Effectiveness of manual therapy in patients with distal radius fracture: a systematic review and meta-analysis

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.

Keywords: Distal radius fracture; functional outcomes; manual therapy; meta-analysis; randomized controlled trial.

Conflict of interest statement

The authors declare they do not have any potential conflict of interest regarding the investigation, authorship, and/or publication of this article.

Figures

Figure 1.

Flow diagram for study selection process.

Figure 2.

Risk of bias summary: review authors’ judgments about each risk of bias item for each included study.

Figure 3.

Risk of bias graph: review authors’ judgments about each risk of bias item presented as percentages across all included studies.

Figure 4.

Forest plot summary of supervised physiotherapy plus joint mobilization versus home exercise program in flexion and extension wrist motion at 6 weeks follow-up.

Figure 5.

Forest plot summary of exercise program plus mobilization with movement versus exercise program alone in PRWE, DASH and Grip strength at 12 weeks follow-up.

Figure 6.

Forest plot summary of conventional treatment plus manual lymph drainage versus conventional treatment alone in edema at 3–7 days, 17–21 days, 33–42 days, and 63–68 days follow-up.