
Affiliations
Meta-Analysis

Rehabilitation for distal radial fractures in adults

Helen H G Handoll et al. Cochrane Database Syst Rev. .

Abstract

Background: Fracture of the distal radius is a common clinical problem, particularly in older people with osteoporosis. There is considerable variation in the management, including rehabilitation, of these fractures. This is an update of a Cochrane review first published in 2002 and last updated in 2006.

Objectives: To examine the effects of rehabilitation interventions in adults with conservatively or surgically treated distal radial fractures.

Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL 2014; Issue 12), MEDLINE, EMBASE, CINAHL, AMED, PEDro, OTseeker and other databases, trial registers, conference proceedings and reference lists of articles. We did not apply any language restrictions. The date of the last search was 12 January 2015.

Selection criteria: Randomised controlled trials (RCTs) or quasi-RCTs evaluating rehabilitation as part of the management of fractures of the distal radius sustained by adults. Rehabilitation interventions such as active and passive mobilisation exercises, and training for activities of daily living, could be used on their own or in combination, and be applied in various ways by various clinicians.

Data collection and analysis: The review authors independently screened and selected trials, and reviewed eligible trials. We contacted study authors for additional information. We did not pool data.

Main results: We included 26 trials, involving 1269 mainly female and older patients. With few exceptions, these studies did not include people with serious fracture or treatment-related complications, or older people with comorbidities and poor overall function that would have precluded trial participation or required more intensive treatment. Only four of the 23 comparisons covered by these 26 trials were evaluated by more than one trial. Participants of 15 trials were initially treated conservatively, involving plaster cast immobilisation. Initial treatment was surgery (external fixation or internal fixation) for all participants in five trials. Initial treatment was either surgery or plaster cast alone in six trials. Rehabilitation started during immobilisation in seven trials and after post-immobilisation in the other 19 trials. As well as being small, the majority of the included trials had methodological shortcomings and were at high risk of bias, usually related to lack of blinding, that could affect the validity of their findings. Based on GRADE criteria for assessment quality, we rated the evidence for each of the 23 comparisons as either low or very low quality; both ratings indicate considerable uncertainty in the findings.For interventions started during immobilisation, there was very low quality evidence of improved hand function for hand therapy compared with instructions only at four days after plaster cast removal, with some beneficial effects continuing one month later (one trial, 17 participants). There was very low quality evidence of improved hand function in the short-term, but not in the longer-term (three months), for early occupational therapy (one trial, 40 participants), and of a lack of differences in outcome between supervised and unsupervised exercises (one trial, 96 participants).Four trials separately provided very low quality evidence of clinically marginal benefits of specific interventions applied in addition to standard care (therapist-applied programme of digit mobilisation during external fixation (22 participants); pulsed electromagnetic field (PEMF) during cast immobilisation (60 participants); cyclic pneumatic soft tissue compression using an inflatable cuff placed under the plaster cast (19 participants); and cross-education involving strength training of the non-fractured hand during cast immobilisation with or without surgical repair (39 participants)).For interventions started post-immobilisation, there was very low quality evidence from one study (47 participants) of improved function for a single session of physiotherapy, primarily advice and instructions for a home exercise programme, compared with 'no intervention' after cast removal. There was low quality evidence from four heterogeneous trials (30, 33, 66 and 75 participants) of a lack of clinically important differences in outcome in patients receiving routine physiotherapy or occupational therapy in addition to instructions for home exercises versus instructions for home exercises from a therapist. There was very low quality evidence of better short-term hand function in participants given physiotherapy than in those given either instructions for home exercises by a surgeon (16 participants, one trial) or a progressive home exercise programme (20 participants, one trial). Both trials (46 and 76 participants) comparing physiotherapy or occupational therapy versus a progressive home exercise programme after volar plate fixation provided low quality evidence in favour of a structured programme of home exercises preceded by instructions or coaching. One trial (63 participants) provided very low quality evidence of a short-term, but not persisting, benefit of accelerated compared with usual rehabilitation after volar plate fixation.For trials testing single interventions applied post-immobilisation, there was very low quality evidence of no clinically significant differences in outcome in patients receiving passive mobilisation (69 participants, two trials), ice (83 participants, one trial), PEMF (83 participants, one trial), PEMF plus ice (39 participants, one trial), whirlpool immersion (24 participants, one trial), and dynamic extension splint for patients with wrist contracture (40 participants, one trial), compared with no intervention. This finding applied also to the trial (44 participants) comparing PEMF versus ice, and the trial (29 participants) comparing manual oedema mobilisation versus traditional oedema treatment. There was very low quality evidence from single trials of a short-term benefit of continuous passive motion post-external fixation (seven participants), intermittent pneumatic compression (31 participants) and ultrasound (38 participants).

