Early NMES and Mirror Therapy Interventions During Immobilization of Distal Radius Fracture

Lawson Health Research Institute

Status: Enrolling

Conditions: Distal Radius Fracture

Treatments: Other: Mirror Therapy; Other: Neuromuscular Stimulation (NMES); Other: Mirror Therapy + NMES

Study type: Interventional

Funder types: Other

Identifiers

NCT05925673

120275

Details and patient eligibility

About

Current practice for distal radius fractures is to begin rehabilitation after immobilization to remediate the resulting impairments. Neuromuscular electrical stimulation and mirror therapy are strategies that integrate neurological and musculoskeletal activation, that may be beneficial for mitigating the resulting impairments if applied during immobilization. The study aim is to determine whether neuromuscular stimulation and mirror therapy interventions can be implemented during immobilization for distal radius fractures to minimize the resulting impairments when compared to standard rehabilitation.

Full description

Distal radius fractures are one of the most common orthopedic injuries require 6 to 8 weeks of immobilization for bone healing making it an ideal model to evaluate the negative consequences of immobilization. Consequences of immobilization include motor dysfunction (e.g. muscular atrophy), loss of the representation of motor and sensory function, and loss of fine motor skills. Current practice is to begin rehabilitation after immobilization to remediate these impairments. Neuromuscular electrical stimulation and mirror therapy are strategies that integrate neurological and musculoskeletal functioning, that can be used during immobilization to mitigate negative consequences. To date, these strategies have primarily been implemented in stroke rehabilitation, but minimal research has been done to assess their effectiveness with musculoskeletal populations. The study aim is to determine whether neuromuscular stimulation and mirror therapy interventions can be implemented during immobilization for distal radius fractures to minimize impairments when compared to standard rehabilitation. Four groups will be compared: group 1 will engage in standard care, group 2 will engage in a mirror therapy intervention during immobilization, group 3 will engage in a neuromuscular stimulation intervention during immobilization, and group 4 will engage in a combined mirror therapy + neuromuscular stimulation intervention during immobilization. Patient reported and objective outcome measures will be assessed at baseline (before starting intervention; 3 weeks), after cast removal and completion of the intervention (6 weeks), 8 (to 10) weeks, and 12 weeks post fracture. Ideally these interventions will improve outcomes and facilitate rehabilitation after distal radius fracture which could allow patients to return to their daily activities and work more readily after fracture.

Enrollment: 72 estimated patients

Sex: All

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Sustained a distal radius fracture in the last 3 weeks being managed conservatively in a cast
• Able to understand instructions in English
• Able to give informed consent (no known cognitive impairment that would limit this)

Exclusion criteria

• Cognitive disorders that would preclude the participant from following instructions and engaging in the home interventions
• Visual impairments that limit ability to engage in NMES and mirror therapy interventions
• Superficial metal implants in the injured arm
• Cancer (active)
• Severe peripheral vascular disease
• Thrombophlebitis in injured arm

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Factorial Assignment

Masking: Triple Blind

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72 participants in 4 patient groups

Standard of Care

No Intervention group

Description:

Participants will follow standard practice protocols at the Roth McFarlane Hand and Upper Limb Centre in London.

Mirror Therapy

Experimental group

Description:

Participants will engage in a home based mirror therapy intervention from 3 to 6 weeks post-fracture.

Treatment:

Other: Mirror Therapy

Neuromuscular Stimulation (NMES)

Experimental group

Description:

Participants will engage in a home based neuromuscular stimulation intervention from 3 to 6 weeks post-fracture.

Treatment:

Other: Neuromuscular Stimulation (NMES)

Mirror Therapy + NMES

Experimental group

Description:

Participants will engage in a home based combined mirror therapy + neuromuscular stimulation intervention from 3 to 6 weeks post-fracture.

Treatment:

Other: Mirror Therapy + NMES