Date Presented 03/26/20
DRF is one of the most common fractures. Distal radius fracture complications frequently occur and hinder effective hand use. A wide range of complications are often experienced, including pain, impaired range of motion (ROM), and reduced grip and pinch strength. This study intended to evaluate the functional recovery outcomes beyond six months post-DRF. Furthermore, it intended to investigate the possible associated factors that affect the functional recovery of the hand.
Primary Author and Speaker: Mohammad Nazzal
Additional Authors and Speakers: Sabreen Obeid
Contributing Authors: Cigdem Oksuz, Maria Rosado, Ziad Hawamdeh
OBJECTIVE: This research study intended to comprehensively evaluate the functional recovery and occupational performance outcomes beyond six months post Distal Radius Fracture (DRF). Furthermore, it intended to investigate the possible effect of residual physical hand deficits and how it can interfere with the individual’s hand-related functional performance, as measured by Michigan Hand Questionnaire (MHQ –A) over six months and more post DRF.
DESIGN: This study followed an observational cross-sectional design. Seventy-one participants with a confirmed diagnosis of DRF were conveniently recruited from outpatient clinics at rehabilitation departments in two hospitals in Jordan. The inclusion criteria include: Individuals of both genders who sustained DRF 6 months to 2 years ago, with age ranging from 18 up to 65 years old. Individuals who received surgical or conservative treatment were included regardless of whether they had received rehabilitation services or not. Criteria for exclusion included patients with mental/ cognitive disorders, neurological conditions such as stroke, neurodegenerative diseases, autoimmune diseases such as rheumatoid arthritis were also excluded.
METHODS: A combination of patient reported outcome measures and clinician-rated was used to investigate the recovery of DRF. Patient-reported hand outcome measure: (MHQ-A) MHQ is a hand-specific patient-reported outcome measure MHQ consists of six domains; functional ability, Activities of Daily Living (ADLs), work performance, pain, aesthetic, and the satisfaction of the hand function domain, which all gathered in 37 questions (1). Clinician-rated hand measurements include: pain using (VAS). ROM which include, active flexion, extension, supination, pronation, radial and ulnar deviation of the wrist, in addition to grip and pinch strength, and dexterity by Purdue Pegboard Test (2).
RESULTS: Hand-related disability was experienced with minimal to mild levels, according to MHQ-A. Some of the residual physical hand deficits were pain, weak grip and pinches strength, in addition to limited wrist ROM. Flexion and extension of the wrist were the most affected motions, dexterity skills could be distorted to a small degree. Grip strength was affected in all participants. Stepwise regression analysis revealed that while tripod grasp was considered weak, the pain intensity ranged from minimal to mild and both had great effect on the disability after DRF in addition to flexion of the wrist and tip to tip pinch, all represent 75% of MHQ-A variance.
CONCLUSION: Individuals who have sustained DRF are most likely to have some disability level described mostly as minimal to mild. Therapists need to be aware that the presence of disability after DRF is related to many factors and causes depending on the degree of pain and other physical measurements of the hand.
References
1. Chung KC, Pillsbury MS, Walters MR, Hayward RA. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. The Journal of Hand Surgery. 1998;23(4):575-87.
2. Causby R, Reed L, McDonnell M, Hillier S. Use of objective psychomotor tests in health professionals. Perceptual and motor skills. 2014;118(3):765-804.