Authors' conclusions: The available evidence from RCTs is insufficient to establish the relative effectiveness of the various interventions used in the rehabilitation of adults with fractures of the distal radius. Further randomised trials are warranted. However, in order to optimise research effort and engender the large multicentre randomised trials that are required to inform practice, these should be preceded by research that aims to identify priority questions.

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Conflict of interest statement

None known.

Figures

1
1
Study flow diagram for updated review
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Early (during immobilisation) occupational or hand therapy versus no intervention (control), Outcome 1 Meeting criteria for attendance of post‐immobilisation hand therapy group.
1.2
1.2. Analysis
Comparison 1 Early (during immobilisation) occupational or hand therapy versus no intervention (control), Outcome 2 Grip strength (kg) at 4 weeks (post‐immobilisation).
1.3
1.3. Analysis
Comparison 1 Early (during immobilisation) occupational or hand therapy versus no intervention (control), Outcome 3 Range of motion at 4 weeks (post‐immobilisation).
1.4
1.4. Analysis
Comparison 1 Early (during immobilisation) occupational or hand therapy versus no intervention (control), Outcome 4 Oedema (mL) at 4 weeks (post‐immobilisation).
1.5
1.5. Analysis
Comparison 1 Early (during immobilisation) occupational or hand therapy versus no intervention (control), Outcome 5 Any pain at rest at 4 weeks (post‐immobilisation).
1.6
1.6. Analysis
Comparison 1 Early (during immobilisation) occupational or hand therapy versus no intervention (control), Outcome 6 Finger mobility at 4 weeks (post‐immobilisation).
1.7
1.7. Analysis
Comparison 1 Early (during immobilisation) occupational or hand therapy versus no intervention (control), Outcome 7 Complications.
2.1
2.1. Analysis
Comparison 2 Cyclic pneumatic soft tissue compression during immobilisation versus no intervention (control), Outcome 1 Grip strength (kg).
2.2
2.2. Analysis
Comparison 2 Cyclic pneumatic soft tissue compression during immobilisation versus no intervention (control), Outcome 2 Pinch strength (kg).
2.3
2.3. Analysis
Comparison 2 Cyclic pneumatic soft tissue compression during immobilisation versus no intervention (control), Outcome 3 Range of motion (degrees).
3.1
3.1. Analysis
Comparison 3 Early (during external fixation) digit mobilisation programme versus no intervention (control), Outcome 1 Manual Ability Measure‐36 ‐ Taiwan version 45 questions (36 to 180: best result).
3.2
3.2. Analysis
Comparison 3 Early (during external fixation) digit mobilisation programme versus no intervention (control), Outcome 2 Grip, pinch and 'three jaw chuck' pinch strengths (% of uninvolved hand).
3.3
3.3. Analysis
Comparison 3 Early (during external fixation) digit mobilisation programme versus no intervention (control), Outcome 3 Range of motion (% of other hand).
4.1
4.1. Analysis
Comparison 4 Pulsed electromagnetic field (PEMF) (during cast immobilisation) versus no intervention (control), Outcome 1 PRWE scores at 2 to 3 days after cast removal.
4.2
4.2. Analysis
Comparison 4 Pulsed electromagnetic field (PEMF) (during cast immobilisation) versus no intervention (control), Outcome 2 Range of motion at day 2 to 3 after cast removal.
4.3
4.3. Analysis
Comparison 4 Pulsed electromagnetic field (PEMF) (during cast immobilisation) versus no intervention (control), Outcome 3 Hand oedema: difference between hands in circumference (mm).
4.4
4.4. Analysis
Comparison 4 Pulsed electromagnetic field (PEMF) (during cast immobilisation) versus no intervention (control), Outcome 4 Complications.
5.1
5.1. Analysis
