Evaluation of wrist movement during purposeful activities and wrist exercises after surgery for a wrist fracture

INTERVENTION: The study will employ a crossover study design where participants will participate in two conditions in random order during a single session on the same day. The sessions will be supervised by the primary researcher who is a NZ registered occupational therapist and hand therapist: • Purposeful activity (PA): 10‐minute performance of a self‐selected activity • Active exercise (AE): 10‐minute performance of a set of standard wrist and forearm exercises Participants will have a 60‐minute rest period between conditions. The sessions will be supervised by the primary researcher who is a NZ registered occupational therapist and hand therapist. Purposeful activity (PA) Participants will perform a 10‐minute session of a purposeful activity. The activity will be chosen by the participant from a range of daily activities that are routinely performed between weeks four and eight following surgery. Criteria for activity • Light daily activity • Able to be graded up or down with respect to challenge • Take at least ten minutes to perform • Requires repeated movements of the hand, wrist and forearm to perform • Does not involve immersion in water • Defined according to American Occupational Therapy Association as an activity or occupation with purpose, utility or meaning Examples of such activities include: preparing and consuming a hot drink, preparing a light snack, playing a board game, general household tidying, hanging out laundry, pet care activity, craft, art or light workshop activity Prior to the performance of each condition, participants will be given the same instructions: to perform as much of the activity or set of exercises as desired; to move the wrist as much as possible during the 10 minutes; to put in as CONDITION: Injuries and Accidents ‐ Fractures Physical Medicine / Rehabilitation ‐ Occupational therapy Surgical treatment of distal radius fracture; ; Surgical treatment of distal radius fracture PRIMARY OUTCOME: Total volume of movement: calculated by rectifying the signal and determining the area under the curve for the sum of the wrist extension/flexion, radial/ulna deviation and pronation/supination arcs of motion. Total volume of movement is a measure of movement quantity.; ; A Biometrics twin‐axis goniometer and torsiometer will be used to measure wrist and forearm movements. The validity of these devices has been previously determined. The devices have been widely used in wrist post‐surgical populations and shown to be accurate and reliable for measurement of wrist range of movement, velocity and smoothness. All outcomes will be recorded by Biometrics Ltd analysis software version 11 . Data are sent via a wireless dongle to a computer. [The total volume of movement will be measured for both conditions i.e. for the 10‐minute purposeful activity condition and for the 10‐minute active exercise condition. The two 10‐minute conditions will be performed on the same day.] INCLUSION CRITERIA: • Aged over 18 years • Less than four weeks postoperative • Stable fixation, deemed by surgeon to be suitable for mobilisation • Conversational English SECONDARY OUTCOME: Maximum end range for supination: assessed by electrogoniometry [Maximum end range for supination will be measured for both conditions i.e. for the 10‐minute purposeful activity condition and for the 10‐minute active exercise condition. The two 10‐minute conditions will be performed on the same day.] Maximum end range for ulnar deviation: assessed by electrogoniometry [Maximum end range for ulnar deviation will be measured for both conditions i.e. for the 10‐minute purposeful activity condition and for the 10‐minute active exercise condition. The two 10‐minute conditions will be performed on the same day.] Maximum end range for wrist extension: assessed by electrogoniometry [The maximum end range will be measured for both conditions i.e. for the 10‐minute purposeful activity condition and for the 10‐minute active exercise condition. The two 10‐minute conditions will be performed on the same day.] Movement smoothness will be measured by acceleration data from the electrogoniometers. It will be calculated as the number of zero‐crossings for the flexion/extension and pronation/supination arcs of motion. The zero‐point is whenever acceleration changes from acceleration to deceleration and back again. It shows the number of times that the wrist slows down or speeds up during movement. [Movement smoothness will be measured for both conditions i.e. for the 10‐minute purposeful activity condition and for the 10‐minute active exercise condition. The two 10‐minute conditions will be performed on the same day.] Number of repetitions beyond 10° for supination: assessed by electrogoniometry[The number of repetitions beyond 10° for supination will be measured for both conditions i.e. for the 10‐minute purposeful activity condition and for the 10‐minute active exercise condition. The two 10‐minute conditions will be performed on the same day.] Number of repetitions beyond 10° for ulnar deviation: assessed by electrogoniometry[The number of repetitions beyond 10° for ulnar deviation will be measured for both conditions i.e. for the 10‐minute purposeful activity condition and for the 10‐minute active exercise condition. The two 10‐minute conditions will be performed on the same day.] Number of repetitions beyond 10° for wrist extension: assessed by electrogoniometry[The number of repetitions beyond 10° for wrist extension will be measured for both conditions i.e. for the 10‐minute purposeful activity condition and for the 10‐minute active exercise condition. The two 10‐minute conditions will be performed on the same day.] Total movement duration during the 10 minutes session: calculated from the time when the wrist is not moving (velocity below 1°/s for a continuous period of at least 0.5 s) during the 10‐minute recording session, via the electrogoniometry devices [Movement duration will be measured for both conditions i.e. for the 10‐minute purposeful activity condition and for the 10‐minute active exercise condition. The two 10‐minute conditions will be performed on the same day.]