Author Names
Gutiérrez-Espinoza, H., Araya-Quintanilla, F., Olguín-Huerta, C., Valenzuela-Fuenzalida, J., Gutiérrez-Monclus, R., Moncada-Ramírez, V.
Reviewer Name
Paula Stonehouse Salinas
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
Objective: To determine the effectiveness of manual therapy (MT) for functional outcomes in patients with distal radius fracture (DRF). Methods: An electronic search was performed in the Medline, Central, Embase, PEDro, Lilacs, CINAHL, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that included MT techniques with or without other therapeutic interventions in functional outcomes, such as wrist or upper limb function, pain, grip strength, and wrist range of motion in patients older than 18 years with DRF. Results: Eight clinical trials met the eligibility criteria; for the quantitative synthesis, six studies were included. For supervised physiotherapy plus joint mobilization versus home exercise program at 6 weeks follow-up, the mean difference (MD) for wrist flexion was 7.1 degrees (p = 0.20), and extension was 11.99 degrees (p = 0.16). For exercise program plus mobilization with movement versus exercise program at 12 weeks follow-up, the PRWE was −10.2 points (p = 0.02), the DASH was −9.86 points (p = 0.0001), and grip strength was 3.9 percent (p = 0.25). For conventional treatment plus manual lymph drainage versus conventional treatment, for edema the MD at 3–7 days was −14.58 ml (p = 0.03), at 17–21 days −17.96 ml (p = 0.009), at 33– 42 days −15.34 ml (p = 0.003), and at 63–68 days −13.97 ml (p = 0.002). Conclusion: There was very low to high evidence according to the GRADE rating. Adding mobilization with movement and manual lymphatic drainage showed statistically significant differences in wrist, upper limb function, and hand edema in patients with DRF.
NIH Risk of Bias Tool
Quality Assessment of Systematic Reviews and Meta-Analyses
- Is the review based on a focused question that is adequately formulated and described?
- Yes
- Were eligibility criteria for included and excluded studies predefined and specified?
- Yes
- Did the literature search strategy use a comprehensive, systematic approach?
- Yes
- Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
- Yes
- Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
- Yes
- Were the included studies listed along with important characteristics and results of each study?
- Yes
- Was publication bias assessed?
- Yes
- Was heterogeneity assessed? (This question applies only to meta-analyses.)
- Yes
Key Finding #1
Adding joint mobilization did not show clinical or statistically significant differences in wrist range of motion in patients with DRF.
Key Finding #2
Mobilization with movement showed statistically significant differences in wrist, upper limb function, and hand edema.
Please provide your summary of the paper
The purpose of this study was to determine the effectiveness of manual therapy (MT) for functional outcomes in patient with distal radius fracture (DRF). Eight studies were included in the systematic review with an overall population of 335 patients (174 in the MT group and 181 in the Control group). These were the following results. For supervised PT plus joint mobilization versus home exercise, there were no clinical or statistically significant differences in wrist ROM. For exercise program plus mobilization with movement versus exercise program there were statistically significant differences in wrist and upper limb function at 12 weeks. The mobilization forces were applied to the radiocarpal and ulnocarpal joints with manual glide of the carpal row during active wrist flexion and extension. Previous systematic reviews did not support the added use of joint mobilization after DRF and another one showed limited evidence, which shows it does not translate to an improvement for functional results. The authors discussed that the current use of systematic reviews is less than optimal for these studies due to the small number of studies published and the limited methodological quality of RCTs that have looked at joint mobilization techniques in DRF. For conventional treatment plus manual lymph drainage versus conventional treatment for edema, there was a statistically significant decrease in the short term.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
These findings are important when providing patients with potential treatment options for DRF, especially in the short-term. Clinicians should take an individualized patient approach to decide which treatment option is best for that patient, as the study looked at various techniques, each with multiple outcomes. If a patient has edema, it is possible to use manual lymphatic drainage to see significant decrease in the edema. If a clinician decides to use a manual therapy technique, it is important that they know the technique will be most effective when the mobilization is done with movement. There is limited research for this topic and some conflicting evidence, so clinicians should use their expert clinical judgement and skills to best serve their patients.