Comparison 5 Cross‐education (strengthening exercises for opposite hand) versus no intervention (control), Outcome 1 Patient‐Rated Wrist Evaluation (PRWE) (0 to 150: worst results).
5.2
5.2. Analysis
Comparison 5 Cross‐education (strengthening exercises for opposite hand) versus no intervention (control), Outcome 2 Grip strength of fractured hand (kg).
5.3
5.3. Analysis
Comparison 5 Cross‐education (strengthening exercises for opposite hand) versus no intervention (control), Outcome 3 Range of motion: supination/pronation (degrees).
5.4
5.4. Analysis
Comparison 5 Cross‐education (strengthening exercises for opposite hand) versus no intervention (control), Outcome 4 Range of motion: flexion/extension (degrees).
6.1
6.1. Analysis
Comparison 6 Physiotherapy (one session for home exercises) versus no intervention (control) (post‐immobilisation), Outcome 1 PRWE scores at 3 and 6 weeks.
6.2
6.2. Analysis
Comparison 6 Physiotherapy (one session for home exercises) versus no intervention (control) (post‐immobilisation), Outcome 2 QuickDASH scores at 3 and 6 weeks.
6.3
6.3. Analysis
Comparison 6 Physiotherapy (one session for home exercises) versus no intervention (control) (post‐immobilisation), Outcome 3 Grip strength (kg) at 3 and 6 weeks.
6.4
6.4. Analysis
Comparison 6 Physiotherapy (one session for home exercises) versus no intervention (control) (post‐immobilisation), Outcome 4 Range of motion at 6 weeks (degrees).
6.5
6.5. Analysis
Comparison 6 Physiotherapy (one session for home exercises) versus no intervention (control) (post‐immobilisation), Outcome 5 Change in range of motion at 6 weeks (degrees).
6.6
6.6. Analysis
Comparison 6 Physiotherapy (one session for home exercises) versus no intervention (control) (post‐immobilisation), Outcome 6 Complications.
6.7
6.7. Analysis
Comparison 6 Physiotherapy (one session for home exercises) versus no intervention (control) (post‐immobilisation), Outcome 7 Request for more physiotherapy.
7.1
7.1. Analysis
Comparison 7 Post‐immobilisation occupational or physiotherapy versus no intervention (control), Outcome 1 Patient‐Rated Wrist Evaluation (PRWE) at 24 weeks (%: 100% = worst results).
7.2
7.2. Analysis
Comparison 7 Post‐immobilisation occupational or physiotherapy versus no intervention (control), Outcome 2 Activities of daily living scores (% of unaffected side).
7.3
7.3. Analysis
Comparison 7 Post‐immobilisation occupational or physiotherapy versus no intervention (control), Outcome 3 Grip strength (kg).
7.4
7.4. Analysis
Comparison 7 Post‐immobilisation occupational or physiotherapy versus no intervention (control), Outcome 4 Grip strength (% of unaffected side).
7.5
7.5. Analysis
Comparison 7 Post‐immobilisation occupational or physiotherapy versus no intervention (control), Outcome 5 Pain (VAS: none to worst imaginable at 10 cm).
7.6
7.6. Analysis
Comparison 7 Post‐immobilisation occupational or physiotherapy versus no intervention (control), Outcome 6 Range of motion at 24 weeks.
7.7
7.7. Analysis
Comparison 7 Post‐immobilisation occupational or physiotherapy versus no intervention (control), Outcome 7 Range of motion (% of unaffected side) at 3 months.
7.8
7.8. Analysis
Comparison 7 Post‐immobilisation occupational or physiotherapy versus no intervention (control), Outcome 8 Range of motion (% of unaffected side) at 6 months.
7.9
7.9. Analysis
Comparison 7 Post‐immobilisation occupational or physiotherapy versus no intervention (control), Outcome 9 Number of treatments.
7.10
7.10. Analysis
Comparison 7 Post‐immobilisation occupational or physiotherapy versus no intervention (control), Outcome 10 Complications.
8.1
8.1. Analysis
Comparison 8 Continuous passive motion (CPM) (post‐external fixation) versus no intervention (control), Outcome 1 Time to recover independence (weeks).
9.1
9.1. Analysis
Comparison 9 Pulsed electromagnetic field (PEMF) (post‐immobilisation) versus sham control, Outcome 1 Pain and volume at day 5.
