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
• manual therapy
• functional outcomes
• randomized controlled trial
• meta-analysis

Disclosure statement

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

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Notes on contributors

Héctor Gutiérrez-Espinoza

Hector Gutiérrez-Espinoza is researcher of Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile.

Felipe Araya-Quintanilla

Felipe Araya-Quintanilla is researcher of Rehabilitation in Health Research Center, Universidad de las Americas, Santiago, Chile.

Cristian Olguín-Huerta

Cristian Olguín-Huerta is researcher of School of Health Sciences, Universidad Gabriela Mistral, Santiago, Chile.

Juan Valenzuela-Fuenzalida

Juan Valenzuela-Fuenzalida is researcher of Universidad Bernardo O´Higgins, Santiago, Chile.

Rodrigo Gutiérrez-Monclus

Rodrigo Gutiérrez-Monclus is researcher of Instituto Traumatologico, Santiago, Chile.

Victoria Moncada-Ramírez

Victoria Moncada-Ramirez is researcher of Rehabilitation in Health Research Center, Universidad de las Americas, Santiago, Chile