Effects of mobilisation with movement in participants with distal radius fracture: A randomised controlled trial.

INTERVENTION: The intervention group will receive four standard physiotherapy consultations (approximately 20‐30 minutes each) over four weeks. These sessions will commence within one week of removal of the plaster. A participant will receive two intervention sessions within the first week, session 3 will occur one week after session 2, session 4 will occur two weeks after session 3. The treatment will be Mulligan mobilisation with movement (MWM) into the direction used to increase supination of the forearm and extension of the wrist. In addition to the therapist intervention, the participant will be taught at the first session to to do self‐MWMs x 6 for forearm supination and wrist extension at home, twice a day (duration 6 minutes). They will also receive instructions by the physiotherapist to perform range of motion (ROM) exercises for the wrist (flexion, extension, pronation/supination arc), elbow (flexion/extension arc) and shoulder flexion x 5 for each exercise. The participant will be asked to do these ROM exercises twice a day (duration 4 minutes). Each home exercise session should last approximately 10 minutes; 6 minutes for the self‐MWMs and 4 minutes for the ROM exercises. The home MWM and ROM sessions will continue for a duration of 4 weeks post first treatment session. Participants will be encouraged to resume graded activities using the upper limb during activities of daily living. They will all be given a booklet with advice on fracture protection, swelling control, skin care. Participants will have their attendance at the 4 Physiotherapy sessions logged in the Physiotherapist Notes ‐ which will be supplied to the researchers after their 4th treatment session. The participants will keep a diary to log their adherence to the Self‐MWMs and ROM exercises. CONDITION: Distal radius fracture PRIMARY OUTCOME: Mean forearm active supination range of motion measured with a goniometer and following the standard administering procedures as outlined by the American Society of Hand Therapists and also using the Dr Goniometer smartphone app. ; ; The Patient Rated Wrist Evaluation questionnaire is a composite secondary outcome. The questionnaire includes a numerical rating scale (0‐10) for pain and rating scales (0‐10) for functional activities. INCLUSION CRITERIA: Participants will be people who have suffered a fracture to the distal radius that has been treated non‐surgically with a plaster cast. They will be required to be aged over 18 years of age. SECONDARY OUTCOME: Adherence to home exercise program will be assessed using the home exercise diaries. Participants will have to tick if they completed the exercise session. To determine adherence rates the number of sessions they completed will be compared to number of sessions prescribed. Functional test: ability to pour a cup of water into another cup using pronation and backwards into a cup using supination. Global rating of change Mean forearm active pronation range of motion measured with a goniometer and following the standard administering procedures as outlined by the American Society of Hand Therapists and also using the Dr Goniometer app. Mean isometric grip strength scores, measured in kilograms using a calibrated Jamar goniometer on setting 2 to ensure maximum grip strength with the participant seated and the elbow flexed to 90 degrees. Mean score on the Quality of Life SF8 questionnaire Mean score on the Quick‐DASH questionnaire will be used to measure disability of the affected upper limb. Mean wrist active extension range of motion measured with a goniometer and following the standard administering procedures as outlined by the American Society of Hand Therapists and also using the Dr Goniometer app. Mean wrist active flexion range of motion measured with a goniometer and following the standard administering procedures as outlined by the American Society of Hand Therapists and also using the Dr Goniometer app. Pain and function as assessed on the Patient Rated Wrist Evaluation questionnaire