9.2
9.2. Analysis
Comparison 9 Pulsed electromagnetic field (PEMF) (post‐immobilisation) versus sham control, Outcome 2 Range of motion at day 5.
10.1
10.1. Analysis
Comparison 10 Ice (post‐immobilisation) versus no ice (control), Outcome 1 Pain and volume at day 5.
10.2
10.2. Analysis
Comparison 10 Ice (post‐immobilisation) versus no ice (control), Outcome 2 Range of motion at day 5.
11.1
11.1. Analysis
Comparison 11 Pulsed electromagnetic field (PEMF) plus ice (post‐immobilisation) versus no intervention (control), Outcome 1 Pain and volume at day 5.
11.2
11.2. Analysis
Comparison 11 Pulsed electromagnetic field (PEMF) plus ice (post‐immobilisation) versus no intervention (control), Outcome 2 Range of motion at day 5.
12.1
12.1. Analysis
Comparison 12 Passive mobilisation (post‐immobilisation) versus no intervention (control), Outcome 1 Grip strength (kg) at 6 weeks.
12.2
12.2. Analysis
Comparison 12 Passive mobilisation (post‐immobilisation) versus no intervention (control), Outcome 2 Range of motion at 6 weeks.
12.3
12.3. Analysis
Comparison 12 Passive mobilisation (post‐immobilisation) versus no intervention (control), Outcome 3 Web space angle (degrees) at 6 weeks.
12.4
12.4. Analysis
Comparison 12 Passive mobilisation (post‐immobilisation) versus no intervention (control), Outcome 4 Wrist extension at discharge (4 weeks).
12.5
12.5. Analysis
Comparison 12 Passive mobilisation (post‐immobilisation) versus no intervention (control), Outcome 5 Number of treatments.
12.6
12.6. Analysis
Comparison 12 Passive mobilisation (post‐immobilisation) versus no intervention (control), Outcome 6 Time to discharge (days).
12.7
12.7. Analysis
Comparison 12 Passive mobilisation (post‐immobilisation) versus no intervention (control), Outcome 7 Complications at 6 weeks.
13.1
13.1. Analysis
Comparison 13 Low frequency, long‐wave ultrasound (post‐immobilisation) versus sham intervention, Outcome 1 Greater than 30% loss of wrist motion (flexion‐extension) at 8 weeks.
13.2
13.2. Analysis
Comparison 13 Low frequency, long‐wave ultrasound (post‐immobilisation) versus sham intervention, Outcome 2 Referral for physiotherapy.
14.1
14.1. Analysis
Comparison 14 Whirlpool (post‐immobilisation) versus towel (control), Outcome 1 Grip strength at end of treatment (kg).
14.2
14.2. Analysis
Comparison 14 Whirlpool (post‐immobilisation) versus towel (control), Outcome 2 Pain (scale 0: no pain to 5: excruciating) at end of treatment.
14.3
14.3. Analysis
Comparison 14 Whirlpool (post‐immobilisation) versus towel (control), Outcome 3 Range of motion at end of treatment.
14.4
14.4. Analysis
Comparison 14 Whirlpool (post‐immobilisation) versus towel (control), Outcome 4 Finger flexion at end of treatment.
14.5
14.5. Analysis
Comparison 14 Whirlpool (post‐immobilisation) versus towel (control), Outcome 5 Oedema (ml).
15.1
15.1. Analysis
Comparison 15 Dynamic wrist extension splint versus no intervention (control) (post‐immobilisation), Outcome 1 Patient‐Rated Wrist Evaluation (PRWE) (%: 100% = worst results).
15.2
15.2. Analysis
Comparison 15 Dynamic wrist extension splint versus no intervention (control) (post‐immobilisation), Outcome 2 Canadian Occupational Performance Measure at 12 weeks.
15.3
15.3. Analysis
Comparison 15 Dynamic wrist extension splint versus no intervention (control) (post‐immobilisation), Outcome 3 Range of motion at 12 weeks.
16.1
16.1. Analysis
Comparison 16 Post‐immobilisation physiotherapy versus instructions from physician, Outcome 1 Wrist extension (degrees) at 6 weeks.
17.1
17.1. Analysis
Comparison 17 Pulsed electromagnetic field (PEMF) versus ice (post‐immobilisation), Outcome 1 Pain and volume at day 5.
17.2
17.2. Analysis
Comparison 17 Pulsed electromagnetic field (PEMF) versus ice (post‐immobilisation), Outcome 2 Range of motion at day 5.
18.1
18.1. Analysis
Comparison 18 'Manual Edema Mobilization' (MEM) versus 'traditional' oedema treatment, Outcome 1 Canadian Occupational Performance Measure at 9 weeks (clinically important improvement).
18.2
18.2. Analysis
Comparison 18 'Manual Edema Mobilization' (MEM) versus 'traditional' oedema treatment, Outcome 2 Pain (VAS: 0 to 100: worst pain).
18.3
18.3. Analysis
Comparison 18 'Manual Edema Mobilization' (MEM) versus 'traditional' oedema treatment, Outcome 3 Complications.
18.4
18.4. Analysis
Comparison 18 'Manual Edema Mobilization' (MEM) versus 'traditional' oedema treatment, Outcome 4 Number of occupational therapy sessions.
18.5
18.5. Analysis
Comparison 18 'Manual Edema Mobilization' (MEM) versus 'traditional' oedema treatment, Outcome 5 Receiving oedema treatment after scheduled period.
18.6
18.6. Analysis
Comparison 18 'Manual Edema Mobilization' (MEM) versus 'traditional' oedema treatment, Outcome 6 Oedema: volume difference between injured and non‐injured side (mL).
19.1
19.1. Analysis
Comparison 19 Supervised training by physiotherapist versus instructions by physician (from definitive treatment), Outcome 1 Strength and power at 12 weeks.
19.2
19.2. Analysis
Comparison 19 Supervised training by physiotherapist versus instructions by physician (from definitive treatment), Outcome 2 Range of motion at 12 weeks.
20.1
20.1. Analysis
Comparison 20 Physiotherapy/occupational therapy versus home exercise programme (post‐surgery), Outcome 1 PRWE scores at 6 weeks (0: normal to 150: worst outcome).
20.2
20.2. Analysis
Comparison 20 Physiotherapy/occupational therapy versus home exercise programme (post‐surgery), Outcome 2 DASH score (0 to 100: higher scores = worse upper‐extremity function).
20.3
20.3. Analysis
Comparison 20 Physiotherapy/occupational therapy versus home exercise programme (post‐surgery), Outcome 3 Mayo wrist score (0 to 100: higher scores = best functional outcome).
20.4
20.4. Analysis
Comparison 20 Physiotherapy/occupational therapy versus home exercise programme (post‐surgery), Outcome 4 Pain at rest (VAS: 0 to 10: worst pain).
20.5
20.5. Analysis
Comparison 20 Physiotherapy/occupational therapy versus home exercise programme (post‐surgery), Outcome 5 Grip strength (kg).
20.6
20.6. Analysis
Comparison 20 Physiotherapy/occupational therapy versus home exercise programme (post‐surgery), Outcome 6 Pinch strength (kg).
20.7
20.7. Analysis
Comparison 20 Physiotherapy/occupational therapy versus home exercise programme (post‐surgery), Outcome 7 Range of motion at 3 months.
20.8
20.8. Analysis
Comparison 20 Physiotherapy/occupational therapy versus home exercise programme (post‐surgery), Outcome 8 Range of motion at 6 months.
20.9
20.9. Analysis
Comparison 20 Physiotherapy/occupational therapy versus home exercise programme (post‐surgery), Outcome 9 Complications.
21.1
21.1. Analysis
Comparison 21 Accelerated (start 2 weeks) versus usual (start 6 weeks) rehabilitation post‐surgery, Outcome 1 DASH score (0 to 100: higher scores = worse upper‐extremity function).
21.2
21.2. Analysis
Comparison 21 Accelerated (start 2 weeks) versus usual (start 6 weeks) rehabilitation post‐surgery, Outcome 2 Grip strength (lb).
21.3
21.3. Analysis
Comparison 21 Accelerated (start 2 weeks) versus usual (start 6 weeks) rehabilitation post‐surgery, Outcome 3 Pinch strength (lb).
21.4
21.4. Analysis
Comparison 21 Accelerated (start 2 weeks) versus usual (start 6 weeks) rehabilitation post‐surgery, Outcome 4 Range of motion at 12 weeks.
21.5
21.5. Analysis
Comparison 21 Accelerated (start 2 weeks) versus usual (start 6 weeks) rehabilitation post‐surgery, Outcome 5 Range of motion at 6 months.
21.6
21.6. Analysis
Comparison 21 Accelerated (start 2 weeks) versus usual (start 6 weeks) rehabilitation post‐surgery, Outcome 6 Complications.
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Update of

References

References to studies included in this review

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Toomey 1986 {published data only}
    1. Toomey R, Grief Schwartz R, Piper MC. Clinical evaluation of the effects of whirlpool on patients with Colles' fractures. Physiotherapy Canada 1986;38(5):280‐4.
Wakefield 2000 {published and unpublished data}
    1. Wakefield AE, McQueen MM. The role of physiotherapy and clinical predictors of outcome after fracture of the distal radius. Journal of Bone and Joint Surgery ‐ British Volume 2000;82(7):972‐6. - PubMed
Watt 2000 {published and unpublished data}
    1. Watt CF, Taylor NF, Baskus K. Do Colles' fracture patients benefit from routine referral to physiotherapy following cast removal?. Archives of Orthopaedic and Traumatic Surgery 2000;120(7‐8):413‐5. - PubMed

References to studies excluded from this review

ACTRN12606000160538 {unpublished data only}
    1. Goldbloom D, Blackmore S. Aggressive mobilisation following fragment specific fixation of distal radius fractures. www.anzctr.org.au/ACTRN12606000160538.aspx (accessed 12 February 2015).
Ayhan 2014 {published data only}
    1. Ayhan C, Unal E, Yahut Y. Core stabilisation reduces compensatory movement patterns in patients with injury to the arm: a randomized controlled trial. Clinical Rehabilitation 2014;28(1):36‐47. - PubMed
Bünger 2011 {published data only}
    1. Bünger A, Krägenow H. Concept of a randomized controlled pilot study on the "effectiveness of mirror therapy in distal radius fracture" [Erfahrungsbericht über die Planung und Durchführung einer randomisiert‐kontrollierten Pilotstudie zur Thematik "Wirksamkeit der Spiegeltherapie bei distaler Radiusfraktur"]. Ergoscience 2011;4:194‐6.
Can 2001 {published data only}
    1. Can F. [personal communication] 17 January 2003.
    1. Can F, Erden Z, Yuceturk A. The effect of manual therapy in the rehabilitation of distal radius fractures [Turkish]. Fizyoterapi Rehabilitasyon 2001;12(3):99‐104.
Coyle 1998 {published data only}
    1. Coyle JA, Robertson VJ. Comparison of two passive mobilizing techniques following Colles' fracture: a multi‐element design. Manual Therapy 1998;3(1):34‐41. - PubMed
Haren 2000 {published data only}
    1. Haren K, Backman C, Wiberg M. Effect of manual lymph drainage as described by Vodder on oedema of the hand after fracture of the distal radius: A prospective clinical study. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery 2000;34(4):367‐72. - PubMed
Haren 2004 {published data only}
    1. Haren K, Wiberg M. A prospective randomized controlled trial of manual lymph drainage (MLD) for the reduction of hand oedema distal radius fracture. British Journal of Hand Therapy 2006;11(2):41‐7.
    1. Haren K, Wiberg M. The effect of manual lymph drainage on oedema of the hand after fracture of the distal radius [abstract]. British Journal of Hand Therapy 2004;9(2):55‐6.
Hunt 2001 {published and unpublished data}
    1. Hunt J. Evaluation of a functional treatment programme for patients following a fractured distal radius: a pilot study. In: The National Research Register, Issue 1, 2001. Oxford: Update Software.
Jarvis 2001 {published and unpublished data}
    1. Jarvis RE. Comparison of treatments for Colles fracture. In: The National Research Register, Issue 1, 2001. Oxford: Update Software.
Kingston 2014 {published and unpublished data}
    1. Kingston G, Gray M. A clinical trial to investigate whether providing a home exercise program on DVD improves compliance with patients who have hand injuries. www.anzctr.org.au/ACTRN12608000530325.aspx (accessed 15 February 2015).
    1. Kingston GA, Williams G, Gray MA, Judd J. Does a DVD improve compliance with home exercise programs for people who have sustained a traumatic hand injury? Results of a feasibility study. Disability and Rehabilitation: Assistive Technology 2014;9(3):188‐94. - PubMed
Lohstrater 2006 {published data only}
    1. Lohstrater A, Bak P. Efficiency and cost‐effectiveness of the rehabilitation management of the VBG in patients after distal radius fracture [Medizinische und ”konomische effizienz des reha‐managements der VBG bei patienten nach distaler radiusfraktur]. Physikalische Medizin Rehabilitationsmedizin Kurortmedizin 2006;16(3):155‐9.
Naik 2007 {published data only}
    1. Chitra J. [personal correspondence] 3 March 2013.
    1. Naik VC, Chitra J, Khatri S. Effectiveness of Maitland versus Mulligan mobilization technique following post surgical management of colles' ‐ fracture ‐ RCT. Indian Journal of Physiotherapy and Occupational Therapy 2007;1(4):14‐8.
Neeman 1988 {published data only}
    1. Neeman RL. Orthokinetic orthoses application in treatment of patients with Colles' fracture post‐immobilization hypokinesia: A single‐subject design efficacy study. Physiotherapy Canada 1988;40(5):286‐95.
Nikolova 1969 {published data only}
    1. Nikolova L. Physical therapy in the rehabilitation of bone fracture complications [Physiotherapeutische rehabilitation bei knochenbruchkomplikationen]. Munchener Medizinische Wochenschrift 1969;111(11):592‐9. - PubMed
Oskarsson 1997 {published data only}
    1. Oskarsson GV, Hjall A, Aaser P. Physiotherapy: an overestimated factor in after‐treatment of fractures in the distal radius?. Archives of Orthopaedic and Trauma Surgery 1997;116(6‐7):373‐5. - PubMed
Pasila 1980 {published data only}
    1. Pasila M, Sundholm A. Mobilization of stiff hands after 104 Colles' fractures: a comparison between the value of the Movelat and its base cream. Rheumatology and Rehabilitation 1980;19(3):170‐2. - PubMed
Ramesh 1998 {published data only}
    1. Ramesh M, Morrissey B, Healy JB, Roy‐Choudhury S, Macey AC. Effectiveness of the A‐V impulse hand pump. Journal of Bone and Joint Surgery ‐ British Volume 1999;81(2):229‐33. - PubMed
    1. Ramesh M, Morrissey B, Roy‐Choudhury S, Ajaml M, Healy JB, Macey AC. Effectiveness of the A.V. impulse hand pump [abstract]. Journal of Bone and Joint Surgery ‐ British Volume 1998;80 Suppl 1:69. - PubMed
Rodrick 2004 {published data only}
    1. Rodrick JR, Howard S. Sub‐acute edema reduction in patients with wrist disorders: a pilot study comparing the effectiveness of traditional retrograde massage versus manual edema mobilization [abstract]. British Journal of Hand Therapy 2004;9(2):54‐5.
Schwartz‐Jensen 2002 {published data only}
    1. Schwartz Jensen K. Pilot study of the effect of individual occupational therapy given to patients with a distal radial fracture during the immobilization period [abstract]. Journal of Hand Surgery ‐ British Volume 2002;27 Suppl 1:70.
Wang 2012 {published data only}
    1. Wang GJ, Liu J. Clinical randomized controlled trial on ultrashort wave and magnetic therapy for the treatment of early stage distal radius fractures [Chinese]. Zhongguo Gushang 2012;25(7):572‐5. - PubMed
Woodbridge 2003 {unpublished data only}
    1. Woodbridge S. [personal communication] 23 February 2004.
    1. Woodbridge S. [personal communication] 23 January 2003.
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Zhang 2005 {published data only}
    1. Zhang H‐F, Wang J‐B, Zhao Q‐L, Yang S‐P, Zhao M‐J. Effect of gripping exercise on the radius bone mass of patients with Colles fracture. Zhongguo Linchuang Kangfu [Chinese Journal of Clinical Rehabilitation] 2005;9(8):136‐7.

References to studies awaiting assessment

Duvoric 2005 {published data only}
    1. Durovic A, Zivotic‐Vanovic M, Railic Z. Effects of circumferential rigid wrist orthoses in rehabilitation of patients with radius fracture at typical site [Serbian]. Vojnosanitetski Pregled: Military Medical and Pharmaceutical Review 2005;62(4):257‐64. - PubMed
McPhate 1998 {published data only}
    1. Brock KA. [personal communication] 5 December 2005.
    1. Kay S. [personal communication] 27 October 2005.
    1. McPhate M, Robertson VJ. Passive mobilisation in the physiotherapy treatment of Colles fracture [abstract]. Proceedings of the Tenth Biennial Conference of the Manipulative Physiotherapists Association of Australia; 1987 Nov 26‐29; Melbourne (Australia). St Kilda, Victoria, Australia: Manipulative Physiotherapists Association of Australia, 1997:121‐2.
    1. McPhate M, Robertson VJ. Physiotherapy treatment of Colles fractures: hands off or hands on [abstract]. Proceedings of the Fifth International Australian Physiotherapy Association Congress; 1998 May 11; Hobart (Australia). 1998:235.
NCT00816998 {unpublished data only}
    1. Shin AY. Range of motion and patients with distal radius fractures. https://clinicaltrials.gov/show/NCT00816998 (accessed 15 February 2015).
NCT01262807 {unpublished data only}
    1. Dubberley J, Leiter J, Wittmeier K. Reducing range of motion deficits post radial fracture. https://clinicaltrials.gov/ct2/show/NCT01262807 (accessed 2 March 2015).
NCT01589627 {unpublished data only}
    1. Berner S. Wrist Extension Dynasplint (WED) distal radius fracture. https://clinicaltrials.gov/show/NCT01589627 (accessed 12 February 12).
Oken 2011 {published data only}
    1. Oken O, Cecel E, Oken FO, Yorgancioglu RZ. Hospital‐based versus home‐based program in rehabilitation of distal radius fractures. Turkish Journal of Physical Medicine & Rehabilitation/Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi 2011;57(3):139‐42.
Schmidt 2013 {published data only}
    1. Schmidt J, Tessmann UJ, Schmidt I. Compression glove has advantages in the functional aftercare of distal radius fractures [Der Kompressionshandschuh hat Vorteile in der funktionellen Nachbehandlung der distalen Radiusfraktur]. Zeitschrift fur Orthopadie und Unfallchirurgie 2013;151(1):80‐4. - PubMed

References to ongoing studies

ACTRN12612000118808 {unpublished data only}
    1. Bruder A. Does exercise following distal radius fracture improve activity? A multi‐centre randomised controlled trial. http://www.anzctr.org.au/ACTRN12612000118808.aspx (accessed 12 February 2015).
JPRN‐UMIN000015003 {unpublished data only}
    1. Gamo K. Effectiveness of occupational therapy after volar locking plate fixation of the distal radius fracture. A prospective randomized controlled trial. http://apps.who.int/trialsearch/Trial2.aspx?TrialID=JPRN‐UMIN000015003 (accessed 15 February 2015).
NCT01118715 {unpublished data only}
    1. Harris L, Cole A, Monroe P, Chancey J, Shuler M. Compression glove may reduce complications secondary to distal radius fracture (abstract). Journal of Hand Therapy 2011;24(4):383‐4.
    1. Schuler M. [personal communication] 1 June 2015.
    1. Schuler M. Use of compression glove to prevent complications after distal radius fractures: a randomized controlled trial. https://clinicaltrials.gov/show/NCT01118715 (accessed February 12 2015).
NCT01394809 {unpublished data only}
    1. Korbus H, Schott N. Effects of motor cognitive training on functional loss after osteoporotic wrist fractures (PROFinD‐TP4). http://clinicaltrials.gov/show/NCT01394809 (accessed 3 August 2013).
    1. Schott N, Korbus H. Preventing functional loss during immobilization after osteoporotic wrist fractures in elderly patients: a randomized clinical trial. BMC Musculoskeletal Disorders 2014;15:287. - PMC - PubMed
NCT01518179 {unpublished data only}
    1. Bernfeld B, Milman U, Schreuer N, Miler I. Compression gloves for distal radius fracture. https://clinicaltrials.gov/show/NCT01518179 (accessed 12 February 2015).
NCT01693094 {unpublished data only}
    1. Ring D. A randomized trial measuring the effect of decision aids on patients' satisfaction, conflict of decision‐making and clinical outcome. https://clinicaltrials.gov/show/NCT01693094 (accessed 12 February 2015).
NCT01921062 {unpublished data only}
    1. Broekstra DC, Stenekes MW. Motor imagery in rehabilitation after a distal radius fracture (MIDRF). https://clinicaltrials.gov/show/NCT01921062 (accessed 12 February 2015).
NCT02015468 {unpublished data only}
    1. Hammer O‐L, Madsen JE. The value of early mobilization and physiotherapy following wrist fractures treated by volar plating. https://clinicaltrials.gov/show/NCT02015468 (accessed 12 February 2015).

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References to other published versions of this review

Handoll 2002
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Handoll 2003d
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